I’ve been asked by a number of colleagues to address this topic, since the rates of insomnia are troublesome in our field; those of us who work EMS, fire and law enforcement already know that our chosen calling ranks among the highest sleep-deprived professions.
I completely understand that issue; I myself am a card-carrying member of The Insomnia Club. After 20 years as a medic, it hasn’t gotten any better, either, regardless of whatever methods I use to try and even grab a solid four hours of sleep on my off days. Insomnia is an age-old problem – and the bane of existence most times for those of us who engage in shiftwork – but it is only in recent years that it is has become recognized as not only a health issue but a safety issue as well.
Sleep deprivation is defined by the Centers for Disease Control and Prevention (CDC) as having only 4 to 6 hours of sleep in a 24-hour period. Considering the shiftwork we do – most in the EMS, the fire service and law enforcement work at least 12 hours shifts – it is easy to see how insomnia would be an issue. For EMS and FD, we work 12 to 24 hour shifts. Add in being held over for another 12 to 24 hours for mandated overtime for coverage in schedule gaps. It’s not unusual to work 72 hours straight without a break from station life. Not one FD colleague I know sleeps well at their station. And some of them have a second job, which means that they leave their stations in the morning on very little shut-eye, and go to work somewhere else for another 8 to 12 hours.
It’s the nature of the beast; we are conditioned to always be at the ready, waiting for the next call for service to drop, to spring into action no matter what is going on around us or inside of us. Failure is simply not an option, and not in our vocabulary. But adequate sleep is a necessary part of human life and essential for our health and wellbeing. The CDC recommends 8 hours of adequate sleep a day. (The last time I had 8 hours of sleep, incidentally, was in kindergarten.)
Fire Engineering magazine released an interesting article in July of 2016 in part examining what sleep deprivation, insomnia and fatigue can do to fire fighters. They describe sleep deprivation as a major cause in occupational and physical/psychological stress. Some of the listed results include:
- Inability to think clearly
- Poor judgment
- Slowed reaction time
- Decrease in critical thinking skills
- Increased stress
- Fatigue while driving apparatus
- Lowered immune system
The CDC conducts a yearly National Health Interview Survey, part of which examines insomnia and sleep deprivation and the effects on health and safety. As early as 2012, they identified 50 of the most sleep-deprived professions. Police officers were number 3; EMS and the fire service were number 4. Out of 50 professions? That’s quite staggering.
But the real problem is this: our acquired insomnia doesn’t go away once you take off the uniform. It bleeds over into our off hours. And this condition now has a name, and its own ICD-10 code: Shift Work Sleep Disorder (SWSD). The health effects of SWSD include increased incidence of cardiac disease, diabetes, lowering the immune system’s ability to fight off sickness, risk of substance abuse, and an increase in depression and anxiety.
Even more frightening, a 2007 study conducted by the International Agency on the Research of Cancer stated that shiftwork has been linked with increased cancers. So, then, what do we do? A FireRescue1 news article in 2014 referenced a study done among the military on sleep deprivation. It found that soldiers deprived of sleep for 48 hours lost the ability to think clearly, make sound decisions, to adapt to rapidly changing conditions, and suffered a decrease in critical thinking.
If that sounds familiar, it’s because we can most certainly relate that to the fire service. The article offered some suggestions to leaders in the industry to try and combat sleep deprivation among its workers, even though trying to balance them in the reality of the job conditions sounds challenging:
- Agencies need to recognize that adequate sleep is just as important to wellness as fitness, diet, agility and training.
- Individual departments need to survey their own fire fighters and evaluate the statistics of sleep deprivation and consider some changes.
- Gather data on how its fire fighters are sleeping both on and off the job.
- Allow appropriate naps during downtime.
- Make resources available to those who are experiencing sleep disorders.
- Take a hard look at shift scheduling and overtime rules.
- Look ahead at new technology available to help sleep and performance.
To me, we need to let go of the ridiculous notion that we perform just as well on the 48th hour of being awake as we do during the first hour. The U.S. Department of Justice, Office of Justice Programs and National Institute of Justice did their own fact-finding mission on sleep disorders and law enforcement, looking to Brigham and Women’s Hospital (a teaching affiliate of Harvard Medical School in Boston) for the results of an 18-month study among LEOs and sleep deprivation.
Data was gathered from police officers across North America on sleep, health and performance. The results? More than 40% of police officers screened positive for sleep disorders, the most common being obstructive sleep apnea. The direct impact is on officer safety. Let’s get back to insomnia crossing over into our off hours. What can we do right now, in real time, to help ourselves?
The National Sleep Foundation has some tips on good sleep practices:
- Make sure to have at least 30 minutes of winding down time before bed, and do something relaxing like reading a book.
- Dim the lights in the house an hour before you go to sleep. (If you sleep during the day, consider light-blocking curtains in the bedroom.)
- Shut off your electronic devices. No laptops, iPads, tablets, phones or any other smart devices with light-up screens near you.
- Try a deep breathing or relaxation exercise.
- After 20 minutes in bed, if you are still wide awake, don’t lay there tossing and turning. Get up and move to another space in the house and read, or engage in another relaxing activity.
- Wake up at the same time every day, off days included.
- No caffeine at least a few hours before bedtime.
To that, I’ll add a few of my own. Try a lavender scent on your pillow. Make sure your sleeping environment is cool enough. Put a fan on, just for the noise. Last resort? Try an over the counter sleep aid. There are a few good, safe ones out there that are non-habit forming.
If everything fails, and insomnia is becoming a detriment, it is time to see your doctor. I know; we all hate going to the doctor – especially us paramedics. But considering the consequences I mentioned, it might be time. There are prescription sleep aids that your physician can help you take temporarily to get your sleep rhythm back to normal. And since doctors are also number four on that list of the 50 most sleep-deprived professions, I’d trust their opinions.
Take care of each other out there, and be well!
Disclaimer: The content in this article is the opinion of the writer and does not necessarily reflect the policies or opinions of US Patriot Tactical.
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