How is your sleep? Probably not to good....

 

How is your sleep? This is a common question that often comes when discussing a firefighters health and wellness. Over the years it has become clear to me that the real enemy is not heart disease, fire, or the traumatic exposures but rather the poor sleep quality. It is not uncommon to hear from a firefighter “Coach I have changed my eating habits and started to exercise but I can’t lose weight” and in reality if they do have poor sleep they are climbing an uphill battle. So what can we do?

 

Over the next 4 weeks we will be discussing the consequences of prolonged sleep restriction, hormonal imbalances that exist, health concerns, and strategies to help improve the firefighters sleep.

 

A little story……

 

It was about ten years ago when a Fire department I was working for was asked to be a part of National Sleep Study. I was excited and honored to have our department chosen, but over time I started to realize something, “It didn’t matter how much we look at their sleep; all you have to do is a 24 hour shift to know firefighters have poor sleep.” I often thought “We cant change the job, and we cant really improve their sleep while on the job. If the tones go off, they have to respond.” This thinking lead me to look at things differently. Instead of focusing on sleep quality while on duty, maybe we should look at improving sleep off duty. More important “what actually occurs when you have chronic sleep restrictions?”

 

About 10 years ago I attended the IAFF Redmond Symposium in Chicago to learn as much as I could about the fire service. During that week one fact really stuck in mind “firefighters have heart attacks between the times of 3pm-5pm.” I found this to be odd, as the general public usually have heart attacks first thing in the morning (some believe its due to the elevated cortisol). I proceeded to engrain myself even more in the culture and decided to do a few 24 hour shifts. While I was observing the firefighters go throughout their day I started to realize something, work during the day is basically “filler” and that their job actually does not start until later (6pm). If you ever spent time at a fire station, the day time is usually filled with training, food shopping, inspections, house chores, cooking, and your occasional call. Those things really do not bother the firefighter (they like to be busy). Think about it, when do most people call 911? Daytime of nighttime? Nighttime is the correct answer because most of the world is at work during the day. So in reality a firefighter’s work schedule is flipped upside from the rest of the working population (we sleep when they work).

 

This idea was always a theory of mine, but in 2010 Skidmore College published a study that only reaffirmed my logic. Dr. Smith and her team looked at cardiac events in the fire service and wanted to find the best method to mitigate the risk. They observed two separate fire departments: Oxnard FD (West Coast) and Boston FD (East Coast). Both are polar opposites of each other in dept size, call volume, and response, yet they were all firefighters. What became clear for both departments was roughly 70% of all calls came between 6pm-6am. It was obvious that Oxnard would have more EMS calls, whereas Boston FD had more fires, and that is where I began to think “A call is a call.” In fact, ask a firefighter if he would rather get up at 1am for a fire or an EMS call, the most common answer would be “Fire!” Why? Because firefighters actually only spend 1% of their time fighting fire and that’s what they love to do. It’s the cherry on top.

 

Before people start to get ahead of themselves, one of the most important questions to ask is “What is the dept. call volume?” Why? Because it will help you develop a more specific health and wellness program / strategy. For example: EMS calls have amore profound affect on their health over a 30-year career, whereas firefighters are 136% more likely to have a heart attack once the fire is out which would be in the short term.

 

Moving on, another unspoken theory began to surface as I immersed myself into their culture. If I ever asked “how was your shift?” the response was generally the same “It was ok, we only got up 3 times last night.” It wasn’t until 5 years into the job that I realized, they judge their shift based on how many times they had to get up after midnight. This was the second major shift in my thinking in regards to their sleep. How is the mind and body affected from constantly being woken up? I’ll give you an example: If anyone ever had a new born child they understand the concept of constantly waking up every few hours, but over time the child develops and sleeps longer and within a few years the parents have a normal sleep cycle. Now imagine a firefighter having the same poor sleep over 30 years. It will have a serious affect on their over all well being. For those who think think I am crazy, I encourage you to ask a firefighter how their shift was. They will generally answer based off one criteria: How many calls they had after midnight.

 

So what actually occurs to the body and mind during your sleep cycle? Your body will go through 4 stages of sleep. During stages 3 & 4 Growth hormone is secreted (1996), which allows your body to stimulate growth, boosts immune function, and build up energy for the next day. It is also during this stage where deep sleep begins, as the brain begins producing slower delta waves. The brain produces even more delta waves and you move into an even deeper, more restorative stage of sleep next. So it is not hard to understand why this stage is the most difficult to wake up from. Slow wave sleep comes mostly in the first half of the night, REM in the second half. If a firefighter is constantly woken up every 2 hours their brain will actually not achieve stages 3 and 4, and therefore not have a release of growth hormone making them feel very tired and sluggish. However, if they can get about 3-4 hours of sleep while on shift they will get the growth hormone release which will help with recovery and allow them to function the next day (it wont be optimal but they can manage). Again, ask a firefighter “Can you function the next day with straight 4 hours of sleep?” their response is generally “Yes but it is hard”, and then ask them “What if you got a total of 6 hours of sleep but were woken up every 2 hours?” there generally will say “I am worthless then…its very hard”….Now we know why!

 

Stay tuned for next weeks article, we will go into more of the hormonal imbalances (aka Cortisol, melatonin, growth hormone, testosterone, etc…) that occur when the body does not get enough sleep, and eventually.

 

Take Away:

 

  • Roughly 70% of all calls (EMS / FIRE) occur between 6pm – 6am
  • Heart rate response in young firefighters spike on every call
  • Heart rate responses in veterans generally spike on Fire calls, not EMS.
  • 4 Stages of sleep
  • Stages 3 & 4 is where growth hormone is secreted.

 

Van Cauter E1, Plat L. (1996 May) Physiology of growth hormone secretion during sleep. J Pediatr.;128(5 Pt 2):S32-7.

 

 

 

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