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Paramedic Mental Health: You are what you sleep

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Introduction

It’s no secret that shift work can alter and adversely affect the health and well-being of paramedics. Yet paramedics are increasingly getting less and less sleep. Studies show that people are now averaging six to seven hours of sleep per night which is on average two hours of sleep less per night than our counterparts from the 20th century.

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The root cause is multifaceted, however, social media, handheld devices, light pollution, and television are largely attributed to this change in human behaviour. As society evolves and becomes busier, people are viewing sleep almost as an inconvenience that interrupts life. Yet, a lack of sleep can have a profound effect on physiological and psychological health, affecting many aspects of a paramedic’s work and personal life.

Aristotle said, “With regard to sleep and waking, we must consider what they are: whether they are peculiar to the soul or to the body, or common to both.” It was a philosophical enquiry into the nature of sleep, and whilst nowadays we have a deeper understanding of the brain’s inner workings, the impact of sleeplessness on mental health is profound. What we now know is that adequate sleep is vital to our physical and mental health. 

In paramedic care

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Paramedics are constantly faced with increasing workloads that are physically and mentally confronting and, therefore, emotionally tiring. This not only compromises the safety and the efficiency of the care provided, but it can also affect paramedic wellbeing.

While the majority of paramedics entered the role in order to provide care, increasing policy targets, rapid changes to skills and policy procedures as well as increased workload have detrimentally affected the caring aspect of the role. These factors are also causing exhaustion and sleeplessness in themselves due to paramedics’ concerns with fulfilling these performance-related goals.

Compassion fatigue is a somewhat common ailment of paramedics caused by the culmination of working with traumatized individuals and human suffering.  Compassion fatigue can lead a paramedic to feel fatigued and absent of energy, which can result in a decrease in empathy toward patients and emotional exhaustion. Without employing elements of self-care that include obtaining an adequate amount of sleep, paramedics are more likely to become burnt out, provide subquality patient care and make medical errors.

Studies have shown that shift work can trigger insomnia due to interruption of the normal sleep cycle and circadian rhythm. While night shift workers reported greater interrupted sleep patterns and less sleep had, overall disruption to the circadian rhythm caused by any form of shift work is detrimental to achieving adequate sleep.  This shift- work-induced sleep deprivation can increase the risk of accidents shift-work disorder (a sleep condition characterised by excessively sleepiness) and chronic disease. Lost sleep can result in cardiovascular disease and metabolic disorders as well as depression, chronic fatigue and anxiety.

Strategies to reduce fatigue

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Whilst it is clear paramedics and shift workers need sleep, this can be challenging. Sleep loss can be one of the most significant issues associated with poor mental health amongst shift workers and it is vital to sustain as normal of a sleeping pattern as possible. Bearing in mind that, often, daytime sleep is usually more disturbed due to light, noise and warmer temperatures. For these reasons it is a recommendation to make your sleeping area as conducive to sleep as possible. Rest or try sleeping before your night shift. If that doesn’t work, try and sleep immediately after you finish. Studies show that our brains are not resting when scrolling through a social media feed or watching television. Reduction in screen time before sleep or rest, picking up a book or just relaxing with your eyes closed are conducive to a restful sleep.

Conclusion

Ironically our brains are not less active when we sleep, they are just differently active. Sleeping gives our body a chance to process information. In fact, many sleep scientists now believe sleep is part of a process to clear unnecessary memories and make way for new learning material each day. As paramedics operate in a physically and psychologically demanding environment, adequate sleep is one of the first steps in combatting these demands and supporting our mental health.

References

  1. Clompus, S. R., &  Albarran, J. W., (2016). Exploring the nature of resilience in paramedic practice: A psycho-social study. International Emergency Nursing, 28, 1-7. https://doi.org/10.1016/j.ienj.2015.11.006
  2. Khan, W. A., Conduit, R., Kennedy, G. A., & Jackson, M. L. (2020). The relationship between shift-work, sleep, and mental health among paramedics in Australia. Sleep Health, 6(3). 330-337. https://doi.org/10.1016/j.sleh.2019.12.002
  3. Marshall, D. (2011). Chapter 46 – The Role of the Physician in Palliative and End-of-Life Care. In L. L. Emmanuel, & S. L. Librach (Eds.), Palliative Care: Core skills and clinical competencies (2nd ed., pp. 648 – 656).  Elsevier. https://doi.org/10.1016/B978-1-4377-1619-1.00046-9
  4. Sofianopoulos S, Williams B, Archer F, Thompson B. The exploration of physical fatigue, sleep and depression in paramedics: a pilot study. Australasian Journal of Paramedicine. 2011;9(1).
Ali Rengers

Ali Rengers

Ali Rengers is a paramedicine student at Griffith University who recently achieved First Runner Up with the KJ McPherson Foundation Scientific Poster competition for her team's poster, "Out of hospital cardiac arrest." Post-graduation she aims to pursue critical care studies while continuing to contribute to research in the paramedicine field. Ali also enjoys climbing and bouldering in her spare time.

Steve Whitfield

Steve Whitfield

Steve Sunny Whitfield is a lecturer at Griffith University School of Medicine (paramedicine) with experience in humanitarian operations, high altitude expeditions, marine expeditions and flight and retrieval medicine. In 2015 Steve founded a platform that became the international collaboration Medics Beyond Borders to support health care in remote communities. Steve is also a keen geographer, surfer and climber. Updated 2021

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