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Prevent, identify and treat sleep disorders in firefighters

Firefighters are more susceptible to sleep disorders and their inherent dangers and health implications


It is not news to any firefighter or first responder that sleep can be a challenge – what is news is how big the issue of sleep deprivation can be and the negative impact it can have on your health.

Interrupted sleep, not getting enough sleep or sleeping at irregular times can have severe implications for health by interrupting circadian rhythms. These rhythms are the physical, mental and behavioral changes that occur over a 24-hour period and regulate the body’s processes through the release of melatonin.

According to the American Academy of Sleep Medicine, interruption of these rhythms leads to short term impacts like difficulty with concentration, headaches, mood changes and irritability. In the long term, interruption of these chemical processes can increase risk for cancer, cardiovascular disease and obesity.

Shift workers face particular challenges related to sleep. When workers start shift work, it is not uncommon for them to have difficulty falling asleep or staying asleep and they often find themselves tired even after 7-8 hours of sleep. If this trend continues for several weeks, it can be considered Shift Work Disorder. The disorder is the result of a workers’ circadian rhythm being interrupted and melatonin being produced at the wrong time by the body.

Work-related impacts of shift work include higher rates of injury, accidents, mistakes and missed work days.

Unique challenges of measuring firefighter sleep patterns

The sleep issue is challenging to study with firefighters because they do not work the shifts typical in shift work research. Typically, shift work research focuses on workers such as nurses, residents and truck drivers who are clearly required to be awake for their entire shifts. Firefighters, on the other hand, typically can get rest overnight when they are not on calls. The challenge for researchers is that, even within the same department, firefighters at different stations can have very different call volumes both during the day and overnight.

Still, the available evidence on the topic suggests that sleep disorders are of concern for the fire service. Scientists from Harvard conducted a study of 66 fire departments across the country. Their findings, published in the Journal of Clinical Sleep Medicine, state that more than a third of firefighters responding to their survey screened positive for a sleep disorder. The most common disorder identified was obstructive sleep apnea (28.4%), followed by shift work disorder (9.1%), insomnia (6.0%) and restless leg syndrome (3.4%).

Firefighters who screened positive for a sleep disorder were 200% more likely to report having a motor vehicle crash than those firefighters who did not screen positive. They also were 241% more likely to report having cardiovascular disease and 191% more likely to report diabetes. They were 310% more likely to report symptoms of depression and 381% more likely to report anxiety.

What do these findings mean for firefighters?

Adhere to sleep hygiene habits when possible

Previous research suggests it is very important for firefighters to identify if they have a sleep disorder and to treat the disorder when possible. The working group at Harvard has a screening test available.

It also is important for firefighters to get as much good sleep as they can when they can get it. Typical sleep hygiene habits, like going to sleep as close to the same time as possible each night, keeping your sleeping area quiet and dark, and ensuring exposure to natural light during the day are even more important for firefighters.

Firefighters and departments should also promote other potential mechanisms for improving sleep and reducing the impact of shift work.

For firefighters who are struggling with alertness, there can be benefits to the appropriate use of caffeine. Studies on caffeine have found that it has a u-shaped curve, meaning there are attention and cognitive benefits to using caffeine, but that there is a limit to the amount that can have a benefit.

Short naps (20-30 minutes) during the day also can benefit alertness. Particularly for firefighters who know they will be out on calls during the night, brief naps may be beneficial. Consumption of a moderate amount of caffeine immediately followed by a short nap has been found to be the most effective means of improving sleepiness.

Finally, regular exercise has a positive impact both on sleep and the health challenges such as cardiovascular disease, cancer and obesity that increase with interrupted sleep.

Someone has to respond in the middle of the night, so firefighters will always face the challenge of sleep, which is why it is important to do as much as possible to combat the impact.

Sara Jahnke, PhD, is the director and a senior scientist with the Center for Fire, Rescue & EMS Health Research at the National Development & Research Institutes - USA. With over a decade of research experience on firefighter health, Dr. Jahnke has been the principal investigator on 10 national studies as well as dozens of studies as a co-investigator. Her work has focused on a range of health concerns, including the health of female firefighters, behavioral health, risk of injury, cancer, cardiovascular risk factors, and substance use, with funding from the Assistance to Firefighters Grant R&D Program, the National Institutes of Health and other foundations. Jahnke has more than 100 publications in the peer-reviewed medical literature. Awards include the 2019 Endowed Lecture at the annual conference of the American College of Epidemiology; the 2018 President’s Award for Excellence in Fire Service Research as well as the Excellence in Research, Safety, Health & Survival Award, both from the International Association of Fire Chiefs (IAFC); and the 2016 John Granito Award for Excellence in Firefighter Research from the International Journal of Fire Service Leadership and Management. Connect with Jahnke on LinkedIn, Twitter or via email.