In the spirit of taking this site and the content towards an open source information portal for anyone, but more especially for the field provider in EMS., this post will lay out the strategies I use and have recommended for better sleep modalities and greatly increasing not only quality of sleep, but also building strategies around sleep cycles and efficacy of napping.
I believe the biggest problem within EMS is fatigue and sleep deficits. Poor sleep quality and lack of sleep all lead to many of the health problems facing the US adult population, however within EMS these problems are highly amplified in that it is the expectation of most EMS services in this country that field provider rest comes after response times, completing run reports, and any other service related issues. http://www.iafc.org/files/progssleep_sleepdeprivationreport.pdf This has always been the norm within EMS of placing the emergency call above all else. Expectations are set with response time matrixes and a well-established history of, “I did this when I was on the truck, you can too”. This mentality however has produced a highly fatigued, less responsive work force with high markers in cardiac disease, hypertension, depression, alcoholism, diabetes, lower cognition, high cortisol levels, and increased possibilities of dementia and, or Alzheimer’s. http://www.reuters.com/article/2013/11/06/us-sleep-heart-risk-idUSBRE9A511K20131106
While the way EMS does business, as a model is slow to change, the field provider can change much more quickly if there is a desire to do so. I say this because Pre Hospital providers, that include the EMT, Intermediate, and Paramedic are the product of their industry and a certain type of personality is usually drawn to the career. A great deal of stubbornness is as much help as it is a hindrance in the Pre Hospital Provider role.
The following are the strategies that I use after I began to see personality changes with less sleep at busier stations, and realized that I had to make some changes in my life. These strategies also go hand in hand with better nutrition and exercise; however I believe you will find a higher quality of sleep using these techniques either way.
First, supplementation is very important on several levels. I take several things at night pre bedtime to not only facilitate quality sleep, but also insure I stay asleep. ZMA with L Theanine http://www.amazon.com/s/ref=nb_sb_ss_i_1_13?url=search-alias%3Daps&field-keywords=true+athlete+zma&sprefix=true is a supplement that does several things. ZMA raises testosterone levels, and with the magnesium in it, also promotes relaxation. http://www.mensfitness.com/nutrition/supplements/supplement-guide-zma The L theanine which is found in Green Tea and promotes restfulness also has nootropic effects. As a side note, when taken with caffeine, L theanine has a tendency to potentiate the caffeine. http://www.webmd.com/vitamins-supplements/ingredientmono-1053-theanine.aspx?activeingredientid=1053&activeingred The standard dose for men is 3 caps, and women is 2 caps as most supplement companies produce nearly identical dosages. L theanine can also be purchased separately and taken with a ZMA supplement not containing it already. Both are found on Amazon very reasonably. I also take 5 HTP, which is a serotonin precursor and also produces a sense of relaxation. http://naturalmedicinejournal.com/journal/2011-10/many-uses-5-htp Also readily available on Amazon. I have found a great deal of efficacy with using 5 HTP, but I would also recommend trying it out in a controlled setting meaning taking it while you’re at home and observe whether you have other effects. Some studies suggest that if you are taking anti depressants then 5 HTP is not recommended. I have used L tryptophan as well with good result, however for me L tryptophan is not as cost effective. It is also a serotonin precursor. I find that my waking mood is more my usual self during waking hours when using 5 HTP. Sleep deficits are well researched to show depletion of endogenous serotonin levels. http://www.serotune.com/blogs/articles/2659862-what-are-the-symptoms-and-causes-of-serotonin-deficiency Some people respond well to using Melatonin, however I have never found any difference in my ability to fall asleep or over all sleep quality. Again, it’s a matter of finding what works best for you. I regularly take the ZMA with L theanine and the 5 HTP while on shift and have had no ill effects, i.e. grogginess, inability to perform the task at hand, and on the contrary, even if I am able to nap for as little as 15 to 20 minutes, I have a higher level of cognition than if I don’t take these supplements. I do recommend doing your own research when it comes to any supplementation, especially while on shift.
Another tool I use and it is by far the best one I use, is more actually a bio hack. When I tell you what it is, you will likely call bullshit, but I can tell you there is huge amount of science and research on it. Using infrared light therapy just before sleep will signal your pineal gland to secrete melatonin and you will become sleepy pretty quickly. Infrared light therapy has several other uses, however I haven’t quantified those uses in personal trials. I can say that as a sleep aid it is amazing. I purchased this one off of Amazon http://www.amazon.com/Zoo-Med-Nocturnal-Infrared-Incandescent/dp/B000255OU4/ref=sr_1_1?ie=UTF8&qid=1406856061&sr=8-1&keywords=infrared+bulb I bought a small lamp that clamps to the bed. You just lie under the light for about 15 minutes or so, letting as much of your skin be exposed to the red light as possible. The sleepiness comes on fast trust me.
All the other sleep strategies apply as far as a cool, dark room, and white noise if that’s something you use.
One other thing I use is an Earthing Mat. I have found that it works better for naps, but it’s does promote restfulness. I have used to reduce jet lag which I have found a great deal of efficacy with. http://www.earthing.com/Shop_s/1824.htm This is the starter mat. It can also be found on Amazon. The web site will be able to explain the science better than I can here and in the interest of brevity.
Another piece of tech I use on occasion is a Sleep Induction Mat from BulletProof Exec and their store web site Upgraded Self. The site provides the science of how a spikey little mat works to help you fall asleep faster. https://www.upgradedself.com/bulletproof-sleep-induction-mat I also use the night light listed on the tech products page as a supplement to my infrared therapy. It’s used primarily as a night light to be able to see if you get up and it does not emit blue UV. From the product page, The Low-Blue Night Light comes with a unique amber LED bulb that does NOT emit ANY visible blue wavelengths of light known to suppress melatonin unlike ordinary bulbs, making it a perfect choice for people who are prone to tossing, turning, and awakening in the middle of the night. An experiment found that people who woke up in the middle of the night and saw this amber light continued producing melatonin.
While these sleep protocols work very well for me and for the people I’ve recommended them to. It is like most things, something that needs to be experimented with. I will also be writing an article on Nootropics, supplements to enhance cognitive ability, which have some sleep spill over in that you will likely have lucid dreams. Or have the sensation of thinking while you’re actually in REM sleep.
If you have any questions, feel free to contact me and I will try to answer any questions you may have. I will also update this information from time to time as or if my own personal sleep protocols change or new research is found. I can tell you that using these sleep protocols over the last year has vastly reduced my overall fatigue, and allows me to make any sleep, whether a nap, or a night’s sleep, a higher quality rest. I am able to function at a higher level of cognition than I once did. I also am able to produce fairly decent physical output such as a moderate to heavy workouts after a busy 24 hour shift on very little sleep.
I hope this helps anyone who is looking to increase their sleep efficacy and feel better even after short periods of rest.