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.
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 par-
ticipate in a voluntary sleep disorder screening program to identify
known sleep disorders such as sleep apnea, moderate to severe insom-
nia, 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.
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