Improving Sleep Among Frontline Workers

May 6, 2019

Frontline workers are exposed to varying degrees of traumatic situations almost daily, increasing the prevalence of mental health issues and associated sleep disorders. Indeed, 2017 research from Johnson & Johnson shows that Canadian military service members and first responders struggle to get support for their own health needs. 

The study, which looked at Canadian military service members, first responders, and members of the public, found that 40% were concerned about the risk of mental illness in frontline workers and 37% were concerned about sleep disorders. 

Achieving good quality sleep can be greatly impacted by your circadian rhythm – also known as the sleep/wake cycle, which is a 24-hour cycle controlled by the hypothalamus in the brain. It is responsible for the phases of sleep and wakefulness we experience and tends to coincide with day time and night time. This is because factors like light and darkness affect the circadian rhythm, with light releasing hormones that cause wakefulness and darkness releasing hormones that encourage sleepiness. For frontline workers exposed to night shifts or rotating shifts, this natural rhythm is altered dramatically.

Sleep Disorders
When police officers, firefighters, hospital workers or paramedics respond to a call for help, they could be faced with harrowing situations. These, coupled with unstable circadian rhythms due to shift work, can lead to difficulty sleeping, insomnia, or nightmares during sleep. As a result, frontline workers who suffer from sleep disorders can have difficulty focusing at work, leading to lapses in judgement and accidents. They may also develop further psychological issues, including post-traumatic stress disorder (PTSD), depression, and eating disorders. 

One factor that could greatly facilitate better sleep is thought acceptance, which is a component of Acceptance and Commitment Therapy (ACT) – an alternative to the traditional and better-known Cognitive Behavioural Therapy (CBT). While CBT teaches individuals to challenge their thoughts and emotions, ACT teaches them to embrace and accept them. 

Achieving better sleep via ACT is all about thought acceptance, which can encourage frontline workers to accept any difficult thoughts, feelings and memories, rather than attempt to bury them. Dr. John Morrissey, a member of the College of Psychotherapists of Ontario, says, “Thought acceptance as I use it acknowledges that, as humans, we need to process our life experiences. It has the person focus on what is reality, what can be changed, what needs to be attended to, and what is a permanent condition or circumstance.” This can be achieved with a therapist and on one’s own. With thought acceptance, patients learn to face their experiences head on, leading up to a point where they can relive their experiences without becoming emotionally overwhelmed.

However, as is the case with most types of therapy, it may not be effective for some. Dr. Morrissey points out that some of the people he has treated had difficulty focusing on the process, leading him to include additional techniques such as focusing on positive life experiences. So, if ACT isn’t for you, there are other basic steps to better sleep. Dr. Morrissey recommends a regular sleep schedule; even for those working on rotating shifts. “The human body is a habit-forming organism and benefits from repetitive behaviour. I ask people to choose the most appropriate times for them to have a good sleep pattern and to maintain that pattern. I also suggest that they learn about their circadian rhythm and make the room they sleep in as dark as possible while sleeping, and very bright when they choose to be awake.”

Better Awareness 
The importance of a good sleep pattern cannot be overemphasized. Frontline workers, both those on rotating shifts and regular day workers, must maintain a healthy sleep pattern for the body to refresh itself and be ready for action. In the case of emergency workers, snap judgment calls can occur at any time, and a lapse in judgment due to fatigue can literally be the difference between life and death. 

When a sleep disorder is diagnosed, it is important to overcome any prejudices and fears, and seek the help you need. Seeking help is a first step towards the aim of thought acceptance. Ultimately, good sleep is an important part of a healthy lifestyle, and as such, should be recognized by frontline workers, their employees, unions, and the government. 

What exactly is Good Quality Sleep?

According to the U.S. National Sleep Foundation, the key determinants of good quality sleep include:

  • Falling asleep less than 30 minutes after going to bed;
  • Waking up no more than once per night;
  • Being awake for less than 20 minutes after initially falling asleep;
  • Sleeping for at least 85% of the time spent in bed; and,
  • Sleep duration of 7-9 hours (adults aged 18-64).


Acceptance and Commitment Therapy

1. Acceptance
When exposed to a negative experience, the mind tries to avoid re-living it, relegating those experiences to the background. Acceptance encourages you to actively embrace the experiences without attaching any negative interpretations to them.

2. Cognitive Defusion
This is practiced with the intention of changing how we react to our thoughts and feelings. People can learn to reduce the urge to alter the context of their thoughts and memories. A policeman who witnesses a violent shooting, for example, can learn to live through the events of the shooting rather than altering them to downplay the situation in efforts to cope.

3. Being Present
This involves being aware of the present situation. It entails treating the situation with openness, receptiveness, and interest. You can learn to sit through any negative feelings associated with a work-related event and to explore those feelings with curiosity to understand them better.

4. Self as Context
This is the notion that we are more than our experiences. Individuals are encouraged to understand that they are not the experience itself, but rather the one experiencing the situation. For example, a paramedic can fight through overwhelming anxiety at seeing a particularly gruesome accident, viewing the anxiety as an understandable emotion and channelling their mindset into saving lives. Such as: ‘I am not the anxiety; I am experiencing anxiety.’

5. Values
Personal values directly or indirectly influence our actions. In this respect, ACT seeks to help individuals live according to their own personal values. This helps to look beyond events to the achievement of their personal values (commitment, for example); any traumatic events they witness are a product of living according to their value of wanting to help others.

6. Committed Action
We can commit to actions that promote our goals and enable us to channel our energy into our work. A team of firefighters may decide to improve their response times to emergency calls. As each commits to the actions necessary to achieve that team goal, it allows them to focus on the task at hand rather than be overwhelmed by the emotions associated with their job. 

Dr Nicola Davies is a Psychologist and writer with an interest in the psychology behind frontline work.