Stuck Living in “C-Shift”? Insomnia and Treatment for Retired First Responders
Main points, no filter
o Unpredictable sleep schedules (like years of shift work) fuel insomnia
o Insomnia can continue years after shiftwork has ended
o Insomnia can be managed with CBT-I (Cognitive Behavioral Treatment for Insomnia)
o Retirement doesn’t always equal relaxation
When the shiftwork ends but the sleepless nights haven’t
Are you finding that despite retirement, you’re still operating on a shiftwork schedule? Just because you don’t follow the 24 on 48 off routine anymore it doesn’t mean that your body resets to pre-shiftwork mode. Unfortunately, shiftwork can have negative impacts on sleep and daily functioning for years after the shifts have ended. Shiftwork forces the body to be awake and alert when it is biologically programmed for sleep, such as during the night or early mornings.
The impact of poor sleep and insomnia
o Mental health concerns such as depression and anxiety
o Cardiovascular disease
o Decreased function of the immune system
o Weight fluctuations
o Difficulty managing stress
o Increased day-to-day errors and accidents
o Poor concentration and memory concerns
Still checking if it’s C Shift before responding to events?
If a friend or family member asks you to attend an event, are you thinking about whether or not the event falls during C shift? Are you thinking about if are going to be at the station instead of remembering that you are retired and can go back to a “normal” schedule? When you follow a certain schedule or routine for years on end, it’s difficult to change your habits. Our bodies adjust to the shiftwork and struggle to return to a day shift sort of lifestyle.
What would you pay for a good night’s sleep?
When people are feeling desperate or particularly interested in something, we often hear the phrase I’d give anything for [insert random want here]. Well, what would you give, or rather invest, for a good night’s sleep? What would you invest for ongoing good sleep? You may have already invested in a new mattress, pillows, or sheets and comforters. Maybe it was a sound machine, air purifier, or sleep medication. But what about something less tangible (but more effective) that you haven’t tried yet? Cognitive Behavioral Therapy for Insomnia (CBT-I) is a structured therapy that will help you get some sleep.
Why therapy and CBT-I is worth the investment
o You get to keep the skills. I promise I won’t take them back when you complete treatment
o CBT-I is evidence based. Research has shown it to be effective in the treatment of insomnia
o CBT-I is the “gold standard” treatment for insomnia
o You’ve tried everything else
We often hear that therapy is too expensive or perhaps you think you just don’t have the time or energy. Think about the financial and time investments you make on a regular basis. Perhaps you invest in something as simple as a daily cup of coffee from your favorite coffee chain. Maybe you go for massages or belong to a country club to play golf. Or maybe you have hired a personal trainer or joined a gym. All of these are different types of investments. Some are simple monetary investments, others are investments in hobbies, places to socialize, or ways to stay physically healthy. Well, your mental health should be an investment as well, and a good night’s sleep impacts your mental health and functioning on a daily basis.
The science behind sleep and CBT-I
Have you ever read the book The Martian or seen the movie? When the main character realizes he is on a desolate planet with no way to survive, he says “I’m gonna have to science the shit out of this”. Lying awake night after night staring at the ceiling even though you are beyond exhausted can lead people to feeling like they are living on another planet. So, let’s science the shit out of this and talk about sleep and how CBT-I works.
Sleep is a basic human need, just like we need food or water. The amount of sleep we need changes based on our age, but regardless of how old we are, we all function best with consistent, good quality sleep.
Stages of Sleep
o REM (Rapid Eye Movement) Sleep. This is the stage where dreams occur. The skeletal muscles in the body aren’t moving while we sleep, however we may see movement in the eyes. We experience more REM sleep during the second half of our sleep period, so it is not uncommon to wake from dreams closer to our wake time.
o Non-REM Sleep. This occurs for the majority of the night, and consists of its own stages
o N1-light sleep. If you are woken from this sleep, you likely won’t be aware you were sleeping. Those experiencing insomnia spend a fair amount of time in this stage of sleep, which is not refreshing or restorative.
o N2-deeper sleep. If woken from this sleep, people will be aware they have been sleeping.
o N3-slow-wave or delta sleep. This is the deepest sleep stage and it takes more effort to wake one from this type of sleep.
For people who generally sleep well, sleep cycles occur throughout the night as we move through Non-REM and REM sleep, with the deepest sleep occurring in the earliest hours of sleep. Even for people who sleep well, it is normal to wake up for short periods, especially as it gets closer to our typical wake time. For people who experience insomnia, awakenings may be more frequent, and you may not go through all of the stages of sleep on a typical night.
Other terms you learn in CBT-I
Sleep Drive
Our sleep drive, the desire or need to sleep, is sort of like a fuel tank. In the morning, our sleep drive is at its lowest, as though we have a full tank of gas. Throughout the day, that tank begins to empty, and our sleep drive increases. In an ideal situation, our tank would be empty at the end of the day when it’s bedtime and we would fill it back up with a full night’s sleep. Engaging in behaviors such as taking a nap during the day can decrease our sleep drive, which makes it harder to fall asleep when it’s time for bed. With insomnia, our sleep drive isn’t working the way it should.
Circadian Rhythm
Circadian rhythm is based on your body’s internal clock, which typically runs on a 24-hour period that regulates our sleep-wake pattern. When you are working a 24-hour shift at work and staying awake during typical sleep times, this rhythm is disrupted.
Now that we have the science behind sleep, what do we do in CBT-I?
CBT-I breakdown
o 5-6 weekly sessions on average
o 50 minutes per session
o Track your sleep daily
o Follow your new sleep schedule that we create together
o Collaborate to identify what is getting in the way
o Make changes and adjustments as appropriate (challenge unhelpful thoughts, utilize relaxation strategies)
Simple, right? Honestly, it’s not so bad. Keep in mind, any significant behavior change can be difficult to adjust to at first. Compare it to starting a new workout at the gym. It might be uncomfortable in the beginning, but before you know it, you will be feeling better and likely happy that you gave it a chance.
CBT- I helps with overthinking that’s keeping you awake at night
Sometimes our body is tired but our mind is not. We may be thinking about today, tomorrow, or everything in between. Maybe we are thinking about the past, or aren’t even sure what is keeping us from relaxing at night. Sometimes when that 3am hour hits, we are focusing on bills, relationships, and the “what ifs” instead of getting our much-needed rest. When you have insomnia, it’s also common to worry about the amount of sleep you are going to get, and people tend to “clock watch” and calculate how much sleep they will get if they fall asleep “right now”.
But I’m retired, I am “relaxed”
We often equate lack of working with relaxation, when this isn’t necessarily the case. Just because you aren’t rushing around and dealing with work stress doesn’t mean that you are fully relaxed. In fact, retirement can be a difficult transition, with many people trading out the day-to-day work stressors with new stressors, such as feeling lost, bored, or lacking passion and productivity. Don’t get me wrong, you might find golfing, reading, or traveling relaxing. However, specific, active relaxation strategies can help to activate our parasympathetic nervous system, which is our rest and digest system that helps to calm our body and our mind.
The truth about relaxation
o It’s easier said than done
o Relaxation strategies are often active, not passive (deep breathing, meditation, progressive muscle relaxation, or guided imagery)
o Just because you aren’t being physically active doesn’t mean your brain is relaxed (if you are still worrying or overthinking while lounging in a hammock, this isn’t relaxing)
o Practice makes perfect (the more you practice, the more automatic your relaxation response will become)
Did you ever play a sport growing up? Prior to getting to play your first game, you have to attend practices, where you learn the rules of the game, as well as the skills needed to be successful. We need to practice the new skills so that when game time gets here, we know what we are doing. Relaxation works the same way; the more we practice, the better we are. Relaxation isn’t just a switch you can flip the day you retire.
When it isn’t just a bad dream keeping you up
Let’s talk about the elephant in the room. Being a first responder comes with a significant amount of responsibility. It can also come with a significant number of traumatic experiences. Sometimes you are given the opportunity to process through these experiences. Sometimes we shove them to the back of our mind where we hope they quietly stay for the rest of our lives. The reality is, when you retire, these experiences and memories often start to creep back up. Idle time, thinking back through your career, or just reminders of the past can bring these memories to the forefront.
When to be concerned that it’s more than just a dream
o Repeated nightmares about the same traumatic experience
o Avoidance of going to sleep for fear of having a nightmare
o Waking up in a panic (short of breath, heart racing, sweating)
Everyone has bad dreams on occasion. However, people who have experienced traumatic events may experience nightmares that occur over and over again. Nightmares can even become so intense that people avoid sleeping in an effort to avoid the nightmare. If this sounds familiar to you, don’t worry, we can work together to help decrease nightmares (and trauma symptoms) as well as helping to improve your sleep.
Ready to give CBT-I a chance? Schedule a consult today! Want to learn a bit more first? Check out our blog on insomnia treatment here Insomnia Treatment: Unpacking the Basics, No Filter . Or try out this free app (here for Google) Insomnia Coach - Apps on Google Play (or here for Apple) Insomnia Coach on the App Store today.