Sleep and Emergency Service Workers

It is estimated that within the core blue-light and frontline medical emergency sector in the UK that over 180,000 personnel work varying, continuous shift patterns (nights, weekends, and rotating 10-to-12-hour schedules). Sleep becomes an important factor for emergency service workers.

Critical decisions are made daily in the workplace, in hospital operating theatres, police response vehicles, and by paramedics attending the scene of a road traffic collision. 

These decisions have profound consequences for the safety and wellbeing of those who rely on the professionals making them. However, those responsible for such safety-critical decisions may have obtained significantly less sleep than individuals working in many other professions.

Despite the high levels of skill, training, and experience required in these roles, fatigue and sleep deprivation can impair attention, judgement, reaction time, and decision-making, potentially affecting performance when it matters most.

Sleep Deprivation and Emergency Service Workers

Many modern professions, including emergency services, can demand we work through the nocturnal hours. Human beings, however, are not designed to function optimally during the night. The human body is designed to be at its optimal performance in energy, alertness, concentration and other aspects of mental and physical capability during the day, aligned with our circadian rhythm. [1]

As sleep deprivation accumulates, individuals become less accurate in assessing the extent of their own impairment. Although objective measures of performance continue to decline, subjective ratings of sleepiness and fatigue often fail to reflect the true degree of cognitive impairment.

Shift Work Sleep Disorder

Shift Work Sleep Disorder (SWSD) is a circadian rhythm sleep disorder that commonly affects people who work non-traditional hours that involve overnight, early morning, or rotating shifts.

International research identifies the ‘Inability to sleep’ as one of the most common health complaints globally, often second only to cold/cough or respiratory issues. [2]

How Shift Work Can Cause Insomnia 

• Circadian Misalignment: Working when the body naturally signals sleep, and trying to rest when it expects wakefulness, disrupts melatonin and cortisol cycles. For example, a nurse on night shifts might find it difficult to fall asleep during the day because their body is naturally alert and wired for daytime activity. For those trying to sleep after night shifts, light management is critical. Wearing dark sunglasses on the commute home, if safe to do so whilst driving, reduces morning light exposure that might otherwise delay daytime sleep onset. Once home, the bedroom should be kept dark until waking. [3]

• Hyperarousal: Shift workers often experience increased cognitive arousal - such as excessive worry or negative thoughts about sleep - which is a key mechanism that both triggers and sustains insomnia. For instance, an employee finishing a late shift may lie awake replaying work stresses and worrying about getting enough rest before the next shift. 

• Accumulated Sleep Debt: Night shifts typically result in 1-4 hours less sleep compared to day shifts. For example, a lorry driver working overnight may only manage a few hours of broken sleep in the morning, gradually building a substantial "sleep debt" over the week.

• Social Isolation: Unusual working hours can reduce involvement in social and family life, increasing stress and psychological distress, which further contribute to sleep difficulties. Shift workers might, for instance, miss family dinners or weekend events, leading to feelings of loneliness and heightened stress. [4]

Shift Work Sleep Disorder or Insomnia - what's the difference?

Shift Work Sleep Disorder (SWSD) and insomnia disorder are closely related but remain distinct conditions, which makes diagnosis challenging. Both involve sleep disturbances, but SWSD is specifically tied to a person's work schedule disrupting their circadian rhythm - symptoms typically appear when the individual works nights or rotating shifts. In contrast, insomnia disorder is characterised by ongoing difficulty in falling or staying asleep, or poor sleep quality, that persists regardless of changes in routine or external factors.

To help differentiate: 

• SWSD: Sleep problems are directly linked to the shift schedule. For example, a doctor working night shifts may have trouble falling asleep during the day, but once on regular daytime hours or during holidays, their sleep returns to normal. 

• Insomnia disorder: Sleep difficulties persist even when the person is not working shifts or is on holiday. For instance, someone may struggle to sleep whether they are working, on annual leave, or during weekends, indicating an ongoing issue not solely caused by their work schedule. Because symptoms of SWSD can sometimes evolve into chronic insomnia—where sleep problems continue even on days off—it can be difficult to distinguish between the two, especially when both disorders coexist or overlap. [5]

Case Study: How Shiftwork affects a Fire Fighter

"I am an on-call firefighter in my small town. I work another normal day job, but I am also available for firefighter activations 24/7.

This means that I can be called away from my normal job at anytime, but the hardest thing is being called out in the middle of the night to a traffic crash or fire. Being woken suddenly from sleep can be disorientating, then the adrenaline starts pumping. If the call out lasts all night I then have to go straight to work in the morning. Sometimes I am awake 24 hours straight. I worry about driving when tired and how the lack of sleep affects my work performance and safety.

I find that I become hypervigilant everytime my phone alerts come through, particularly during the night. Even in my sleep I am listening for the phone, so I never feel as if I get a good night’s sleep.

I love the firefighting and being able to assist the community in times of need, but it does take a toll on health and relationships. I have 2 young children and my wife is often left to care for them alone with no notice.  Family and social time is often disrupted because you never know when a call will come in and you have to go. The work life balance is really difficult. Weekends are often spent trying to catch up on sleep.

As a firefighter we deal with a lot of trauma and while we get counselling support and talk about it amongst ourselves, it can play on your mind at times and affect your sleep, particularly when kids are involved."

Conclusion

In conclusion, although many emergency service professions rely on people working through the night, the human body is not designed for sustained circadian disruption, and the consequences extend far beyond simple fatigue. Misaligned sleep leads to impaired cognition, emotional dysregulation, increased accident risk, and serious long-term health conditions, often made more dangerous by the brain’s ability to adapt to a false “new normal” of functioning. Recognising fatigue as a biological warning signal is essential, as is taking proactive steps—such as improving sleep quality, managing light exposure, using strategic napping, and seeking support for underlying sleep disorders. Ultimately, prioritising sleep is not a luxury but a critical foundation for health, safety, and optimal performance in a 24-hour society.

What can help with chronic insomnia?

Cognitive Behavioural Therapy for Insomnia (CBT-I) is widely recognised as the "gold standard" first-line treatment for chronic insomnia, as recommended by leading medical bodies such as the American College of Physicians . This structured, non-pharmacological therapy works by targeting and changing problematic behaviours and thoughts related to sleep. Notably, CBT-I has demonstrated a 70–80% success rate in improving sleep, according to clinical studies published by the American College of Physicians, which lends strong credibility to its effectiveness.

Traditionally, CBT-I is a multicomponent treatment that combines several approaches, including sleep education, cognitive restructuring, stimulus control, and matching our time in bed to the amount of sleep our bodies are actually producing.

References

1] KM-Human Factors Engineering. 2015. Shift work and our internal biological clock. https://km-humanfactors.com/nl/the-science/shift-work-and-our-biological-clock/

[2] Folia Medica. May 2025. Chronic insomnia – beyond the symptom of insufficient sleep. https://foliamedica.bg/article/151493/

[3] Emergency Medicine Cases. 2026. Ep 207 Sleep Strategies for Shift Work. https://emergencymedicinecases.com/sleep-strategies-shift-work/#:~:text=For%20those%20sleeping%20after%20night,Shift%20Scheduling%20Strategies

[4] Science Direct. 2025. Cognitive factors increase the risk of shift work disorder through insomnia symptoms. https://www.sciencedirect.com/science/article/pii/S1389945725004812#:~:text=Shift%20work%20disorder%20(SWD)%20is,symptoms%20%5B3%2C4%5D.

[5] Cognitive-Behavioural Therapy for Insomnia (CBT-I) Across the Life Span. 2022. CBT-I Protocols for Shift Workers and Health Operators. WILEY Blackwell.