By Jacqueline Toomey
The culture of “I’ll sleep when I’m dead” is killing firefighters.
The burgeoning discussion within the fire service regarding mental health and wellness needs to stop making claims about causes behind mental health problems and wake up to the dark, concrete truth beneath it: sleep loss is taking firefighter lives. Through mourning the loss of my husband’s partner on the job, my family learned firsthand the reality of this topic.
At a roundtable discussion with firefighters involved in peer support for a major metro fire department, we examined the matter that is gaining national attention within the fire service: suicide as seen through the lens of sleep deprivation. One member from across the room replied cautiously: “You’re going to have a hard time to get guys to buy in to the idea that sleep loss causes suicide.” But nothing in me has interest or concern for the art of persuasion; this is not a speculation or feeling. These are facts. Stone cold. Sleep loss is killing fire fighters, period.
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Suicide is the line of duty death that isn’t considered as such. It’s time to face this type of line-of-duty death that no one wants to talk about with a scientifically new understanding. Sadly, those who fall victim to it also fall short of the hero’s honors and recognition the profession extends to any other death in the fire service. There is now research that lends evidence to suicide as a complex result of physiological processes resulting from the impact of chronic sleep disruption over a career.
Researchers from the Stanford University School of Medicine published a 10-year study that found a relationship between suicide in adults and sleep disruption. Of 420 participants, 20 individuals with chronic sleep disturbances committed suicide during the study. This is just a small window into the dark underworld of firefighting: sleep deprivation. Let’s take a closer look at what happens physiologically and psychologically when you regularly experience interrupted sleep. Here are three reasons why sleep loss contributes to suicidal ideation and completion.
Lack of sleep: Stripping the Balance
You may have heard of the brain-gut connection. Serotonin, mostly produced in the gut, is a neurotransmitter linked to feeling good and is greatly impacted by sleep patterns. Researchers at the Department of Molecular Neurobiology at the University of Groningen, Netherlands, found that chronic sleep restriction leads to a gradual and persistent desensitization of serotonin receptors, lowering it ability to boost our mood, resulting in depression. To make matters worse, this neurotransmitter is 80-90 percent produced the gastrointestinal tract and when the body experiences the stress of sleep disruption, the sympathetic response halts activity in the gut, impairing the production of this chemical that makes us feel positive. Extremely low levels of serotonin are found in the brains and cerebral spinal fluid in the bodies of people who have committed suicide.
Another special neurotransmitter, dopamine, is a brain chemical that influences how we experience pleasure and pain. But dopamine is only functional if it has substantive receptor sites. Research suggests that lack of sleep may reduce the number of dopamine receptors. According to the Journal of Neuroscience, this chemical effect explains changes in behavior that occur alongside sleep deprivation. These changes include increases in risk-taking behavior, irrational thoughts, impulsive choices, and drug relapse. This type of behavior increases in relation to how sleep deprived an individual is, giving us a glimpse into why people may complete the act of suicide. When dopamine levels are low, one may experience complete lack of motivation, apathy, debilitating fatigue, foggy brain, addictive behavior, shifty moods, and memory impairment. Dopamine function plays an important role in how you feel, levels of motivation, and how interpersonal relationships play out.
Sleep deprivation activates the body’s fight-or-flight response. This response primes the body with essential hormones to gear up to combat or flee imminent danger. However, the high frequency that firefighter’s bodies remain in this state due to daily occurrences on the job have grave consequences for their health. While this response is necessary for survival in certain extreme circumstances, the long-term impact causes overwhelming detriment and enduring damage to regions of the brain.
Sleep deprivation or repetitive circadian disruption causes the amygdala or “stress center” of the brain to activate. When this happens, the amygdala hijacks the rational brain. The prefrontal cortex, which is normally responsible for executive decision making and moderating social behavior, is no longer in control. What results is a propensity for behavior that is out of character, irrational, and impulsive. According to the Department of Neurobiology at Yale: “Even quite mild acute uncontrollable stress can cause a rapid and dramatic loss of prefrontal cognitive abilities, and more prolonged stress exposure causes architectural changes in prefrontal dendrites.” Stress from sleep deprivation structurally shrinks important areas of the brain such as the prefrontal cortex and the hippocampus, which are critical for decision making, processing, and emotional regulation. One of the main factors to blame in brain shrinkage is cortisol, the stress hormone pumped out by the adrenal glands when the body is forced to wake up and run a call. Excess cortisol injures and kills cells in the hippocampus. It is a common denominator for individuals who suffer from depression.
Rapid Eye Movement (REM) Sleep
The loss of the REM stage of the sleep cycle may be the greatest contributing factor to suicidal ideation for the sleep-deprived firefighter. During the REM stage, the final portion of the 90-minute sleep cycle, critical psychological processing occurs. It is during this phase that the mind processes emotional responses and events of the day. Undergoing this phase multiple times per night is crucial in maintaining emotional stability. When your sleep is interrupted, your body is forced to restart the sleep cycle from the beginning, regardless of how short the interruption might have been. In other words, if you work at a station that runs three or four times per night or one call every 45-60 minutes, it is possible that you may rarely or never enter REM sleep. This is the reason that many people will experience depression and irritability after a night with disrupted sleep. Your body physically never processed the events of the preceding day.
Science once theorized that depression and psychological disorders caused sleep problems, but now research shows the opposite: the less sleep a person receives, the more likely the individual is to have psychological problems that could ultimately result in death. Have you ever noticed as a firefighter that most suicides are committed during the late hours of the night and into early morning? There is something to be said about feeling alone in the dark turning over thoughts when there is nothing found in the light to distract you. The conscious, awake mind is not capable of processing emotions in the way REM sleep does, especially when the amygdala is in the driver’s seat. Research by Michael Perlis, PhD, professor and director of the Pennsylvania Behavioral Sleep Medicine Program, finds that completed suicides are far more likely to occur at night between the hours of midnight and 4:00 a.m. He states: “Sleep disturbance has consistently been found to be a risk factor for suicidal ideation and behavior.” Perlis explains that “it is likely that being awake at night, when one is biologically prepared to be asleep, may be a risk factor in and of itself. The risk being that at this phase of the 24-hour day we all may be particularly vulnerable to catastrophic thinking and low impulse control.”
The research is proven, and the science is compelling. What we need now is for leaders in the fire service to step up and take charge of challenging a culture in this industry that has turned its back on the need for and the importance of sleep. There are ways to mitigate the effect of sleep deprivation, but before any of these practices are implemented, leaders in the fire service, both formal and informal, need to transform the tone and culture around sleep. Sleep routines such as defined periods of rest (a sleep recovery practice or nap) can be neatly incorporated into a daily firehouse schedule to optimize it. Defined and purposeful rest makes it meaningful and efficient, not lazy and prolonged. Learning how to optimize sleep is just another element of becoming an elite first responder, just like any responder trains to optimize his or her proficiency in lifesaving skills. Most importantly, enhanced sleep may make or break a lifesaving moment. There must be a shift in the attitude in the firehouse away from the “I’ll sleep when I’m dead” mentality towards an understanding that sleep is valuable. Every aspect of our lives- and those who receive critically lifesaving emergency services- depends on it.
This article has been written to help spread awareness of the very real and immediate dangers of sleep deprivation. It is dedicated with honor and respect of the late Denver Firefighter Michael Jeffries, who sadly succumbed to suicide in 2016.
Jacqueline Toomey co-created the First Responder Sleep Recovery Program with her firefighter husband, Sean Toomey. She received her bachelor’s degree from Regis University, completed master’s-level coursework in education at Metro State University, and trained in nutrition therapy. Jacqueline began teaching in 2004 and continues to train in integrative, holistic mind-body modalities for healing, holding nearly 1,000 hours of Yoga Alliance recognized certifications. She has had the honor to train thousands of firefighters, police officers and medics, and together the Toomeys are honored to teach thousands of first responders at departments, conferences, and locals across the United States and Canada.
Arnsten, Amy F. T. Department of Neurobiology, Yale University School of Medicine. (2009 June 10). Stress Signaling Pathways That Impair Prefrontal Cortex Structure and Function. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2907136/
Bach, Rebecca. (2014, August 14). Poor Sleep Quality Increases Suicide Risk for Older Adults, Researcher Finds. https://med.stanford.edu/news/all-news/2014/08/poor-sleep-quality-increases-suicide-risk-for-older-adults–rese.html
Brooks, Megan. (2014, June 2). Suicide More Likely After Midnight. https://www.medscape.com/viewarticle/826054
Roman, V., Walstra, I., Luiten, P.G., & Meerlo, P. Department of Molecular Neurobiology, University, of Groningen, Haren, The Netherlands. (2005, December 28) Too Little Sleep Gradually Desensitizes the Serotonin 1A Receptor System. https://www.ncbi.nlm.nih.gov/pubmed/16408408
Volkow, N., Tomasi, D., Wang, G., Telang, F., Fowler, J., Logan, J., Benveniste, H., Kim, R., Thanos, P., & Ferre, S. (2012, May 9). Evidence That Sleep Deprivation Downregulates Dopamine D2R in Ventral Striatum in the Human Brain Journal of Neuroscience, 32 (19), 6711-6717 DOI: https://www.ncbi.nlm.nih.gov/pubmed/22573693