You know that game people play when they are bored? The one where you have to choose “would you rather …” and the choices are equally unappealing? So, would you rather eat a bowl of pan-fried maggots without salt or pet sit the boss’s 100-pound teacup pig? That kind of thing.
We put that type of question to some sleep experts. Why? Because we all know firefighters’ sleep basically sucks. And we know sleep quality is one of the leading predictors for a long and healthy life.
Thankfully, there is a lot of really sound advice for how to improve sleep if you are a firefighter. Limiting caffeine intake, cool and dark sleeping rooms, limiting digital screen time, and lighting and alerting technology are all ways for volunteer and career firefighters to get a better night’s sleep.
But diving into best practices isn’t as much fun, and we’re bored. So, would you rather try to sleep at night and be woken by a barrage of tone outs, or stay up all night on shift and sleep during the day when you are off?
Those salt-free maggots starting to gain appeal?
Neither, of course, is good for you. But is one genuinely worse than the other? Traditionally, career firefighters fall in the former camp of grabbing what sleep they can at night. The same is true for most volunteers, whether responding from home or doing overnight shifts. Police, nurses and dispatchers, on the other hand, must stay up for the whole night and play sleep catch up in the daytime hours.
“From a sleep science standpoint, disrupted nighttime sleep is generally the lesser of two evils, in my opinion,” says Brandon Dreiman. He’s a retired Indianapolis Fire Department captain, a peer support master instructor and a certified sleep therapist who now works with ProTeam Wellness.
“Even when firefighters are awakened by calls, they are attempting to sleep during the brain’s natural sleep window,” Dreiman says. “The brain is biologically primed to produce the deepest and most restorative sleep at night. As a general rule, trying to sleep at night (even when disrupted) is a better option.”
Those attempting daytime sleep are fighting against what their bodies want, and not winning. In fact, they lose on both the sleep quality and sleep quantity fronts.
“Even in ideal conditions, most people get one to four fewer hours of sleep during the day than they do at night,” Dreiman says. “They also tend to get less deep sleep and less REM sleep overall.”
And a 2017 study led by researchers from the CDC’s Department of Population Health and NYU’s Center for Healthful Behavior Change found a long list of health risks associated with working nights and sleeping days. That list includes heightened risks of cardiovascular disease, stroke, mental illness, diabetes, hypertension, obesity, breast cancer, migraines and more.
They have lower immune system response and a lower ability to manage diabetes. Your body really doesn’t like when you mess with your circadian rhythm. And it has some pretty forceful ways of getting that point across.
“Chronic circadian misalignment caused by trying to sleep during the day is associated with worse mood, poorer concentration, greater risk of depression and PTSD symptoms, higher rates of cardiovascular and metabolic problems, and even increased cancer risk,” Dreiman says.
So, we have a clear winner in the “would you rather” game. Right?
Eh. Maybe.
“There is a tipping point,” Dreiman says. “If overnight call volume becomes high enough that firefighters cannot obtain at least one reasonably consolidated block of three to four hours of sleep, the benefit of sleeping at night begins to erode. A firefighter who is awakened once or twice and still gets a block of sleep from, say, midnight to 4 a.m. is likely in a much better situation than someone trying to invert their schedule and sleep during the day.
“However, if the tones are going off every hour or two all night, or if firefighters routinely end the shift with less than four to five total hours of fragmented sleep, they may start to experience a level of impairment comparable to or even worse than traditional night shift work. At that point, they are getting the worst of both worlds: they are sleeping at the right biological time, but not enough to gain the restorative benefit.”
So, we have a qualified winner, which is fairly good news for career and volunteer firefighters. Sorry, cops and dispatchers.
And while what we know about our sucky sleep is scientifically convincing, there’s more to learn about how bad the problem is and what we can do to fix it.
Sara Jahnke is a leading fire service researcher who launched Science to the Station: A Health and Wellness Alliance. It is a platform to bring important firefighter health and wellness science to firefighters. Jahnke is leading a team of researchers on a nationwide study they are calling the SHIFT study (Shift Scheduling and Sleep Health in Firefighters). It is a FEMA-funded national research study examining how sleep and behavioral health impact firefighter safety, performance, and long-term well-being.
It is also focusing on the volunteer firefighter segment and their spouses or partners. When the pager or phone app next to the bed goes off at 2:47 a.m., it is not just the firefighter being jolted from sleep.
“We’re excited about this project on many fronts,” Jahnke says. “We have to take a deeper dive into what is making our sleep so bad, and what those long-reaching consequences of doing nothing about it might be. And the volunteers … ugh. There are so many of them, they are so important to the fire service and their communities, yet we know so little about them from a research standpoint. That has to change.”
And once the fire service gets a better handle on sleep, shift schedules and long-term health, they can get back to more entertaining problems. You know, would you really rather show up at the dog park with a teacup pig in tow?
