Technology Resources for Improving Sleep Among Firefighters 

Sponsor/Type: Dept. of Homeland Security/Federal emergency Management Agency (FEMA)
Project Period: 08/09/2023 – 08/08/2025


Sleep is a major complicating issue in many if not most firefighter behavioral health conditions as well as a risk factor in a wide range of health, safety, injury, and performance issues. It is also baked into the fabric of the enterprise. Our prior FPS initiatives have prioritized needs such as stigma, depression, alcohol use, and suicide risk, but the health concern most often reported is sleep deprivation and poor sleep quality (reported by 59% of firefighters). Poor sleep quality threatens safety, impairs performance, and compromises decision making. Apps utilizing proven cognitive behavior therapy elements have proven successful in promoting use of effective sleep strategies, resulting in lasting positive change. There is a critical need for resources to improve sleep quality in the fire service and this project will address a critical emerging identified need to help firefighters remain safe, healthy, and able to succeed in their critical missions.

Program Description

The Center for Firefighter Behavioral Health (CFFBH) at the Medical University of South Carolina (MUSC) specializes in creating and launching freely accessible, online resources to improve firefighter behavioral health. We are affiliated with the Technology Applications Center for Healthful Living (TACHL) at MUSC with strong connections to the resources of MUSC’s Biomedical Informatics Center. Our team is routinely charged to develop new health and wellness resources serving not only firefighters but a number of other populations (e.g., victims of disasters, trauma, and mass violence incidents), and has built a hard-earned reputation for creating highly functional, easily accessed, user friendly apps and initiatives with strong empirical evidence for their impact and benefit. The proposed project capitalizes on our strongest skill sets to expand our impact into areas of occupational health and wellness where lasting behavior change has proven to be a persistent challenge.

A recent FRCE work group addressing NFPA 1583 Health and Wellness programs issued a strong call for industry-specific, culturally relevant, interactive apps and resources to support firefighter engagement and progress. Repeated study and evaluation show that successful health and wellness programs, including those focused on improving sleep hygiene, must combine education and activity with structured approaches to engagement, feedback, interaction, and reinforcement. We propose to build on the success of our firefighter behavioral health apps by adapting our CBTi app, based on proven strategies of cognitive behavior therapy (CBT), to create a CBT-informed app addressing health risks associated with impaired sleep and improved sleep hygiene.

Tools will contain a series of interactive activities designed specifically to help firefighters identify needs related to sleep, set short- and long-term goals, track and practice between-session activities and progress toward goals, and engage in check-ups. Within each of the sleep components, activities will utilize education, motivational interviewing, and behavioral activation techniques to deliver information and resources focused on improving sleep quality and wellness. The app will specifically target barriers to adequate sleep hygiene often faced by firefighters such as shift schedules, loud and disruptive environments when on duty, sleep-related symptoms of exposure to trauma, and strategies to lessen the impact of substances (caffeine, smoking, alcohol) on sleep quality.

Our team combines decades of clinical experience with cutting edge digital health expertise to address barriers to access, availability, quality, and acceptability of professional care and personal support. Our suite of mobile apps and web-based resources at houses resources to help officers, peers, family members, and friends support firefighter behavioral health in areas ranging from substance abuse to suicide and includes tools to help firefighters overcome their resistance to help seeking and finding their way to the help they need with providers who understand firefighter culture. For this particular work, we have added a team member with specific expertise in treating sleep problems in specialty populations.

Much of her prior work has focused on groups that experience circumstances and symptoms similar to those experienced by firefighters, including caregivers and infants with sleep disturbance due to limited control of their opportunity to sleep at night and adults who have experienced multiple traumatic events that result hyperarousal when attempting to sleep. She has been practicing and publishing in this area since 2010, is currently the clinical director of the Sleep and Anxiety Treatment and Research Program at MUSC, and holds a diplomat in behavioral sleep medicine (DBSM).

We propose to refine and expand our highly successful online approach to include new components and activities addressing sleep impairment and improve sleep hygiene. The tools will contain a series of interactive activities designed specifically to help firefighters identify needs related to sleep, set short- and long-term goals, progress toward goals, and engage in check-ups. Each component will incorporate activities utilizing education, motivational interviewing, and behavioral activation to deliver information and resources focused on improving sleep hygiene. All components will be built on platforms our team has successfully implemented in related settings (e.g., telehealth outreach, disaster response, military health). Development will be guided by our substantial evaluation studies on prior work and multistage firefighter focus group to supply input to each phase, strategies that have proven successful throughout our prior FPS projects.

For more information contact
Tatiana M. Davidson