Working in public safety — whether in the fire service, law enforcement, corrections, or EMS — almost never involves a regular nine-to-five schedule. Instead, first responders face erratic hours, shift rotations, overnight calls, and long on-call periods that disrupt typical sleep-wake cycles. As a result, many struggle to get restful, restorative sleep.
Beyond the crazy hours, first responders often deal with additional pressures that impair sleep quality. Stressful, sometimes traumatic calls, hypervigilance, high caffeine use, and difficulties sleeping during daylight hours (often in environments with light or noise) tend to add up. As a result, many first responders are chronically sleep-deprived or suffer from disorders such as Shift Work Disorder (SWD), which is caused when the body’s circadian rhythm is repeatedly misaligned with required work hours.
Besides affecting personal health, this pervasive problem can also impact performance and safety. Poor sleep undermines alertness, concentration, reaction time, and decision-making — all critical faculties when responding to emergencies. Given how common and how serious these sleep disorders are among first responders, addressing sleep is essential to public safety.
Recognizing this, many first-responder agencies and wellness advocates emphasize a multi-pronged approach to improve rest even under challenging schedules. Key strategies include:
- Practicing good “sleep hygiene” by creating a sleep environment that is dark, cool, quiet, and comfortable.
- Using physical or mental relaxation techniques to wind down.
- Avoiding screens 30 to 60 minutes before bedtime.
- When appropriate, using pharmaceutical or supplemental aids to help restore healthy sleep patterns.
In some cases, carefully managed prescription medications may be needed. In others, first responders often turn to over-the-counter supplements such as melatonin as a tool to help signal the body it’s time to rest.
“Melatonin supplements may not be as harmless as commonly assumed.”
What Is Melatonin? Biology, Mechanism, and Role in Sleep
Melatonin is a hormone produced naturally by the body, primarily by the pineal gland. Under normal conditions, the body begins secreting melatonin in response to darkness, which helps regulate the circadian rhythm — the body’s internal clock that signals when we feel awake and when we feel sleepy.
In a well-regulated circadian system, melatonin levels gradually rise in the evening as light fades, reach a peak during the night, then fall as daylight returns. This helps drive the natural cycle of sleep and wakefulness. For someone with a shift-work schedule (working nights, rotating shifts, sleeping during daylight hours), the timing of light exposure disrupts this natural rhythm. Light at the “wrong” time can suppress melatonin production, making it harder to fall asleep — even when exhausted.
Incidentally, this is why it’s best to avoid screens right before bedtime. The blue light emitted by a phone, tablet, or television suppresses the body’s natural production of melatonin, making it more difficult to fall asleep and stay asleep.
And that’s where supplemental melatonin comes into play. Melatonin supplements mimic or reinforce the body’s natural night signal, helping to “reset” the internal clock when schedules are misaligned or when the environment is not conducive to natural melatonin production (e.g., sleeping during daytime). With correct timing and dosing, melatonin has been shown to shift circadian rhythms to better align sleep and wake times with an individual’s required schedule.
That said, melatonin is not a magic bullet. While melatonin may be helpful, it is not universally effective to improve sleep quality without accompanying lifestyle or environmental changes. Also, because supplemental melatonin is regulated in the U.S. as a dietary supplement (and not a medication), quality, purity, and effectiveness can vary from brand to brand, and even from batch to batch.
Regardless of the drawbacks, use of supplemental melatonin more than quintupled between 1999 and 2018.
New Research on Long-Term Melatonin Use
While melatonin has long been viewed as a relatively benign supplement, new research raises important questions about its long-term safety — particularly for individuals already at higher risk for cardiovascular disease.
In a study presented by the American Heart Association, researchers reviewed five years of health records from more than 130,000 adults with insomnia who had used melatonin for at least one year. These long-term melatonin users, they found, were more likely to be diagnosed with heart failure, require hospitalization for cardiac conditions, or die from any cause compared with those who did not use melatonin. Although the study does not establish a clear cause-and-effect relationship, it signals a potentially significant health concern that warrants further investigation.
Though the researchers were careful to emphasize that these findings are preliminary and observational, the scale of the study and the clear association between long-term melatonin use and increased cardiovascular risk raise legitimate questions about the common assumption that melatonin is universally “safe” because it is naturally occurring.
These findings are especially relevant for the public-safety community because cardiovascular health is already a major risk factor among first responders, particularly firefighters. Sudden cardiac death remains the leading cause of on-duty firefighter fatalities each year. Research shows that more than 45% of firefighter line-of-duty deaths are due to cardiac events, often involving underlying conditions such as hypertension, atherosclerosis, and cardiomyopathy.
Firefighters and EMS personnel also routinely face strenuous physical demands, heat exposure, toxic inhalants, interrupted sleep cycles, and chronic stress — all of which can contribute to cardiovascular strain. Law enforcement and corrections officers experience these risks as well, with shift work, hypervigilance, and trauma-related stress linked to elevated rates of hypertension and metabolic disorders.
Considering this elevated baseline risk, any supplement with a potential connection to heart failure or all-cause mortality is worth reevaluating.
It’s possible long-term melatonin use is simply a marker for individuals with more severe or persistent sleep problems — which is also a risk factor for cardiovascular disease. But it’s also plausible that chronic supplementation could interact with existing conditions or circadian misalignment in ways researchers still don’t fully understand.
Either scenario underscores the importance of informed guidance rather than casual, indefinite supplementation. As the lead author of the study put it, “Melatonin supplements may not be as harmless as commonly assumed.”
Tip Sheet: 8 Proven Strategies for Better Sleep: DOWNLOAD NOW!
Taking Action
Due to the operational demands and disruptive nature of shift work, sleep is always going to be a challenge in public safety. For first responders navigating irregular schedules, nighttime stress, and chronic sleep disruption, melatonin will undoubtedly remain a tool many consider. However, when individuals turn to supplements like melatonin to help them sleep, they need to be aware that long-term use may carry risks.
Talking with a physician, undergoing routine medical checkups, and using a combination of sleep strategies — environmental changes, physical and mental wind-down techniques, behavioral approaches, and, when absolutely necessary, professionally supervised medications — remain essential steps in protecting sleep quality and long-term health in the first-responder population.
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