Sleep Series 5: Treatments (part 1)

Treatments (part 1)

The previous articles provided an introduction to this topic, reviewed sleep physiology, discussed the need to recover, and explored adverse consequences of sleep deprivation, poor sleep quality, and bad sleeping habits. We now focus on treatments that can be achieved at the individual and organizational level. This two-part article will review types of actions that can help reduce sleep related consequences.

The obvious solution to reduce many sleep related problems is to be healthy and obtain uninterrupted sleep of sufficient quantity in a well-suited environment. The reality, however, is that this may be difficult for fire and emergency services personnel who typically respond to incidents during the night. Fortunately, you have some control and can take steps to increase sleep quality and develop better sleeping habits. In the following two articles, we will discuss actions that divide in to three categories: organizational, environmental, and personal.

Organizational Treatments

Organizational treatments consists of actions fire administrators (e.g., fire chief) can perform to improve firefighter sleep. These include (but are not limited to) educating firefighters on the importance of sleep and its related consequences, allocating sufficient time off between shifts, Adjusting the shift start time, using naps during the day, and discussing the appropriate use of second jobs.

Implementing a Sleep Health Education Program

Recent studies have demonstrated that majority of firefighters have poor sleep quality,1-3 sleep deprivation,4 poor sleeping habits,5 and excessive daytime sleepiness.6 Firefighters with sleep disorders are more likely to report getting injured, using sick days, falling asleep while driving, and causing a vehicle accident.7 In addition, they are likely to develop long-term adverse health effects without intervention. Therefore, the first step after recognition this problem is to develop and implement a sleep health education program.8 A program like this would provide the opportunity for fire department officials to train and educate firefighters about the importance of good sleep practices and help lead behavioral changes that ultimately influences health and safety, alertness, and job performance. Furthermore, department officials could use this program as an opportunity to screen firefighters for common sleep disorders. Many tools exist on the internet that can help.*

Time between Shifts

How much leisure time is required for recovery is a function of individual characteristics such as level of energy, workload on the body, previous deficit, etc. In general, however, researchers have noted a relationship between circadian disruption and time needed for restoration of normal rhythm.9,10 Researchers reported that one day of recovery is never sufficient after working irregular work hours; two days are best, whereas three or four may be need for those with severely disturbed circadian rhythm.9 This theory can be illustrated in a recent case study that compared firefighter sleep quality among three typical shift schedules in the U.S. (24on/48off, 48on/96off, and Kelly-OXOXOXXXX).3 The results suggested that the 24on/48off schedule was the best, compared to the 48on/96off and Kelly because it allowed two days off between shifts. This duration provided time to renormalize the circadian rhythm.

In this study3, the 48on/96off and Kelly schedules did not provide firefighters sufficient time off between shifts to normalize their circadian rhythms. Essentially, firefighters working 48on/96off and Kelly had not recovered before their next shift. They had to wait until their recovery period (i.e., end of tour) before receiving two days of rest and allowing for renormalization. Those working the 48on/96off schedule waited two days before having two consecutive days off. Yet, firefighters working the Kelly waited five days before receiving two consecutive days off. Although it may appear that the firefighter just has to ‘wait it out’ and will be ‘recovered’ once they receive their off days at the end of their tour, the damage builds overtime. Billings and Focht (2016) illustrates this relationship in their article and explains that the repeated exposure to this behavior is evident in the sleep quality scores. Even the 24on/48off schedule, where they found the best sleep quality scores, has some cumulative effects because firefighters are exposed to one night of interruptions.

Shift Start Time

Research suggests that a later start time is important for three reasons:11 1) early morning starts reduce the amount of sleep obtained because people usually go to bed around the same time regardless of the time a shift starts, 2) early morning starts correlate with increased fatigue, and 3) early morning starts increase errors and accidents.11 Additional research suggest that early morning shifts tend to associate with disturbed sleep patterns, feelings of not be refreshed, and increased sleepiness during the afternoon.12 A later start time would provide firefighters the opportunity to obtain a sufficient amount of sleep.


Researchers find that the use of naps helps restore performance.13-15 A prophylactic nap (taken to avoid sleep deprivation) can sustain alertness and performance throughout a nightshift.16-18 Some research suggest developing ‘rules’ when implementing a nap strategy at work: 1) promote longer 60 to 90-minute naps (or less than 20 minutes to avoid deep sleep [see Sleep Physiology article]), 2) consider the timing of naps so all workers are able to participate within the effective nadir of sleepiness, 3) provide an environment for quality sleep, and 4) plan naps to improve shift conditions.18 Although naps can be advantageous for firefighters, it is important to remember that naps are not a substitute for full sleep.

Appropriate use of Second Job

Most firefighters have second jobs, which may negatively influence sleep quality.3 Firefighter should arrive at work refreshed and ready to respond to incidents. A firefighter’s level of alertness and performance may be impaired if they previously worked without obtaining adequate sleep and rest. Department officials should discuss options relating to working second jobs immediately prior to coming to work to help ensure firefighters are ready for the day’s work.

The next article will discuss environmental and personal actions to help improve sleep quality and sleeping habits.

  1. Mehrdad, Ramin, et al. 2013. "Sleep Quality of Professional Firefighters," International Journal of Preventive Medicine 4(9):1095.
  2. Lim, Dong-Kyun, et al. 2014. "Factors Related to Sleep Disorders among Male Firefighters," Annals of Occupational and Environmental Medicine 26(1):11.
  3. Billings, Joel and Will Focht. 2016. "Firefighter Shift Schedules Affect Sleep Quality," Journal of Occupational Environmental Medicine 58(3):294-298. doi:10.1097/jom.0000000000000624
  4. Carey, Mary G., et al. 2011. "Sleep Problems, Depression, Substance Use, Social Bonding, and Quality of Life in Professional Firefighters,” Journal of Occupational Environmental Medicine 53(8):928-933. doi:10.1097/JOM.0b013e318225898f
  5. Lusa, Sirpa, et al. 2002. "Perceived Physical Work Capacity, Stress, Sleep Disturbance and Occupational Accidents among Firefighters Working During a Strike," Work & Stress 16(3):264-274. doi:10.1080/02678370210163301
  6. Haddock, C. Keith, et al. 2013. "Excessive Daytime Sleepiness in Firefighters in the Central United States," Journal of Occupational Environmental Medicine 55(4):416-423. doi:10.1097/JOM.0b013e31827cbb0b
  7. Barger, Laura K, et al. 2015. "Common Sleep Disorders Increase Risk of Motor Vehicle Crashes and Adverse Health Outcomes in Firefighters," Journal of Clinical Sleep Medicine 11(3):233.
  8. Barger, Laura K., et al. 2016. "Implementing a Sleep Health Education and Sleep Disorders Screening Program in Fire Departments: A Comparison of Methodology," Journal of Occupational Environmental Medicine Publish Ahead of Print(doi:10.1097/jom.0000000000000709
  9. Åkerstedt, Torbjörn, et al. 2000. "Sleepiness and Days of Recovery," Transportation Research Part F: Traffic Psychology and Behaviour 3(4):251-261. doi:
  10. Rosa, Roger R. and Michael J. Colligan. 1988. "Long Workdays Versus Restdays: Assessing Fatigue and Alertness with a Portable Performance Battery," Human Factors 30(3):305-317. doi:doi:10.1177/001872088803000305
  11. Knauth, Peter. 1993. "The Design of Shift Systems," Ergonomics 36(1-3):15-28. doi:10.1080/00140139308967850
  12. Åkerstedt, Torbjörn. 2003. "Shift Work and Disturbed Sleep/Wakefulness," Occupational Medicine 53(2):89-94. doi:10.1093/occmed/kqg046
  13. Fallis, Wendy M, et al. 2011. "Napping During Night Shift: Practices, Preferences, and Perceptions of Critical Care and Emergency Department Nurses," Critical Care Nurse 31(2):e1-e11.
  14. Hirose, Toshio. 2005. "An Occupational Health Physician's Report on the Improvement in the Sleeping Conditions of Night Shift Workers," Industrial Health 43(1):58-62. doi:10.2486/indhealth.43.58
  15. Pilcher, June J., et al. 2005. "Self-Report Naps in Irregular Work Schedules," Industrial Health 43(1):123-128. doi:10.2486/indhealth.43.123
  16. Bonnet, MH. 1991. "The Effect of Varying Prophylactic Naps on Performance, Alertness and Mood Throughout a 52-Hour Continuous Operation," Sleep 14(4):307-315.
  17. Gillberg, Mats. 1984. "The Effects of Two Alternative Timings of a One-Hour Nap on Early Morning Performance," Biological Psychology 19(1):45-54. doi:
  18. Takeyama, Hidemaro, et al. 2005. "The Nighttime Nap Strategies for Improving Night Shift Work in Workplace," Industrial Health 43(1):24-29. doi:10.2486/indhealth.43.24
Disclaimer *FDSleep does not endorse a particular product. Furthermore, FDSleep always recommends obtaining advice from a medical provider or expert.

Next Series - Treatments (part 2)