Why So Sleepy?

I think we all have accepted that shift work and disrupted sleep is a health detriment; the question of what to do about it is easily answered. Find a different job…

Ok so if that is not an immediate option read on.

The work pattern itself appears to be very important in the grand scheme…

“data from 7 studies that evaluated the risk for incidents (including accidents and injuries) during successive night shifts. They found that the risk approximately doubled with each shift worked, from ~6% during the second night shift to 17% during the third night shift and 36% during the fourth night shift” (Folkard and Tucker)

They go further to say

 

“The observed marked increase in the risk for incidents during working hours suggests that working more than 4 consecutive 12-hour night shifts should be avoided.”

Generally the consensus is that the longer the disruption of natural sleep cycles the more dangerous it becomes; dangerous from the perspective of mental and physical impairment as well as dangerous to overall health and wellness.

 

“When persistent, the chronic sleep debt such individuals incur may contribute to long-term health detriments, eg, cardiovascular disease and ongoing ES, during periods when wakefulness is required.”

Where we, the fire service, fit in all of this is even more unfortunate because it would appear that interrupted sleep cycles are even more detrimental than an opposite sleep cycle, eg, night shift.

They should also be encouraged to ensure a single 7- to 8-hour sleep episode during a 24-hour period, as opposed to, for example, two 4-hour sleep periods.8,9 There is now good evidence to suggest that sleep fragmentation of this type can adversely affect sleep architecture (ie, the natural stages of sleep), which leads to an accumulated sleep debt.10 Incurring a sleep debt can exacerbate the negative effects of shift work on cognitive performance and may also aggravate any underlying sleep disorder by adding to the ES experienced during periods of wakefulness.”

If you haven’t figured out yet ES is short for Excessive Sleepiness…

So what to do?

Steps to achieve an appropriate environment for restorative sleep

Step Practical advice
Ensure the room is dark • Ensure the room has sufficiently well-lined curtains, or install black-out blinds on all windows
Ensure a constant temperature in the bedroom • Aim for a temperature of around 20°C (68°F)
• Avoid too many bedclothes
Reduce noise exposure before and during the required sleep period • Avoid watching television or listening to loud music immediately before the required sleep period
• Use a room at the rear of the house if near a busy road
• Consider ear plugs if the ambient noise is intrusive
• Put telephones on an answering machine
• Ask family members to be quiet
Avoid large meals, caffeine-containing drinks, smoking, and alcohol before the required sleep period • Schedule meal times so that the main meal of the day is eaten during or before the work period
• Consider having a warm magnesium drink before the required sleep period
Exercise
Clearly I am a fan of exercise and I’m certain that it helps to promote healthy sleep. We tend to carry a ton of restless energy and angst throughout the day and there is nothing quite like a heavy deadlift to put you sleep.

“Exercise has been shown to be helpful in promoting sleep onset and improving the perceived quality of sleep.11 Exactly how exercise promotes sleep remains unclear, but the beneficial effects of exercise on mood and anxiety may contribute.11,12 In addition, exercise has been shown to facilitate phase shifting of the circadian system13 and thus may help in the adaptation process to shift work.14 The most appropriate timing and type of exercise to support individuals with SWD remain to be defined.”

For those of you still reading SWD is Shift Workers Disorder…
I prefer to get it done in the AM, cortisol levels are highest first thing in the morning and exercise has been shown to help reduce them which sets your body off on the right hormonal foot for the day. Definitely keep you PT away from bedtime as it can affect you ability to fall asleep.
Light exposure
Think camping; when was the last time you were able to stay awake 3-4 hours into darkness? You probably wake up super early as well, say right around sunrise.

“The human endogenous circadian rhythm is closely linked to the external light/dark cycle; this interaction involves the receipt of daylight-stimulated nerve activity via the retinal ganglion and the retinohypothalamic tract and is controlled by the suprachiasmatic nuclei of the hypothalamus”

Limiting light exposure prior to bedtime and sleeping in complete darkness is essential to quality rest. In the book “Lights Out, Sugar Sleep and Survival” they recommend limiting screen time (TV, Computer, iPhone) after 9pm and, if exposure is inevitable, to wear rose colored glasses. In addition to the retinal ganglion mentioned above it turns out that the skin has photo receptive qualities that also trigger the production of serotonin (the happy awake hormone) and the resulting cessation of melatonin (the sleepy restorative hormone) production.
If this is killing you skip to the end for the “B-shift Breakdown”
Attention to diet

Eating right before bedtime, especially carbohydrate is generally a no-no; you want your digestive system to get a break in service along with the rest of your body. If you are like me it can be pretty difficult to eat your last meal and 5 pm so I tend to snack. I generally eat things that are high in fat and protein because they are more satiating and the risk of a huge sugar spike to keep me up is reduced. A work of caution here is that protein can have the same stimulating effect as sugar. I do think that an ancestral type diet is best for most people and is certainly worth a shot if you are having any sort of illness or disorder. As you all know by now that type of diet is inherently low-carb and high in protein and fat which for me has always equaled good sleep. There is always another side to coin however…

“One study has suggested that attention to dietary composition may have an impact on alertness and performance among individuals working night shifts in a hospital setting.44 The study suggested that a diet with a carbohydrate-to-protein ratio of around 3:1 is optimal in terms of benefits for both mood and anxiety”

I believe sleep is so important that I would recommend trying the above macronutrient ratio using natural, whole, foods if you are unable to get good rest on a more paleo ratio.

Mindfulness

 

It bears repeating that sleep is the underpinning of our athletic, mental, and physical health; in doing research for this post I have come across literally hundreds of articles on stress induced insomnia and I think that we in the fire service suffer equally from both this type of sleep disorder and circadian disruption (night calls). Stress reduction needs to be an integral part of you sleep management plan and it turns out relaxing and letting the stress go can take some serious practice. Of all the practices I have read about the one that seems to come up the most is progressive relaxation.

Here’s How:

  1. After finding a quiet place and several free minutes to practice progressive muscle relaxation, sit or lie down and make yourself comfortable.
  2. Begin by tensing all the muscles in your face. Make a tight grimace, close your eyes as tightly as possible, clench your teeth, even move your ears up if you can. Hold this for the count of eight as you inhale.
  3. Now exhale and relax completely. Let your face go completely lax, as though you were sleeping. Feel the tension seep from your facial muscles, and enjoy the feeling.
  4. Next, completely tense your neck and shoulders, again inhaling and counting to eight. Then exhale and relax.
  5. Continue down your body, repeating the procedure with the following muscle groups:
  • shoulders and arms
  • abdomen and chest
  • buttocks, legs and feet

Quickly focusing on each group one after the other, with practice you can relax your body like ‘liquid relaxation’ poured on your head and it flowed down and completely covered you. You can use progressive muscle relaxation to quickly de-stress any time.

 

Try this when you lay down for bed and try not to stress on falling asleep, it seems that anticipation of sleeplessness is sure way to stay awake.

B-Shift Breakdown

 

Sleep is good

–         get at least 7-9 hours per night

–         sleep in a cold, dark, quite place

–         avoid working more than 3 shifts in a row

–         avoid sugar and caffeine after noon

–         exercise during the day, avoid it right before bed

–         establish a sleep routine and keep it as regular as possible on and off shift

–         practice stress reduction, eg, yoga, meditation, progressive relaxation, Olympic lifting daily

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