Is Work Keeping You Awake?

For some people, sleep is a natural occurrence at the end of each day. They head to bed, fall asleep quickly, rest peacefully through the night and awake fresh for a new day after an ideal eight-hour event.

However, for others, sleep can be elusive, fragmented, interrupted and virtually non-existent. According to some sleep experts, anything less than six to six-and-a-half hours of concentrated sleep can impair cognitive abilities and lower immune response.

"In my opinion, proper sleep is more important than proper diet and exercise," says William Kohler, MD, director of the Florida Sleep Institute, Spring Hill, FL. "Sleep is so important for our ability to function."

Lisa Shives, MD, sleep expert and founder of Northshore Sleep Medicine, Skokie, IL, agrees. "Sleep is so important on so many levels," she says. "Even chronic partial sleep restrictions have been shown to reduce reaction times and decision making (executive function) skills, and lower immune response.

"In the long run, you can have increased risk of heart disease obesity and diabetes," she continues. "We don't completely understand all of the interaction, but with diabetes, research has shown that even short-term sleep deprivation can influence the hormonal balance between glucose and insulin. There's also an imbalance in appetite hormones. It gets complicated. If you're chronically sleep deprived, your adrenaline system is over-activated. You don't get the key hours of quiescent downtime where your heart rate and blood pressure are low and your inflammation response is dampened. If you have an event that chronically disturbs or restricts sleep to a short time, all these mechanisms are heightened. They're turned on when should be turned off."

Shives notes one research study that showed even one night of sleeping four hours instead of eight dramatically reduces immunity. One group of healthy people slept four hours while a control group slept eight. Each person was then given a flu vaccine. "Two days later, the antibodies of those who slept four hours were in the basement," she says. "They just couldn't mount any immunity."

Techniques for Better Sleep

For EMS workers and other shift-workers getting the ideal eight hours, or even the minimum six, can be a challenge given a life of 24-hours shifts and erratic work schedules. Yet consistency is key to getting enough sleep.

"The brain thrives on consistency," says Kohler. "We have a circadian clock which regulates hormonal cycles and alertness. That timing of wakefulness and sleep is controlled in part by that clock. If we switch our sleep pattern, that clock has to readjust, and that's difficult."

Yet, it isn't impossible. These sleep experts offer these tips to get a better night's (or day's) sleep:

1. Avoid caffeine, alcohol and cigarettes. These stimulants increase alertness which can make it more difficult to fall asleep.

2. Avoid heavy meals right before going to sleep. A light snack, especially one that contains tryptophan which can be found in many protein-based foods and dietary proteins, can help you sleep. "But eating heavy meals right before bedtime can cause heartburn, which disrupts sleep," notes Kohler.

3. Avoid heavy physical activity right before going to sleep. Heavy physical activity increases the output of epinephrine, which is a stimulant.

4. Avoid naps. When you nap, you sacrifice concentrated, quality sleep. "You go through stages when you sleep," says Kohler. "About 90 minutes after you fall asleep you go into REM (rapid eye movement) sleep. You have three to five REM periods during the night, with the bulk of them during the morning hours. If you don't consolidate your sleep, the amount of quality sleep will be altered."

5. Protect the sleeping environment. Remove phones from the bedroom, including cell phones. Consider unhooking the wires to the doorbell, and make sure your spouse and children respect your sleeping time. Use room-darkening shades and eye masks to darken the room. Keep the room temperature cool. "Our brain sleeps best when our core temperature is cold," says Kohler. "If the room is too hot, it's more difficult to sleep."

6. Neutralize the sleeping environment. There is typically more noise during the day, notes Shives. Neighbors mow lawns, construction crews run jackhammers, dogs bark, etc. Buy a white noise machine or turn on a fan to neutralize the sleeping environment. Consider using ear plugs to further block out noise.

7. Adhere to a consistent schedule. Even on days you don't work, try to keep the same sleep/wake schedule. "It's admittedly difficult, but biologically you'll be better off," says Shives. "Socially you want to get back on track with family and friends, but try to keep the same schedule."

8. Keep a sleep log. Take note of when you go to bed and how long it takes you to fall asleep. Keep track of what time you get up, and if you take any naps. "A sleep log can be a valuable way to objectively evaluate how much sleep you actually get," says Kohler.

9. Watch for signs of sleep deprivation. Excessive yawning, difficulty focusing, frequent illnesses, depression and irritability are all symptoms of sleep deprivation and signs you should evaluate your sleep patterns.

10. Choose sleep aids carefully. Taking supplements that contain melatonin, a hormone that maintains the body's circadian rhythm, can improve sleep patterns. While sleep aides may be a consideration, take them cautiously. "They shouldn't be thrown at someone quickly without looking at the situation and evaluating how they're living a 24-hour day," says Shives.

Do Your Research

There are several good websites focused on sleep medicine. Kohler suggests American Academy of Sleep Medicine, National Sleep Foundation, and KIDZZZSLEEP.

Seek professional help when necessary. If you have access to a sleep doctor, make an appointment if you feel sleep deprived. "Sleep medicine is relatively new," says Shives. "You may need more assistance than a general practitioner can provide."