Background <p>Poor sleep and fatigue are common among paramedics, with negative implications for the safety and well-being of paramedics and the community. Targeted education can support sleep and fatigue outcomes, however knowledge relating to the optimal content, delivery methods, and timing of education delivery, is limited. This study explores the experiences of sleep, fatigue, and shift work among early-career paramedics to inform sleep and fatigue education specifically for the paramedic workforce, with considerations for implementation across the paramedic career span.</p> Methods <p>We used a qualitative approach underpinned by a critical realist paradigm. Semi-structured interviews with early-career paramedics (<i>n</i> = 30) were conducted, and data analysed inductively using conventional content analysis.</p> Results <p>Three categories were constructed: (1) Learning to sleep well as a paramedic, (2) Sleep knowledge and experiences of paramedics, and (3) Sleep and fatigue education preferences for paramedics. As shift workers, paramedics learned to sleep well experientially and through informal knowledge sharing, rather than meaningful education or preparation. Feeling unprepared for shift work was common, as was a desire for evidence-based education and systematic support throughout the career. Co-designed, contextually relevant, adaptive and embedded educational approaches were preferred. Results also reflected a critical gap in knowledge and awareness surrounding sleep disorders, suggesting a need for meaningful education and support pathways.</p> Conclusions <p>Findings underscored a need for evidence-based education about sleep, fatigue, and sleep disorders within paramedic tertiary education and organisational systems. Co-designed approaches combining expert knowledge and lived experience with clearer help-seeking pathways are essential for improving paramedic and community well-being, safety, and workforce sustainability.</p>