Treatments (part 2)
This half of the Treatments will review the two remaining categories of actions (environmental and personal) to help reduce sleep deprivation, increase sleep quality, and improve sleeping habits.
Environmental (Station) Treatments
Environmental treatments consist of structural enhancements that can affect sleep. In general, most of these are tied to organizational actions (described in first half of this article). However, the designs and characteristics among stations may vary in one department and therefore warrants its own category.
Type of Living Quarters
Three types of living quarters exist: open, semi-open, and individual. In an open environment, personnel may sleep in an open room with no walls or doors separating each bed. In a semi-open environment, firefighters may sleep in the same open space, but are separated by cubical like walls. The walls do not extend to the ceiling and there are no doors. In an individual environment, walls extend to the ceiling and rooms have doors. An effort has been made to make each room private and contain some type of door (or shield covering the doorway).
A research study examined sleeping areas in emergency medical departments.1 It was suggested that rooms be designed to enhance quality of sleep being single-occupant room with low lighting and constructed to limit external sound and light. Although that article focused on physicians in medical departments, these recommendations can be applicable toward the fire service.
Room Temperature
Room temperature can affect sleep experience. Fire stations may have one of three types of temperature access. Firefighters may not be allowed to adjust the temperature in the station (e.g., controlled by city or fire chief), firefighters may have partial adjustment of temperature (+ / - a few degrees), or they may have full access to adjust temperature. Depending on the type of living quarters, nine options are available for temperature control. Open environments may have no access, partial access, or complete access and same applies to semi-open and individual rooms.
Although complete access would allow firefighters to set a comfortable temperature, it is important to remember that each person has a different preference in temperature level, which may create an uncomfortable sleeping environment. Of course, this issue is greater in an open and semi-open compared to an individual room, where the room is set to one temperature.
Lighting System
The use of sudden alarms and lights may be a source of stress for paramedics and firefighters. The activation of lights during the night can be bothersome especially if stations use Troffer light fixtures, creating a ‘shock’ to the body. Lighting systems that use red lights and slowly illuminate to wake firefighters may reduce the sudden ‘shock’ to the body. Placement of lights may also be a concern; directly over the head may increase stress level. More research is needed on the effects of different lighting systems.
Alerting System
A recent published study found evidence to suggest that they type of alerting may influence a firefighter’s physiological response to the alarm.2 Two components exist for alerting systems: sound type and broadcasting type. Fire stations may have one of two types of alerting system sounds: electronic (which can be programmable) and mechanical sound (e.g., old school bell type). It is probably easy to guess that the electronic sound system would be advantageous for firefighters compared to the loud, one-tone mechanical system. A gradual increase in sound may reduce stress upon waking. Furthermore, pitch and sounds may be programmable for the type of incident. This would help reduce uncertainty and stress upon waking.
Departments may also operate among an open, station, and/or unit broadcasting system. An open broadcast is sent to everyone (all stations and firefighters) regardless of who is responsible for responding to an incident. It is easy to hypothesize that this system would be the worst for firefighter sleep since everyone would wake regardless of the call’s relevancy. The second type (most common) is station broadcast. This system only alerts the station that houses the unit/company responsible for responding to an incident. The benefit of this type of broadcast is that it limits unnecessary interruptions among those not responsible for responding. However, the system would still be distracting if a station housed two separate units. Therefore, the third system is a company/unit type of broadcast. This system would only notify individual firefighters who are responsible for responding. This system would be implemented in individuals sleep quarters and may allow firefighters to program which unit they operate on that particular day. During the day the broadcast could be switched to station wide, since firefighters are less likely to be in their rooms.
Bedding Material
Career firefighters spend one-third of their nights at the fire department. Sleeping on poor quality, old, or worn bedding can be uncomfortable and reduce sleep quality. Departments should review policy on the type and quality of bedding they supply, if/when bedding is rotated, and when bedding is replaced.
Individual Treatments
Individual treatments consist of personal actions taken to better sleep quality and sleeping habits.
- Limit stimulants before bedtime (e.g., caffeine)
- Coffee
- Energy Drinks
- Energy shots
- Use naps to your advantage. Only you know when your sleep need! Most likely, you are in need of sleep. An incident during the night (or heavy call volume during the day) may exacerbate this need of sleep and possibly reduce performance and alertness during the latter part of your shift.
- Manage your second job appropriately and allow yourself the opportunity to rest and sleep before arriving to work.
- Limit noise and light during the night if your station has open or semi-open sleeping quarters. Watching a movie or using your phone decreases your opportunity to sleep and could be distracting to others attempting to sleep.
- Listen to others if they think you may have a possible sleep disorder. Most people are initially informed by their partner of the possibility of sleep disorder. If you or others are worried, schedule an appointment with a medical provider for a screening.
Please not that some of the recommendation in the two-part treatment article are speculation based on my knowledge and research experience. Most recommendations, however, are supported with research findings and are appropriately cited. Please also note that the recommendation listed above are in terms of sleep and may not consider any trade-offs. For example, although individual rooms are beneficial for firefighter sleep, they may cost a significant amount of money.
Resources
- Joffe, Mark D. 2006. "Emergency Department Provider Fatigue and Shift Concerns," Clinical Pediatric Emergency Medicine 7(4):248-254. doi:http://dx.doi.org/10.1016/j.cpem.2006.08.008
- MacNeal, James, et al. 2016. “Effect of Station-Specific Alerting and Ramp-up Tones on Firefighters’ Alarm Time Heart Rates,” Journal of Occupational and Environmental Hygiene 13(11)866-870. doi: http://dx.doi.org/10.1080/15459624.2016.1183018
Next Series - Conclusion