Nervous System Resuscitation for First Responders

Reviewed by Peter Antevy, MD

Have you ever been so exhausted you can’t sleep? Can’t shut your brain down when it’s time to relax? Wake up at 0300 hours, wheels turning, ready to go, only to be exhausted by mid-morning?

Do you experience sleep disturbances including insomnia or drowsiness? Brain fog? Irritability? Restlessness? Impaired concentration and mood swings including anxiety, agitation, depression, paranoia, and euphoria? Feel like you must have a nightcap to wind down?

These are just a few symptoms of an overactive, dysregulated nervous system or decreased vagal tone.

For me this included having two, three, even four jobs since I was able to drive—never slowing down. I was working, teaching, training, exercising like a fiend, racing bikes, competing in various sports, you name it. I never gave myself a moment to just pause.

I was accomplished—some would even say successful. But my central nervous system was completely dysregulated. I was extremely emotionally reactive. I would binge drink and party only to wake up and punish myself with shame and some sort of intense physical exercise the following day, which would continue the fight-or-flight cycle.

Hitting Rock Bottom

I was in my twenties and resilient enough to keep it together. What I didn’t know was that continuing this lifestyle would eventually take me to a place that was isolating and full of angst—a dark and scary place that some don’t recover from.

In 2019, I hit rock bottom after a series of less-than-ideal events that sent me over the edge, including a lifetime of choices that diminished my capacity to self-regulate. I had become so sympathetic that I could not find the clarity I needed to make rational decisions. Like many in our profession, I went out and proceeded to drink to blow off the stress. This was followed by poor decisions that left me in a deep shame cycle for months.

I was disconnected from myself, my purpose and was self-isolating. It was about six months before I had ideations of suicide. I was fortunate to have someone come home and find me with a loaded gun, contemplating death. I was ready to just end it. I hated what I had allowed myself to become.

Is it the Job?

First responders can compartmentalize what we see at work daily. I believe it’s not the job that breaks us down—we show up on day 1 with cracks in our foundation. We all have traumas, big and small.

As physician and addiction specialist Gabor Mate says, “Trauma is not what happens to you. It’s what happens inside you in response to what’s happening around you.” The accumulation of these traumas over time contributes to the overstimulation of the sympathetic nervous system (SNS) and the lack of ability to release the pressure in healthy ways.

Yes, we see awful, horrific things, and that can leave their mark on our consciousness. However, if you are in a busy area running frequent lower-acuity calls, you exhaust your resources much faster. You become tired, irritable, and reactive, and if you were never taught how to self-regulate, you might turn to alcohol, gambling, recklessness, drugs, risky behavior, or promiscuity. If you were to ask your members if anything is bothering them, the typical answer would be “I’m good.” These behaviors are symptoms of deeper issues, yet we tend to address them as if they are isolated.

Mental health is a popular topic these days. We have peer support, employee assistance programs (EAP), chaplaincy, mindfulness classes, support groups, and more, yet a large percentage of our members are not using these resources. They have worked well for me in conjunction with a somatic bottom-up approach, starting with the body.

This isn’t all just in our minds. We must offload stagnant energy. Our CNS is fried. The combination of poor sleep habits, poor diet, increased stress and fatigue, high-intensity circuit training, and a lack of down-regulating practices is all a recipe for disaster.

The Role of Diet 

Most of us know that when we’re nutrient-deprived or hungry, we tend to be more irritable. One of the most significant underlying issues for epidemic levels of divisiveness, very illogical behavior, and our current mental health crisis is that our society is in an extremely poor state of health.^3-5

Studies show a clear connection between the foods we eat and the state of our mental health. The gut-brain axis, your gut, and your brain are connected physically through millions of nerves, most importantly the vagus nerve, which represents the main component of the parasympathetic nervous system.

The gut and its microbes control inflammation, digestion, heart rate, immune response, mood, circadian rhythm, stress, anxiety, depression, and more. Treatments that target the vagus nerve increase vagal tone (which can be measured by heart rate variability) and inhibit cytokine (inflammatory response) production. Both are essential mechanisms of resilience.¹

Caffeine and Alcohol

Caffeine can have both positive and negative effects on the nervous system and exacerbate symptoms of anxiety and agitation in individuals with a dysregulated nervous system. It stimulates the release of stress hormones such as cortisol and adrenaline, which may lead to increased restlessness, jitteriness, and a racing heartbeat.

Caffeine has a half-life of about 5-6 hours, meaning it can stay in the body for several hours and interfere with sleep. Caffeine can temporarily raise blood pressure and increase heart rate. In individuals with a dysregulated nervous system, this may lead to greater cardiovascular reactivity and may potentially worsen symptoms such as palpitations or racing heartbeat. If you have a dysregulated nervous system, it is advisable to monitor your response to caffeine and consider reducing or eliminating it from your diet if it worsens your symptoms.⁶

Alcohol is a central nervous system depressant, meaning it slows down the activity of the brain and spinal cord. This leads to a decrease in cognitive function, reflexes, and coordination. It can cause relaxation, sedation, and a feeling of decreased inhibition.

Alcohol affects areas of the brain responsible for judgment, reasoning, and decision-making. As a result, individuals under the influence of alcohol may engage in risky behaviors, have impaired problem-solving abilities, and struggle with sound decision-making. Stress is commonly regarded as an important trigger that promotes increased motivation to drink in some individuals.

However, the relationship between stress and alcohol is complex, likely changing in form during the transition from early moderated alcohol use to more heavy uncontrolled alcohol intake. A growing body of evidence indicates that prolonged alcohol consumption serves as a potent stressor, producing persistent dysregulation of brain reward and stress systems beyond normal homeostatic limits.

Parasympathetic Movement

Several movement practices can help downregulate or calm the nervous system. These practices focus on promoting relaxation, reducing stress, and restoring balance in the body.

• Yoga combines physical postures, breathing exercises, and mindfulness to promote relaxation and reduce stress.
• Tai chi is a gentle martial art that involves slow, flowing movements and deep breathing, and promotes relaxation, improves balance, and enhances body awareness.
• Qigong is a Chinese practice that combines gentle movements, breathing techniques, and meditation. It cultivates and balances the body's vital energy (qi). Qigong exercises can be adapted to focus on relaxation, grounding, and harmonizing the nervous system.

Remember, finding the proper movement practice is a personal journey, and what works for one person may not work for another. It's important to explore different approaches and listen to your body to find the practices that resonate with you.^8-10

Sleep Hygiene

When sleep is consistently inadequate or disrupted, it can lead to a range of negative impacts on the central nervous system, impairing cognitive abilities, attention, concentration, problem-solving, and decision-making, making it challenging to focus and retain information, ultimately affecting productivity and increasing the risk of accidents.

Memory consolidation is also hindered, impacting both short-term and long-term memory. Mood disturbances are common, leading to mood swings, irritability, and heightened emotional reactivity. These can contribute to the development or exacerbation of mood disorders such as depression and anxiety.

Chronic sleep deprivation can activate the stress response system, elevating levels of stress hormones such as cortisol, which can have damaging effects on the brain and other bodily systems. Sleep is crucial for maintaining a robust immune system. Inadequate sleep weakens immune responses, leaving the body vulnerable to infections and illnesses.

Sleeping at odd times of the day creates challenges for maintaining healthy work-life balance in shift workers, as opportunities for family, social, and leisure activities are constrained. This may lead to social isolation and contribute to poor mental health.”¹¹ There are many resources to review for improving your sleep hygiene, including books, podcasts, and articles.

Deliberate Cold Water Immersion

When the body is under stress, it does not know the difference between mental, emotional, or physical stress—the physiological response is the same. The power of deliberate cold water immersion (CWI) comes from creating a sympathetic physical state and then using the power of your breath to down-regulate the nervous system.

By using deliberate CWI, learning to find peace in the mind and body can help you sit with other uncomfortable experiences. Stress, in this case, can be a positive stimulus by teaching your body to adapt to stressful situations and help you build mental resilience. A typical session lasts about 2–5 minutes. It may be recommended you engage in multiple sessions, depending on your needs.¹²

Sauna Therapy

Sauna bathing, or intentional heat exposure, is used mainly for relaxation and pleasure purposes to release body stress or detoxify. Sauna bathing leads to increased HR, thereby imitating moderate physical activity and its potential effects on the autonomic nervous system without active skeletal muscle work (if you’re suffering from an injury, time in the sauna can still give you the benefits of exercise while you recover).

Acute physiological responses to high temperatures during sauna bathing induce fluid loss with increased HR. During the cooling down period, HRV increases, which indicates the dominant role of parasympathetic activity and decreased sympathetic activity of the cardiac autonomic nervous system.^15-16 Using both sauna and CWI can also compound the benefits of both therapies as well as work the vasodilation and constriction of your vessels.

Breathwork

A stressful incident can make the heart pound and breathing quicken. Muscles tense and beads of sweat appear. Over time, repeated activation of the stress response takes a toll on the body. Research suggests that chronic stress contributes to high blood pressure, promotes the formation of artery-clogging deposits, and causes brain changes that may contribute to anxiety, depression, and addiction.

Somatic release breathwork utilizes both elongated inhales—using the mouth for the first half of the session to activate a sympathetic response and discharge defense systems—and elongated exhalations through the nose during the second half to activate a parasympathetic response that leaves you in a state to regulate and repattern while accessing elevated states of emotion.

This breathwork had the most significant impact on me when it came to expressing stagnant energy and allowing my nervous system to return to baseline.

Putting it All Together

When I started this journey, I didn’t know what I was doing or hoping to accomplish. But I knew I was struggling.

The first thing I did was find a therapist through my department's EAP. She introduced me to EMDR therapy, which is both somatic and mental therapy to help complete the circuit of past stressful experiences. When it came to my daily routines, the most logical place to start was to optimize my recovery since I was an athlete.

My diet was always pretty good, so this is where the Oura sleep tracker ring came in. Looking back at my data from 2019, it is clear that I was in a constant fight or flight state. My HRV averaged 78 ms, which shows that I was highly sympathetic.

I took steps to optimize my sleep—reducing caffeine and alcohol and noticing how yoga and meditation affected my scores, motivated me to continue.

In 2021, I discovered deliberate cold water immersion contrasted with sauna therapy. It has become my superpower to remain calm in stressful situations. In 2022, I discovered Somatic Release Breathwork (SBW) and flew across the country to become certified. This practice has allowed me to release the feelings I can’t put into words.

Repeating these practices has shown a steady trend of increasing my HRV to over 189 ms on average and many mornings over 220 ms. I am less reactive and easily flow between states of stimulation to relaxation and from neutral into states of joy and contentment.

No Quick Fix

There is no one-size-fits-all approach to healing one’s CNS, but there are many actionable physical practices in which we can engage as individuals or as a crew at the station to create a sense of well-being and community.

It’s important to recognize that for long-term mental health and stability, this is not a quick fix. These practices take consistent effort and require creating a culture of speaking in terms that create a space for vulnerability without judgment and shame. That is the most challenging part in many organizations.

References

1. Breit S, Kupferberg A, Rogler G, Hasler G. Vagus Nerve as Modulator of the Brain-Gut Axis in Psychiatric and Inflammatory Disorders. Front Psychiatry. 2018 Mar 13;9:44. doi: 10.3389/fpsyt.2018.00044. PMID: 29593576; PMCID: PMC5859128.
2. de Zambotti M, Rosas L, Colrain IM, Baker FC. The Sleep of the Ring: Comparison of the ŌURA Sleep Tracker Against Polysomnography. Behav Sleep Med. 2019 Mar-Apr;17(2):124-136. doi: 10.1080/15402002.2017.1300587. Epub 2017 Mar 21. PMID: 28323455; PMCID: PMC6095823.
3. Gesch CB, Hammond SM, Hampson SE, Eves A, Crowder MJ. Influence of supplementary vitamins, minerals, and essential fatty acids on the antisocial behavior of young adult prisoners. A randomized, placebo-controlled trial. Br J Psychiatry. 2002 Jul;181:22-8. doi: 10.1192/bjp.181.1.22. PMID: 12091259.
4. Schmidt K, Cowen PJ, Harmer CJ, Tzortzis G, Errington S, Burnet PW. Prebiotic intake reduces the waking cortisol response and alters emotional bias in healthy volunteers. Psychopharmacology (Berl). 2015 May;232(10):1793-801. doi: 10.1007/s00213-014-3810-0. Epub 2014 Dec 3. PMID: 25449699; PMCID: PMC4410136.
5. (n.d.). Diet for an Overactive Sympathetic Nervous System. Livestrong. https://www.livestrong.com/article/551858-an-overactive-sympathetic-diet/
6. (n.d.). Coffee Acutely Increases Sympathetic Nerve Activity and Blood Pressure Independently of Caffeine Content. AHA Journal. https://www.ahajournals.org/doi/full/10.1161/01.cir.0000046228.97025.3a
7. Becker HC. Influence of stress associated with chronic alcohol exposure on drinking. Neuropharmacology. 2017 Aug 1;122:115-126. doi: 10.1016/j.neuropharm.2017.04.028. Epub 2017 Apr 19. PMID: 28431971; PMCID: PMC5497303.
8. Streeter CC, Gerbarg PL, Saper RB, Ciraulo DA, Brown RP. Effects of yoga on the autonomic nervous system, gamma-aminobutyric acid, and allostasis in epilepsy, depression, and post-traumatic stress disorder. Med Hypotheses. 2012 May;78(5):571-9. doi: 10.1016/j.mehy.2012.01.021. Epub 2012 Feb 24. PMID: 22365651.
9. Hannah Capon, Melissa O'Shea, Shane McIver, Yoga, and mental health: A synthesis of qualitative findings, Complementary Therapies in Clinical Practice, Volume 37, 2019, Pages 122-132, ISSN 1744-3881, ttps://doi.org/10.1016/j.ctcp.2019.101063. (https://www.sciencedirect.com/science/article/pii/S1744388119304876)
10. Muralikrishnan K, Balakrishnan B, Balasubramanian K, Visnegarawla F. Measurement of the effect of Isha Yoga on the cardiac autonomic nervous system using short-term heart rate variability. J Ayurveda Integr Med. 2012 Apr;3(2):91-6. doi: 10.4103/0975-9476.96528. PMID: 22707866; PMCID: PMC3371565.
11. Torquati L, Mielke GI, Brown WJ, Burton NW, Kolbe-Alexander TL. Shift Work and Poor Mental Health: A Meta-Analysis of Longitudinal Studies. Am J Public Health. 2019 Nov;109(11):e13-e20. doi: 10.2105/AJPH.2019.305278. Epub 2019 Sep 19. PMID: 31536404; PMCID: PMC6775929.
12. Bongiorno, P. (n.d.). A cold splash–hydrotherapy for depression and anxiety. Psychology Today. https://www.psychologytoday.com/us/blog/inner-source/201407/cold-splash-hydrotherapy-depression-and-anxiety
13. Olsen, N. (n.d.). Cryotherapy: Safety, what to expect, and Benefits. Medical News Today. https://www.medicalnewstoday.com/articles/319740
14. https://www.recoveryguru.com.au/blog/best-breathing-practices
15. Laukkanen, J. A., Fiorelli, A., Meyerfeldt, U., Routledge, F. S., Messina, G., Singh, J. P. (2019, June 22). Recovery from sauna bathing favorably modulates the cardiac autonomic nervous system. Complementary Therapies in Medicine. https://www.sciencedirect.com/science/article/abs/pii/S0965229919301943
16. Fallis, J. (2023, July 31). 13 proven ways saunas can improve your mental health. Optimal Living Dynamics. https://www.optimallivingdynamics.com/blog/13-proven-ways-saunas-can-improve-your-mental-health-dry-hot-benefits-depression-anxiety
17. Understanding the stress response. Harvard Health. (2020, July 6). https://www.health.harvard.edu/staying-healthy/understanding-the-stress-response#:~:text=After%20the%20amygdala%20sends%20a,as%20adrenaline)%20into%20the%20bloodstream.

Crystal Little is an EMS captain in Florida.