Features Health and wellness
Catching ZZZs

Chasing sleep – many first responders find themselves on this frustrating hamster wheel and are desperately looking for the exit. A shift finishes up, they drive home and attempt to wind down, only to lay in bed staring at the ceiling.

Getting a restful sleep can be complicated for a whole host of reasons, as a study in the Journal of Global Health (JGH) reported in October 2022. In the study, Prevalence of Sleep Disorders Among First Responders for Medical Emergencies: A Meta-analysis, the authors searched four research databases (Web of Science, Psych Info, CINAHL and PubMed) and ultimately focused on 28 studies that included 100,080 first responders. Interestingly, the JGH study represents the first meta-analysis used to explore and estimate the prevalence of sleep disorders among first responders for medical emergencies – and the findings are telling.

The report’s conclusions paint a picture that many first responders know all too well. It found “a substantially high prevalence of sleep disorders including SWD (shift work disorder), OSA (obstructive sleep apnea), insomnia, and EDS (excessive daytime sleepiness) among first responders for medical emergencies.” The results showed that prevalence rates for sleep disorders among the 100,080 first responders in the study were 31 per cent for SWD, 30 per cent for OSA, 28 per cent for insomnia, 28 per cent for EDS, two per cent for restless leg syndrome and one per cent for narcolepsy. Moreover, the study found that anxiety, cardiovascular disease (CVD), diabetes mellitus (DM), depression, gastroesophageal reflux disorder (GERD) and post-traumatic stress disorder (PTSD) were all associated with OSA.

The study’s authors recommend that “early assessment and management of sleep disorders among first responders is necessary to promote good, quality sleep to help prevent anxiety, depression, CVD, DM, GERD, and PTSD.”

Beverley David, founder of Your Psychology Centre in Uxbridge, Ont., has dedicated much of her career to understanding how sleep disorders and sleep disruptions affect people. David holds a doctorate in sleep research (insomnia) from Loughborough University in the United Kingdom, where she developed and delivered the Sleep Management in Primary Care and the advance Supervision of Sleep Management in Primary Care curriculum. David also co-authored Cognitive Behavioural Therapy for Insomnia (CBT-I) self-help booklets and was the principal researcher for a randomised control trial looking at the efficacy and effectiveness of self-help CBT-I. Suffice it to say, she is an expert in addressing sleep issues and sleep management.

She explains that the reason why first responders are prone to sleep disorders is multi-faceted and the impacts are wide-ranging, including biological, psychological and social. “First, there’s going to be shift work and that can impede their sleep. Then there’s the job – there’s often trauma that makes it hard to leave work behind and that’s going to interfere with sleep. Unfortunately, when you put those two things together – poor sleep and the vocation – it can lead to more drug and alcohol dependency, which then further impacts our sleep. Once we’re in that spot, then our decision-making is affected,” David said.

She notes that sleep is important for our prefrontal cortex, which is in charge of executive functioning. “Planning, timetabling, impulse control – deciding whether you’re going to work out, deciding whether you’re going to have a drink, deciding if you’re going to go to the party or stay home. Wellness starts to be impacted (the timing of our food, the timing of our choices) and once that goes out of synch, it affects our body’s clock, because it all relies on that circadian rhythm. It’s a very multi-faceted problem.”

Once a person is in this cascade of compounding sleep issues, the impacts can become widespread. “When executive functioning is impacted, we will be more impatient, more irritable. There’s a greater report in mood disorder, anxiety, depression, feeling scattered and our relationships will suffer. There are cardiovascular implications and metabolic implications with glucose control which often makes us gain weight. Then there are social impacts. Our relationships are impacted. Are we going out and socializing? Are we spending time with the kids and family? The answer is probably no and that’s a massive protective factor,” David explains.

The ripple effects are far-reaching, usually showing up on the job. David notes that the firefighters she sees often report that they feel sleepy, fatigued, lack energy and have trouble making quick decisions. All of these can hinder a firefighter’s performance when out on a call or performing duties at the station. Fortunately, she said there is plenty that firefighters can do to improve their sleep, with the first step being education. “They have to believe that sleep is pivotal to their wellness, and they need to prioritize it. For a lot of us, it’s the first thing we sacrifice, and we have to move away from that,” she said.

Strategies for better sleep
David suggests that getting family members on board is a crucial step to improving sleep patterns, especially when coming off of shiftwork. She said hanging a “Do Not Disturb” sign on the door can be a good reminder for everyone in the house. Soundproofing the bedroom is another tactic that works well, in addition to keeping the room dark by using blackout curtains, ensuring the air is cool and using an eye mask and earplugs. David explains that when coming home in the morning after working a night shift, it’s important to mimic a nighttime routine. Wear sunglasses on the drive to limit your sunlight exposure and when you arrive home, begin a wind-down routine, eat something light and pay attention to your sleep cues (like yawning, tired eyes) to follow restfulness to sleep.

Being aware of shift patterns and avoiding overtime shifts that will throw off your established schedule is another strategy David encourages. She notes that too many rotations can create the feeling of jet lag and really set you back.

“Keep an eye on your psychology. Ask yourself, ‘Am I getting enough time to myself? Do I have enough joy? How’s my anxiety? Am I moving and eating and sleeping well?’ Don’t miss out on the things that give you quality of life.”

Perhaps one of the most effective strategies to combat sleep issues is a well-timed nap. “The nap is very powerful,” said David. She notes that setting an alarm for 20 minutes and seeing if you wake up feeling rested or groggy can help determine how long you should nap for. “You want to find that sweet spot. If you practice napping, you become good at it. Olympic athletes are good at sleeping on the go, taking that power nap and then waking up feeling super-charged. If there’s a time in your work shift where you’ve done your station duties, perhaps you can plan a little nap. Have some breakfast, work out and then you’ll be ready. Really, sleep is the only answer to sleep deprivation. Microsleeps are when our bodies take sleep [for seconds rather than minutes] whether we like it or not, and it can cause ‘vacant driving’ and zoning out, which can be very dangerous.”

As for supplementing with melatonin – the hormone that’s primarily responsible for regulating the body’s circadian rhythm to manage natural sleep cycles – David suggests that firefighters first try the behavioural strategies mentioned above. She cautions that taking a melatonin supplement should only be done under the guidance of a doctor due to the various strengths its offered in.

Her final recommendation for firefighters struggling to find restful sleep is to keep a sleep diary. “Record how often you wake up feeling groggy and unsatisfied. Keep track of what your daily function looks like. If you’re struggling to see any change even after adding in these behavioural strategies we’ve talked about, then you should go to your doctor. A sleep study might be needed,” David said.

She notes that severe daytime sleepiness, including the propensity to fall asleep at social events, in the car or when conversing with someone, is something that should be discussed with a doctor.

A firefighter’s job is rife with adrenaline, dealing with traumatic events and making split-second decisions to save lives – day in and day out. Attaining restful sleep is a balancing act to be sure, but it’s one that can be achieved with the right supports and strategies in place.

Julie Fitz-Gerald is a freelance writer and author living in Uxbridge, Ont.