Prevent, identify and treat sleep disorders in EMS providers
EMS providers are more susceptible to sleep disorders and their inherent dangers and health implications
By Sara Jahnke, EMS1 Contributor
It is not news to any EMS provider 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 EMS PROVIDERS' sleep patterns
The sleep issue is challenging to study with EMS providers 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. EMS providers, 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, EMS providers 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 percent), followed by shift work disorder (9.1 percent), insomnia (6.0 percent) and restless leg syndrome (3.4 percent).
Firefighters who screened positive for a sleep disorder were 200 percent more likely to report having a motor vehicle crash than those providers who did not screen positive. They also were 241 percent more likely to report having cardiovascular disease and 191 percent more likely to report diabetes. They were 310 percent more likely to report symptoms of depression and 381 percent more likely to report anxiety.
What do these findings mean for EMS providers?
Adhere to sleep hygiene habits when possible
Previous research suggests it is very important for EMS providers 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 EMS providers 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 EMS providers.
EMS providers and departments should also promote other potential mechanisms for improving sleep and reducing the impact of shift work.
For EMS providers 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 EMS providers 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 EMS providers will always face the challenge of sleep which is why it is important to do as much as possible to combat the impact.
About the author
Sara A. Jahnke, Ph.D. is the director of the Center for Fire, Rescue and EMS Health Research at the National Development and Research Institutes. She was the principal investigator on two large-scale, DHS-funded studies of the health and readiness of the U.S. fire service and on a study on the health of women firefighters. She is a co-investigator of several studies focused on fitness, nutrition and health behaviors in firefighters. She completed her doctorate in psychology with a health emphasis at the University of Missouri – Kansas City and the American Heart Associations' Fellowship on the Epidemiology and Prevention of Cardiovascular Disease. You can reach her at Sara.Jahnke@firerescue1.com