Sleep Problems in First Responders and the Military

Fatigue is one of the most common health and safety hazards faced by police officers, as well as other first responders and military personnel in similar operational environments. Whether caused by extended-duty hours, night work, lack of rest, or circadian disruption, fatigue contributes to high levels of mortality and morbidity in these occupational groups. It also degrades cognitive performance, differentially impairing the parts of the brain that are most important for making sound judgments, deciding on appropriate courses of action, and exercising restraint in the face of threat and provocation. This impairment is particularly problematic in civilian police work, which we use here as a general model for all first responders and the military. Police, just like military personnel assigned to ground counterinsurgency operations and peacekeeping assignments, often face aggressors who are difficult to distinguish from bystanders in ambiguous, fastpaced, and complex situations in which they must identify and neutralize threats. The consequences of either failing to exercise restraint and minimize civilian casualties or failing to effectively neutralize an enemy can be equally dire—for operators on the ground and for strategic objectives. Analogous challenges confront other first responders and military specialties. Because the social, organizational, and individual causes of sleep loss among these occupational groups are inextricably linked, in this chapter a review is presented of the systematic interactions that must be taken into account to understand and treat sleep problems and disorders among this critical population. How such an approach provides opportunities for sleep physicians to improve both patient treatment and public health by working with operational agencies is discussed.