If I could only offer one piece of guidance to a first responder, I would advise them to get their sleep in order. As you’ll soon read, sleep affects your physical and mental health and your safety.
“I can get by on five hours of sleep”
You can, if you don’t mind a shortened life span, poor health and decreased safety. Research shows that getting less than six hours of sleep results in a 70% drop in the body’s natural killer cells (“anti-cancer” cells), a decrease in testosterone, serotonin (mood) and dopamine (pleasure), and decreases your time to physical exhaustion by up to 30%. A 30% reduction in time to physical exhaustion could mean the difference between life and death in a deadly force encounter. Your ability to process the traumas and dramas of the day also requires a full night of sleep since most of the processing occurs at the end of the sleep cycle when you have the most REM. Cutting your sleep short could mean that you don’t recover from daily exposure to critical incidents and stressors.
Strategies for sleep
Now that you get why it is important to sleep, let’s talk about how. Having a bedtime ritual and good sleep hygiene can help. We know bedtime rituals are good for kids. The same holds true for adults. An hour before bed, dim all the lights in the house, avoid any white/blue lights from electronics and start slowing your body and mind. First responders tend to be sympathetically activated (fight/flight) at the expense of parasympathetically (rest/digest). This means you have to deliberately shift to the parasympathetic system to fall asleep. This is accomplished by moving slower (not running around the house doing tasks), doing some slow stretching and slow breathing exercises.
An hour before bed, dim all the lights in the house, avoid any white/blue lights from electronics and start slowing your body and mind.
A calm body contributes to a calm mind, but more may be needed. For instance, you may need to focus an overactive mind to keep it from worries and random thoughts. A technique called cognitive shuffling focuses your mind by thinking of a four- to five-letter word, let’s say “shoe,” and naming words you can spell with each letter (S: shark, sock; H: hose, hotdog; and so on). Every time your mind wanders, bring it back to the letter you are working on. After you identify the word, see the image of the object you named. According to the sleep specialist who created this technique, Dr. Luc Beaudoin, this primes your brain to fall asleep. Think of it as an advanced version of counting sheep. Audiobooks and phone apps can also help you focus your brain. Just avoid viewing the screen as much as possible.
Good sleep hygiene also includes having a hot shower before bed, sleeping in a cold, dark room, avoiding alcohol (it will help you fall asleep but will disrupt sleep while being metabolized), avoiding heavy or spicy meals two to three hours before bed, avoiding caffeine five hours before bed and exercising during the day.
Staying asleep can be a struggle. If you wake up, repeat the cognitive shuffling exercise and write down any worries that came to mind, letting them go as you write them down. If you wake up from a nightmare, calm your body with slow movements and breathing, then focus on a pre-determined positive memory — a vacation spot, camping trip, etc. It may take significant effort to stay with the positive memory, but it will get easier with practice. Strangely, playing Tetris (with a dimmed screen) can also distract you from the nightmare as well as lessen its intensity (more on this in another article).
To nap or not
Taking naps of less than 20 minutes can be helpful right before going on shift. Any more than that and you will be groggy when you wake up, as you will be in a deeper level of sleep. Drink caffeine right before taking a nap. It’ll kick in by the time you need to wake. If you have the time to sleep longer, and you didn’t get great sleep the night before, you can take a much longer nap. You will just need time to wake up. Using a light therapy bar from a pharmacy or online can boost your wakefulness. Lastly, stick to your sleep schedule on days off, as your body needs consistency.
If sleep is a nightmare for you, talk to a board-certified sleep specialist (found at www.sleepfoundation.org). General practitioners don’t typically have enough training in sleep issues and are most likely to prescribe medication, which should be a last resort. I hope these recommendations help you get some shut-eye. Sweet dreams!