Hypervigilance, Sleep Disturbance, and Life as a First Responder

If you are in law enforcement, fire, EMS, dispatch, corrections, or a federal role, you are trained to notice what most people miss. You are supposed to be “on” when others are “off.”

But that same high-alert state can follow you home. You may notice:

• You scan every room in a restaurant.

• You sleep with a phone or radio next to the bed.

• You wake up at every noise, replaying calls in your head.

This mix of Hypervigilance and sleep disturbance can feel like it is just “part of the job.” Over time, though, it may wear down your body, your mood, and your relationships. 

This guide explains what is happening, why it is so common in first responders, and how support, including virtual intensive outpatient programs (IOP) can help you reset your nervous system without stepping away from your career.

What Are Hypervigilance and Sleep Disturbance?

Hypervigilance: When the Alarm System Won’t Shut Off

Hypervigilance is a state of constant, heightened alertness. Your nervous system is primed to detect threats, even in situations that are actually safe. You may feel like you are always on edge, always scanning, never fully relaxed.

Clinically, hypervigilance is often described as an exaggerated state of sensory sensitivity and threat detection, frequently connected to trauma and stress-related conditions. For first responders, it can show up as:

• Always facing the door, back to the wall

• Rapidly checking exits, sight lines, and potential threats

• Jumping at sudden noises or movements

• Having a hard time tolerating crowds, traffic, or “downtime”

On duty, these patterns can keep you and others safe. Off duty, they can make everyday life feel like another shift.

Sleep Disturbance: When Rest Feels Unsafe or Impossible

“Sleep disturbance” is a broad term. For first responders, it may include:

• Trouble falling asleep

• Waking up multiple times a night

• Nightmares or vivid duty-related dreams

• Fear of sleeping because of bad dreams or feeling out of control

• Waking up unrefreshed, even after a full night in bed

Research shows that first responders have high rates of insomnia and other sleep disorders, including shift work disorder and sleep apnea.One study of firefighters found that nearly 40% screened positive for at least one sleep disorder.

For many, hypervigilance and sleep disturbance feed each other: the more “on guard” your brain is, the harder it is to fall asleep or stay asleep ,  and the less you sleep, the more wired and jumpy you may feel.

How Hypervigilance and Sleep Issues Show Up in First Responder Life

Hypervigilance and sleep disturbance do not look the same for everyone. But there are common patterns across law enforcement, fire, EMS, dispatch, corrections, and federal public safety roles.

On Shift: High Alert is Rewarded

On the job, you are expected to:

• Anticipate danger before it happens

• Catch small details under pressure

• Make fast decisions with limited information

• Stay alert through long, irregular shifts

The nervous system adapts to this environment. Over time, your baseline may become “high alert,” even when nothing is happening. Long shifts, rotating schedules, overtime, and mandatory holdovers intensify this state.

A systematic review of more than 40 studies found that about 85% of emergency first responders working 24-hour shifts experience sleep deprivation. When you are routinely under-slept and over-activated, your body learns that “wired and tired” is normal.

Off Shift: The Switch Won’t Flip

Sitting at home, nothing may be “wrong” ,  but your body does not seem to believe that. Common off-duty signs include:

• Difficulty relaxing when you are not at work

• Irritability with family over small things

• Feeling restless, bored, or “keyed up” on days off

• Needing alcohol or other substances to “shut off” at night

• Waking up from sleep at the slightest sound, ready to respond

You might notice that you function better on duty than off. Some first responders say that home feels more stressful than work because there is no clear role, no clear mission, and less structure.

In Relationships: Tension, Distance, and Misunderstandings

Hypervigilance and chronic sleep deprivation do not stay in your head ,  they show up in how you interact with others.

You may:

• Snap at loved ones without meaning to

• Avoid crowded events or public places, causing conflict

• Seem emotionally distant or “shut down” when you’re actually exhausted

• Struggle to be present with kids’ activities or partner conversations

Partners and family members may read this as disinterest or anger. In reality, you may be running on fumes, trying to conserve energy in a nervous system that never gets a full reset.

Why Ignoring Hypervigilance and Sleep Problems Is Risky

It is common in first responder culture to push through tiredness, minimize stress, and keep showing up. But untreated hypervigilance and sleep disturbance can carry real risks for you, your career, and the people you care about.

Impact on Mental Health

Chronic sleep disruption is strongly linked to:

• Mood changes (irritability, sadness, emotional numbness)

• Increased anxiety and worry

• Difficulty concentrating and making decisions

• Symptoms consistent with trauma-related conditions

Studies of first responders show that fear of sleep ,  driven by nightmares, hypervigilance, or worry about being unprepared ,  is associated with higher symptoms of posttraumatic stress, depression, and anxiety.

Over time, some first responders may lean on alcohol, prescription medications, or other substances to try to knock themselves out at night or stay alert on duty. This can develop into a substance use problem on top of existing mental health symptoms.

Impact on Physical Health

Sleep deprivation is tied to multiple health risks, including high blood pressure, heart disease, weight gain, and metabolic problems.

In a large study of nearly 7,000 firefighters, untreated sleep disorders were associated with higher rates of motor vehicle crashes and cardiovascular disease.

When your nervous system is stuck in high alert and your body rarely gets deep, restorative sleep, it cannot repair itself effectively. That increases the risk of:

• Chronic pain and slower injury recovery

• Headaches and GI issues

• Weakened immune function

• Burnout and reduced career longevity

Impact on Safety and Performance

For first responders, fatigue and hypervigilance are not just personal issues,  they are operational issues. Research on first responders links sleep disorders with:

• Poorer alertness and concentration

• Slower reaction times

• More errors and near-misses

• Lower quality of life and functioning on and off duty

In other words, “just being tired” can affect split-second decisions, driving, physical tasks, and interpersonal judgment in ways that matter for everyone’s safety.

Workers’ Comp and Return-to-Work

If you are already on workers’ comp for a physical or psychological injury, untreated sleep disturbance and hypervigilance can slow recovery. Good sleep supports healing, rehab progress, and emotional regulation,  all key to return-to-duty decisions.

Documented sleep problems and mental health symptoms, when properly evaluated by a clinician, may also be relevant to workers’ comp claims and accommodations. Addressing these issues is not “weak”; it is part of protecting your health and your ability to do the job.

Evidence-Based Support,  And How Virtual IOP Fits In

The good news: hypervigilance and sleep disturbance are treatable. You did not choose this, and you are not stuck this way.

A combination of trauma-informed therapy, targeted sleep treatment, skills training, and sometimes medication can help your nervous system find a new baseline. Virtual intensive outpatient programs (IOPs) can bring these components together in a flexible, structured way.

Core Approaches That Often Help

Evidence-based care for hypervigilance and sleep disturbance may include:

Trauma-Focused Therapies

These therapies help you process duty-related experiences, reduce threat signals in the brain, and update the “story” that keeps your alarm system running. Common approaches include:

• Cognitive behavioral therapies that work on thoughts, beliefs, and behaviors

• Trauma-focused processing therapies (such as cognitive processing therapy or similar models)

• Skills for grounding, emotional regulation, and nervous system stabilization

These approaches aim to reduce reactivity and improve day-to-day functioning, not erase your memories or change who you are.

CBT-I and Other Sleep-Focused Treatments

Cognitive behavioral therapy for insomnia (CBT-I) is a structured, short-term therapy that teaches skills to fall asleep faster, stay asleep, and retrain your brain’s connection to bedtime. It is considered a first-line treatment for chronic insomnia.

For first responders, CBT-I and related strategies can be adapted to shift work, rotating schedules, and hypervigilance.

Support for Substance Use and Dual Diagnosis

If you are using alcohol, cannabis, sedatives, or stimulants to cope with sleep or stress, an integrated approach,  often called dual diagnosis care,  can address both mental health and substance use together.

SAMHSA notes that intensive outpatient programs (IOPs) are a key level of care for people managing substance use disorders, whether as primary treatment, step-down from inpatient, or step-up from standard outpatient care. For first responders, this can be paired with trauma-focused work and sleep interventions.

How a Virtual IOP Can Help First Responders

A virtual IOP typically offers multiple group sessions per week, along with individual therapy and access to psychiatry or medication management,  delivered online through secure telehealth.

For first responders, a specialized virtual IOP like Step Stone Connect’s may include:

• Clinicians experienced with first responder culture (law enforcement, fire, EMS, corrections, dispatch, federal)

• Evidence-based treatments for trauma, anxiety, depression, and substance use

• Sleep-focused education and skills, including CBT-I–informed strategies

• Online group therapy with peers who understand the job

• Flexible scheduling that works around shifts, overtime, and court

• Family or partner sessions, when appropriate, to rebuild communication

Because it is virtual, you can access care from home or a private office, reducing travel time and making it easier to attend consistently,  even if you live in a rural area or work irregular shifts.

Practical Skills to Start Calming Hypervigilance and Improving Sleep

Treatment is often the most effective way to address entrenched hypervigilance and sleep disturbance. Still, there are steps you can start using now to support your nervous system.

These suggestions are not a replacement for care, but they can be a bridge while you explore options.

1. Understand Your “On/Off” Cycle

First, notice your patterns:

• When during the week do you feel most wired?

• When do you feel most drained?

• What shift patterns or call types make sleep hardest afterward?

Many first responders live in a cycle: over-activation on duty, partial crash off duty, then bracing for the next shift. Simply mapping your cycle can make it easier to plan small changes instead of blaming yourself for “not handling it better.”

2. Build a Post-Shift “Downshift” Routine

Your nervous system cannot go from Code 3 to deep sleep in 10 minutes. It needs a gradual downshift. Consider experimenting with a consistent 20–45-minute routine after shift or before bedtime, such as:

• A hot shower or bath to signal “off duty”

• Light stretching or gentle movement to discharge adrenaline

• A simple snack or hydration (avoid heavy meals and high sugar)

• 5–10 minutes of slow breathing (for example, inhale for 4, exhale for 6–8)

• Brief journaling: noting the hardest moments of the shift and then closing the notebook

Try to avoid diving into social media, gaming, or intense news right before bed ,  these can keep your brain in scanning mode.

3. Make Your Sleep Environment Feel Safer

Hypervigilance often spikes at night. Your brain may be running worst-case scenarios, especially after difficult calls or traumatic events. To work with that, not against it:

• Control what you reasonably can: locks checked, security system set, items staged for the next day.

• Reduce unnecessary stimuli: blackout curtains, white noise, and limiting light from screens.

• Agree on a plan with your partner (if you have one): who responds if something actually happens, so your brain does not feel solely responsible.

You may still wake up more than you’d like, but making your environment feel secure and predictable gives your nervous system fewer reasons to stay on guard.

4. Shift Away from “I Have to Be Ready 24/7”

Many first responders feel guilty sleeping deeply: “What if someone needs me?” or “What if I miss a call or alert?”

If you are off duty, remind yourself:

• You are not failing your community by sleeping.

• You are restoring your capacity to do the job tomorrow.

• Your department, partners, or team members are also carrying the load.

Sometimes it helps to write a short, grounding statement you repeat before bed, such as: “Right now, my job is to rest so I can safely serve later.”

5. Watch for “Red Flag” Patterns

It may be time to reach out for professional support,  such as a clinician or a program like Step Stone Connect’s virtual IOP,  if you notice patterns like:

• Sleeping less than 4–5 hours most nights, for weeks or months

• Relying on alcohol, pills, or other substances to fall asleep or stay awake

• Frequent nightmares about calls, scenes, or worst-case scenarios

• Sudden mood changes, anger, or emotional numbness that others notice

• Memory problems, increased mistakes, or near-misses

• Thoughts that life is not worth it or that people would be better off without you

You do not need all of these signs to justify getting support. Any one of them is enough reason to talk to someone who understands first responder work.

6. Involve Your Department or Workers’ Comp When Appropriate

If hypervigilance and sleep issues are affecting your ability to work safely, it may be appropriate to:

• Talk with a trusted peer support member, chaplain, or supervisor

• Explore employee assistance program (EAP) options

• Discuss documentation of sleep disturbance and related symptoms with a clinician

When you are on workers’ comp already, you might ask your case manager or attorney about adding mental health and sleep-focused treatment,  such as a telehealth IOP,  as part of your recovery plan.

You Are Not “Broken”,  Your Nervous System Is Doing Its Best

If you are dealing with constant hypervigilance, broken sleep, and the emotional fallout that comes with both, it can be easy to assume: “Something is wrong with me. I should be tougher.”

From a clinical perspective, what you are experiencing is often a normal response to long-term exposure to danger, trauma, and disrupted sleep,  in a job that asks you to keep going. Your nervous system is trying to protect you. It just has not gotten the message that you are off duty.

With the right support, it is possible to:

• Reduce how “on edge” you feel day-to-day

• Get more consistent, restorative sleep

• Improve mood, focus, and energy

• Feel more present with family and off-duty life

This does not mean you forget what you have seen or stop being a protector. It means you gain more control over when your alarm system turns on,  and when it stands down.

How Step Stone Connect Can Help

Step Stone Connect serves first responders only: law enforcement, fire, EMS, dispatch, corrections, and federal roles. Through Step Stone Connect’s confidential virtual intensive outpatient program (IOP), you can access focused support for:

• Hypervigilance and trauma-related symptoms

• Sleep disturbance and insomnia

• Anxiety, depression, and stress

• Substance use and dual diagnosis concerns

Our telehealth IOP is designed around first responder culture and schedules. You can attend secure online group therapy, individual sessions, and skills-based workshops from home or another private space. You stay connected to your life, your family, and your career while getting a higher level of care than standard weekly therapy can offer.

Next Step: Reach Out When You Are Ready

You do not have to wait until everything is falling apart to ask for help with hypervigilance and sleep disturbance. Early support can protect your health, your relationships, and your ability to keep doing the work you trained for.

If you are a current or former first responder and these experiences sound familiar, Step Stone Connect can help you explore options without pressure and without judgment.

• Call (866) 518-2985 to talk with our team.

• Or submit a confidential form and schedule a time that works around your shifts.

You have spent your career protecting others. You deserve care that protects you, too.