Protecting and Serving the Mental Health of First Responders: PTSD

Written By: Jennifer Voorhaar, LCSW-C

Our first responders are often the ones we most overlook. Sounds a little strange, doesn’t it? Well, it is true. We have thousands, maybe millions, of men and women in first responder positions serving as police officers, firefighters, EMTs, and paramedics as well as dispatchers. Some say, “that’s what they signed up for.” Some say, ”it’s just a part of the job.” Some say, “they’re fine.”

Well, I say, hogwash! I say, that is nonsense. I say, they deserve more.

According to the National Council on Mental Wellbeing, 70% of adults in the U.S. have experienced some type of traumatic event at least once in their lives. I’d offer that since COVID, that is likely 100% of us. I mean, “surviving a natural disaster” is a criterion for trauma, and certainly a global pandemic fits the bill. Of those 70-100% of the population, about 6% of those individuals will develop Post Traumatic Stress Disorder. The Institutes of Health reports that 80% of first responders experience traumatic events on the job. I’m not sure how that number isn’t 100% given the nature of the job, but I’ll go with the research for now. Furthermore, the Substance Abuse and Mental Health Services Administration reports that roughly 1 in 3 first responders develop PTSD.

Let’s think about this. 6% of the general population may develop PTSD but 33% of first responders will develop PTSD. This is where I say again….hogwash! Nonsense! They deserve more.

Now might be about the time you’re asking yourself, “so what is PTSD anyway?” I’m so glad you asked. In general, or basic terms, it is the experience or collection of symptoms present after a person experiences or witnesses a traumatic event. Their symptoms often impact their day-to-day functioning and are characteristically different from their baseline functioning. Symptoms might include nightmares, flashbacks, avoidance of people, places and things, hyper-vigilance, anxiety, and depression to name a few.

Why might first responders be more likely to experience PTSD? It is likely due to the cumulative nature of their careers. A non-first responder might experience one traumatic event in their lifetime. First responders likely experience more than one every working day. Our brains and our bodies remember the stress and the trauma. Just like a sink or a bucket, there’s a limit, and things start to overflow. The other thing that happens is that our first responders are expected to be like Dory in “Finding Nemo” and just keeping swimming. They go from call to call with no debrief, no down time, no opportunity to breathe, and no chance to process what they’ve seen, heard, and experienced.

Just as with so many other populations of people, there is huge stigma around seeking mental health care. Because their line of work “expects” them to “deal with it” they hesitate to seek mental health support early. Often its not until there are issues in relationships, job performance, health concerns or overall decline in well-being that treatment and support is sought. Let’s say again….hogwash!

Its time for us as a community to make mental health treatment as universally accepted as dental cleanings and eye exams. I may not be having trouble with my teeth but I still go to those cleanings every 6 months. I may not have trouble with my eyes but I’ll still get them checked. Our brains, minds, hearts, and bodies deserve the same care and concern.

If you’re a first responder or you know a first responder, consider these things:

1. Know that you don’t have to just “suck it up” because it’s “what you signed up for.”

2. Find a trusted peer or professional provider to process your experiences with on a regular basis.

3. The more we brush under the proverbial rug, the worse things will become. So, don’t be afraid to acknowledge those calls that stick with you. Talk about the ones that leave you feeling something a little more or different than the one before. Don’t ignore it just because history says you have to keep on going.

4. Take care of yourself, and consider 4 Pillars of Health:

a. Stress

b. Food/Nutrition

c. Movement

d. Sleep

Yes, I know that you are super stressed, eat on the fly, and are too tired to exercise because you don’t sleep (thanks to shift work) but maybe, just maybe, you could consider one tiny tweak in your schedule, habits or routines to allow for:

a. Coping skills to manage stress

b. Partnering with a family member to help with some planning and preparation of healthy meals to feed and fuel your body

c. Walk. Not just on the job. Not sure from the car to the station. Take 10, 15, 20 maybe even 30 minutes and walk. Start there and then see what comes next. Maybe a jog. Maybe some weights. What about some yoga (see where coping skills fit in here too?)

d. Make sleeping a priority. Even with shift work. Even with crazy schedules. Even with spouses and kids and pets in the house. Figure out a way to make sleep a priority. (I know someone who used to make a cozy bed in the master bedroom closet to ensure good sleep after a midnight shift).

The work that our first responders do is heroic. From the dispatcher who answers the call, to the police who secures the scene, to the EMT who transports to the hospital, each and every one is heroic. Let’s work together as a community to ensure they… YOU… have what is needed to be the best they can while they protect, care for, and serve our community.

Sleep and Nutrition

Written By: Tracy Pritchard (MS, CNS, LDN)

Recent studies have shown that our diet influences our sleeping habits more than we previously thought. We definitely need to consider this since sleep may account for approximately one third of our day, and plays a role in our health and well-being. Research has shown correlations between poor sleep and hypertension, obesity, diabetes, dyslipidemia, and other chronic conditions. While we know sleep hygiene and technology play a role, we need to consider the role of the modern diet in the rise in sleep disorders. We could say that what you eat effects your sleep AND that sleep impacts what you eat, making this a complicated relationship.

Think about the last time you were sleep deprived and tired. It was probably more difficult to turn down sugary foods and caffeine since your body was low on energy and may have been craving a quick fix. It is much easier to execute a healthy eating plan and stay focused after a restful night’s sleep. Why is that? Understanding our hormones may help us find the answer. There are two hormones typically associated with hunger and satiety. Ghrelin is the hunger hormone while leptin is the satiety hormone. If you are not getting enough sleep leptin levels drop while ghrelin levels increase. Studies have shown that sleep deprived people are likely to have cravings, and that they eat approximately four hundred extra calories per day.

There is a topic in the nutrition world called chrononutrition, which is associated with the relationship between food, metabolism, meal timing, and the circadian system. Eating at the wrong time especially two hours before bedtime may contribute to impaired digestion and worse sleep quality. In addition, it is best for gut health and sleep quality to avoid consuming a major portion of calories at night. This may explain why shift work, which leads to consuming a lot of calories in the evening, is often associated with poor sleep as well as a higher risk for obesity and other conditions. Studies have also found that time-restricted eating may improve sleep quality. This may be attributed to eating less calories before bedtime, especially if you stop consuming ultra-processed snack foods while watching your favorite show at night. Sleep quality was also better in those who consistently consumed meals three times per day. This can be accomplished by scheduling your intended time for breakfast, lunch, and dinner while also allowing for two hours without food prior to bedtime.

Many principles of healthy eating also support better sleep. For example, eating enough fiber has been associated with better sleep habits. Men need 38 grams per day while women need 25 grams per day. Many people prioritize fiber for other reasons such as lowering cholesterol and keeping the bowels moving well. They may gain the added benefit of better sleep. We have also heard a lot about sugar these days. It is important to note the difference between natural sugars and added sugars. Natural sugars found in vegetables and fruits (which also contain fiber!) may support better quality sleep than added sugars found in ultra-processed foods. Protein helps you stay fuller longer and also supports balanced blood sugar. Balanced blood sugar helps control the appetite, while dysregulated blood sugar often results in cravings and irritability. Protein is also rich in essential amino acids such as tryptophan. The body uses this amino acid to help make serotonin and melatonin. Protein rich foods include meat and poultry, fish and seafood, legumes and tofu, dairy and eggs, some grains, and nuts and seeds.

While there are some foods known to support sleep, it is important to consider your overall dietary pattern and sleep habits rather than individual drinks or foods. While they may be associated with better sleep, they may be more effective once you have addressed sleep hygiene. A healthy sleep environment includes everything from a comfortable mattress, pillows, and blankets to the noise and lights present in your bedroom. For example, if you are having trouble sleeping and research sleep-promoting foods, but your room is noisy and bright or you are using electronics in bed, these habits may suppress your body’s melatonin production thus counteracting the desired benefits of these therapeutic foods. That being said some foods that have been found to improve sleep include turkey, kiwi, tart cherry juice, fatty fish, and nuts/seeds. Chamomile tea and passionflower tea may also be helpful.

Nutritional Elements Impairing Sleep

1. Caffeine is the most widely consumed stimulant found in coffee, tea, carbonated drinks, energy drinks, and chocolates. Caffeine may negatively impact sleep onset and quality. If you are consistently consuming high amounts of caffeine, it may be to blame for impaired sleep patterns.

2. Nicotine is a stimulant found in cigarettes, e-cigarettes, and vapes. Nicotine use within four hours of bedtime leads to increased sleep fragmentation and awakenings.

3. Alcohol is a depressant. If you choose to drink alcohol, best to stop drinking it at least four hours before bedtime.

4. Reflux inducing food includes fried fatty food, spicy food, and ultra-processed food. When these are consumed close to bedtime you may experience acid reflux and heartburn that results in awakenings and poor sleep quality. Instead of frying try roasting, boiling, or air-frying in addition to waiting two hours before bedtime.

A sleep diary that tracks your sleep habits may give you the best insight about your patterns and where you can make some changes. This may include tracking your bedtime and wake time, number of sleep interruptions, perceived sleep quality, daily exercise, and anything else that may be influencing your sleep. In addition to tracking these sleep habits, also consider recording your foods and beverage intake to determine how your sleep is influenced by your food choices and timing.

Featured Recipe

from The Healthy Mind Cookbook by Rebecca Katz

Chamomile Lavender Lemonade

Chamomile and lavender are calming herbs that are great for relieving stress and may help you sleep.

Ingredients:

4 bags Traditional Medicinals Chamomile with Lavender Tea

2 tablespoons honey

½ cup freshly squeezed lemon juice

Instructions:

Bring 4 cups of water to a boil; add the tea bags and let steep for 5 minutes. Add honey and stir to dissolve, then stir in the lemon juice. Serve warm or over ice.

Cook’s Note: Any combination of chamomile and lavender or chamomile and ginger tea bags will work.

Storage: Store in an airtight container in the refrigerator for up to 4 days.

Did you find this information useful? Be sure to tune into Episodes 19 and 20 of The WingSpace Podcast with Jennifer Voorhaar (LCSW-C) and Tracy Pritchard (MS, CNS, LDN) for more information on the relationship between sleep and nutrition!

Your Sleep Hygiene: A Wake Up Call

Written By: Leslie Wells

Like most other forms of hygiene, sleep hygiene is not a one-size-fits all affair. Sleep is not only one of the most valuable ways in which we care for our personal health, but with the key word being “personal,” it can look quite differently for everyone. 

Some studies suggest that teenagers tend to stay up later due to a later release of melatonin than adults. Other studies suggest that as we age, we may tend to shift our sleep patterns to reflect earlier bedtimes and earlier mornings. Babies may sleep for 14-17 hours a day, and may be able to fall asleep in a variety of environments, while adults may avoid naps and still struggle to get 6-8 hours asleep in the same silent spaces. Look at how many differentiations in sleep patterns there can be, while only considering the age variable!

While there are countless other variables to consider when assessing sleep habits and patterns, research suggests that our sleep hygiene will look differently to suit the different stages of our lives. So, how can we assess our current sleep habits and set ourselves up for success in this season? You may already have suspicions that you’re not getting enough sleep, so let’s look at some signs and symptoms of poor quality sleep, or sleep deprivation. 

These can include:

-red/puffy eyes or bags/ dark circles under eyes

-increases in caffeine consumption 

-mood instability/irritability/depression

-issues with focus and memory 

-weight gain 

-cravings for sweet and salty snacks 

-breakouts 

-and of course, most obviously, feeling tired and unrested all day long is a fairly simple way to tell that you may not be getting the right number of z’s each night. 

If you are experiencing any number of the symptoms above, and you think a lack of sleep could be the culprit, it’s time to do some experimenting. It would be great to hand over a fool-proof set of instructions to start getting more sleep, but again, each person is unique, and some trial and error is the best way to ensure great long term results for you. 

First, you need to know how many hours of sleep you’re currently getting (or not getting). To get an idea of your average number of hours asleep each night, keep a notepad and pen next to your bed, and record the time you get in bed each night and the time you get out of bed each morning. 

If you get up in the night for any reason, making note of the reason and frequency will also be helpful information. If you lay in bed for several hours before falling asleep, or if you wake up multiple times per night, you may not want to disturb yourself further by recording these events in the moment, but making a mental note to write it down in the morning can help you track your patterns. Once you have collected information for a minimum of one week, it’s time to answer the following questions:

1. How many hours of sleep am I getting on average? Is it between the recommended amount for adults of 7-9 hours of sleep per 24 hours? 

If you conclude you’re getting less than 7 hours of sleep each night, it’s time to assess whether the time you go to and get out of bed each day can be adjusted to allow for more time in your sleeping space. If not all the time, perhaps there are certain mornings/nights of the week where you have more space in your schedule for an earlier bedtime or later alarm clock, or perhaps there are opportunities to create more space. 

Example A) simplifying your morning routine by showering, setting out your clothes, packing your lunch, etc. the night before can allow you to set a later alarm clock, and enjoy a more gentle start to the day. 

Example B) making enough dinner on Sunday night to eliminate the need to cook on Monday night so that you can have an earlier dinner time, a more restful evening without any kitchen chores, and an earlier bedtime. 

2. What does the hour leading up to your bedtime look like? Are you scrolling on social media or watching TV in between wrestling kids into pajamas? Are you working up until bedtime or working in your bedroom/sleeping space? Is the hour before bedtime always fluctuating or do you have a consistent routine? 

Regaining control over the hour before bedtime can be a major first step in getting more  sleep and falling asleep faster. Even very simple routines can cue our bodies to know that it’s time to start shutting down for sleep. This could look as basic as lowering the lights at the same time each day, powering down or silencing devices, brushing your teeth, and getting into bed. 

3. Have your records revealed any recurring patterns? If so, what can be done to disrupt these patterns that are disrupting your sleep? 

Example A) If you wake up multiple times each night to empty your bladder, those bathroom breaks are disrupting your sleep! Can you increase fluid intake during the day, and take your last sips at least one hour before bedtime to reduce bathrooming in the middle of your sleep cycle? 

Example B) If you wake up multiple times due to discomfort, how can you set yourself up for success? This could look like making changes in sleep attire to be warmer/cooler/less restricted, trying new pillows/bedding, turning a fan on/off, opening/closing a window, etc.

Example C) If you wake up due to disruptions (sound, light, movement of a partner, etc.) how can these be minimized before bedtime? Can you wear a sleep mask or add black out curtains to the windows? Can you wear noise canceling headphones or make a plan with your partner/family for designated quiet hours? 

It’s important to note that if your sleep is consistently disrupted by a partner with whom you share a bed/sleeping space, it can become a bit more challenging to control your sleeping environment/routine, but it’s not impossible! Communicating your needs for healthy sleep with an invitation for them to communicate their needs may lead to a long overdue conversation for both of you. 

4. When is it time to seek a medical/professional opinion? 

If you have not been able to pinpoint the causes and solutions for a lack of sleep on your own, it may be time to consult a doctor or medical professional. Recent studies suggest that sleep disorders affect 50-70 million people on an ongoing basis, the most common being insomnia, sleep apnea, and narcolepsy. However, even seemingly small conditions like snoring and teeth grinding can be major disruptions to our sleep and have long term effects on our health! 

Safeguarding our sleep is a major component of our wellness with dozens of different facets to consider. For more information on sleep hygiene, be sure to tune into The WingSpace Podcast to hear certified nutrition specialist, Tracy Pritchard offer her take on how nutrition can also play a key role in rest and sleep.