Effects of Sleep Deprivation on Fire Fighters and EMS ... - NAEMT

<strong>Effects</strong> <strong>of</strong> <strong>Sleep</strong> <strong>Deprivation</strong> on Fire Fighters and Other EMS Responders
In addition to hours slept, time awake and disrupted day night schedules, the fourth factor affecting
performance is the phenomenon <strong>of</strong> sleep inertia or the impairment in alertness immediately upon
waking. The grogginess experienced is most severe in the first 30 minutes after awakening, and it
varies with the stage <strong>of</strong> sleep, being greatest when aroused from a deep stage <strong>of</strong> NREM sleep.
Although an individual may feel ‘awake’ after a few minute, studies indicate that it may take as
long as two hours to be fully alert when awoken from a deep sleep (Jewett et al., 1999; Wertz et al.,
2006).
1.4c Fatigue, Mood and Quality <strong>of</strong> Life
Chronic sleep loss can lead to feelings <strong>of</strong> depression, and the adverse effects on mood may be
even greater than those on alertness and cognitive performance (Pilcher & Huffcutt, 1996; Sparks
et al., 1997). <strong>Sleep</strong> has effects on brain receptors for serotonin and other neurotransmitters, which
are related to mood and memory. In laboratory studies, only a few days <strong>of</strong> sleep restriction can
alter these receptor levels, and a week <strong>of</strong> restorative sleep was required to reverse the changes
(Roman et al., 2005).
The important interaction among mood, sleep and exposure to sunlight is illustrated by seasonal
affective disorder (SAD) or winter depression. During short winter days, predisposed people
experience SAD or a clinical depression, characterized by low mood and excessive fatigue. The
disorder can be treated with typical serotonin re-uptake inhibitor antidepressants or exposure to
high intensity light, simulating longer brighter days. SAD also illustrates the influence <strong>of</strong> individual
variability on the reaction to environmental changes, as only approximately 10 percent <strong>of</strong> the
population living in northern latitudes develops SAD (Lurie et al., 2006).
In addition to feelings <strong>of</strong> depression, sleep loss also leads to irritability and a sense <strong>of</strong> being ‘stressed.’
Those findings may add to the family disruption that can occur with long work hours and contribute
to the observed adverse effects <strong>of</strong> shift work on social relationships (Poissonnet & Veron, 2000).
According to the International Classification <strong>of</strong> <strong>Sleep</strong> Disorders, shift work sleep disorder is
considered a specific diagnosis because <strong>of</strong> the frequency with which shift workers suffer from
sleep disturbances and excessive sleepiness (Beer, 2000). Compared to their ‘9 to 5’ counterparts,
shift workers are more likely to suffer from insomnia (61% vs. 47%) and excessive daytime sleepiness
(30% vs. 18%). Shift workers also are more likely to drive while fatigued, and they are almost twice
as likely to fall asleep at the wheel.
Recently, employers have recognized that health is
more than the absence <strong>of</strong> injury and illness, and that
worker well being and presenteeism may have a greater
economic impact than the more traditionally indices <strong>of</strong>
health care costs (Mills, 2005). For example, study <strong>of</strong>
workers’ mood resulted in recognition that feelings <strong>of</strong>
depression greatly reduced employee productivity. To
date, work hours and sleep deprivation have not been
related to presenteeism or more global quality <strong>of</strong> life
issues.
Shift work disorder is characterized
by fatigue, functional impairment, difficulties
initiating and maintaining
sleep that are not readily remedied by
behavioral measures and the exclusion
<strong>of</strong> other disorders, such as obstructive
sleep apnea and depression.
It may occur in from 8 to 24 percent
<strong>of</strong> night or rotating shift workers
(Sherman & Strohl, 2004).
8