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| As firefighters, we frequently have our sleep patterns disrupted by calls for service. (Photo by Pixabay.) |
As firefighters, we frequently have our sleep patterns disrupted by calls for service. We respond to calls around the clock and are often forced to operate under a sleep deficiency. Recent research from the United States Fire Administration (USFA) gives us insights into the impact of sleep deprivation, misalignment of the body clock, and chronic sleep deficiency on firefighters.
Sleep Interrupted
When we sleep, our brains enter an altered state of consciousness. During this time, the person sleeping becomes less responsive to his own surroundings, and the brain switches between rapid eye movement (REM) and non-REM sleep. We are naturally programmed to undergo this process for our own health, and interrupting or adding distractions into this process can create sleep problems for us. Sleep disorders, including sleep loss, can cause negative impacts on relationships with other firefighters, family, and the people whom we protect every day.
Sleepiness or fatigue can decrease administrative productivity, but it can be downright dangerous when operating apparatus, driving vehicles, or working on an incident scene. Without adequate sleep, it is more difficult for our bodies to metabolize sugar, which can cause diabetes; fighting infections becomes more challenging; and thoughts become slower and can cause a reduction in effective decision making and safe behaviors. In addition, we are more likely to have an emotional reaction to stressful situations when we are sleep deprived, linking sleep loss to anxiety, depression, and mood disorders. Sleep loss and the resulting function impairment of the prefrontal cortex region of the brain (the part used for complex behavior, thinking, and emotional regulation) make our brain less able to reduce emotions once they have been triggered. This is a factor that we must take a closer look at as we begin to investigate the role of post-traumatic stress disorder (PTSD) in firefighters and firefighter mental health challenges.
Sleep Deprivation Studies
Prior fire service research on the effects of sleep deprivation on firefighters was conducted by the International Association of Fire Chiefs (IAFC), the USFA, and faculty from Oregon Health and Science University in 2007.1 In that study, titled “The Effects of Sleep Deprivation on Fire Fighters and EMS Responders,” parallels were drawn between the dangers of sleep deprivation in other professional and industrial occupations, including seafarers, pilots, captains, commercial vehicles, and the implications for firefighters and EMS responders. Considering that workers in these fields rely on the performance of other members, accomplishing tasks in unpredictable environmental conditions, the effects of worker fatigue in these occupations, especially firefighting, can have catastrophic consequences. (1)
The most recent study on firefighter sleep health, published by the American College of Occupational and Environmental Medicine, involved more than 6,000 firefighters from across the country.2 A combination of expert-led, train-the-trainer, and online training was used to provide a sleep health program to the firefighters. This program included 30-minute training on healthy sleep and fatigue countermeasures, testimonials from firefighters treated for sleep disorders, and messaging from leadership encouraging active participation in the program.
After receiving the initial training sessions, firefighters could participate in a voluntary sleep disorder screening program to identify known sleep disorders such as sleep apnea, moderate to severe insomnia, and restless leg syndrome. Firefighters learned their sleep disorder risk and, if needed, were referred to a sleep clinic in their location or to a list of specialists in their area.
At the end of the program, assessments were completed to evaluate the knowledge of each firefighter based on the educational programs that they had participated in. The firefighters showed a 28.6 percent improvement in their knowledge of sleep health. Firefighters in the expert-led programs showed the most improvement, at 34 percent, with the train-the-trainer at 28.5 percent (5.5 percent lower), and the firefighters who participated in the online programs showing a 24.2 percent improvement, which was almost 10 percent lower than in the expert-led classes. This is an interesting observation in the effectiveness of training content delivery to firefighters, as the participation of the firefighters in the end-of-program questionnaire from the online training subjects was higher than the other modes, even though there was a lower rate of knowledge improvement.
Overall, almost 41 percent of firefighters in the study were identified to be at risk for at least one sleep disorder. Participants in the program reported significant changes in behavior (43 percent) and felt less sleepy at work (39 percent).
Firefighters who participated in the program demonstrated an increase in their knowledge of sleep disorders, the impact of sleep on health and performance, and fatigue countermeasures. At the end of the study, 42 percent of firefighters who were part of focus groups saw positive changes in their sleep behavior, and most of the firefighters felt that the sleep health program had useful information that they would recommend sharing with other fire departments.
As a result of participating in this study, 30 percent of firefighters stated that they would try to get more sleep, and nearly 28 percent said that they would pay more attention to their fatigue level. Others noted that they now use caffeine differently, take more naps, and improved their sleeping environments. These areas of improvement align with several areas of future assessments that were identified in the 2007 IAFC/USFA sleep deprivation report, including strategic napping benefits and the prevalence of sleep disorders among firefighters and EMS responders.
The culture of the fire service was considered by the researchers in creating their sleep health plans. Some of the challenges that they noted were the uniqueness of the fire service, including proximity of sleeping quarters, sharing of bunk rooms, and the ability of some firefighters to directly observe the sleep quality and quantity of other firefighters. As an example, a firefighter who is known for snoring loudly could possibly keep other firefighters in the station awake and disrupt their sleep. Also, the training schedules for firefighters in the study were very active, and firefighters were sensitive about adding new training requirements to their routine. However, many firefighters felt that the sleep health training should be required as mandatory training to be effective.
Recommendations
As we look at these studies and consider how we can apply these discoveries today, here are a few recommendations that we can follow:
1. Have your department review the IAFC/USFA report on the effects of sleep deprivation on firefighters and EMS responders. (1)
2. Take the sleep deprivation quiz. (1)
3. Review the sleep deprivation training video and the “Science of Sleep” video. (1)
4. Pay attention to, and increase awareness of, sleep fatigue in your firefighters. Take action where possible if you identify sleep fatigued firefighters; encourage sleep studies as a step.
5. Use sleep fatigue countermeasures such as restorative sleep and strategic napping, and adopt a personal lifestyle of wellness, health, and fitness to improve alertness.
6. Focus on high-risk populations for safety efforts, such as firefighters who have obstructive sleep apnea or other sleep disorders.
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| The health and wellness benefits of a sleep health program for fire departments have just begun to be identified with this recent study, and in the medical field sleep research is still developing overall. (Photo by author.) |
The health and wellness benefits of a sleep health program for fire departments have just begun to be identified with this recent study, and in the medical field sleep research is still developing overall.3 By adopting some of the lessons from this research in our departments, we can reduce risks and minimize catastrophic potential. Of course, we will always be in a job where we will have late nights and interrupted sleep, but by taking actions to take care of ourselves and our personnel, we can improve the well-being and safety of firefighters and the public. Almost half of the firefighters in this study’s focus groups were able to make positive changes in their sleep behavior by learning more about sleep deprivation and sleep fatigue and using this knowledge to improve their sleep health. If half of the firefighters in your department can improve their well-being and sleep health, this knowledge will prove immediate value.
REFERENCES
1. IAFC, “Sleep Deprivation Resources,” www.iafc.org/topics-and-tools/resources/resource/sleep-deprivation, 2017.
2. Barger, L K., “Implementing a sleep health education and sleep disorders screening program in fire departments: a comparison of methodology,” Journal of Occupational and Environmental Medicine: Vol 58 (6), June 2016.
3. Babson, K., Feldner, M., Sleep and Affect: Assessment, Theory, and Clinical Implications, New York, N.Y., Elsevier, 2015.
