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CAQ Review

Sleep and the Athlete

Pujalte, George G.A. MD, FACSM1; Benjamin, Holly J. MD, FACSM2

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Current Sports Medicine Reports: April 2018 - Volume 17 - Issue 4 - p 109-110
doi: 10.1249/JSR.0000000000000468
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Adequate sleep hygiene is increasingly recognized as a crucial part of athlete recovery, avoidance of overtraining or burnout, and optimization of health. Sleep impacts metabolic regulation and homeostasis and serves a vital restorative function (1). Sleep regulation occurs through an intrinsic sleep-wake cycle of optimal duration, coupled with a circadian rhythm that is influenced by environmental exposures, such as light and darkness. Other factors that affect sleep include exercise, diet/nutrition, supplements/stimulants, medications, travel, social/electronic media, and mental/physical health (2–4). In general, exercise favorably affects sleep quality and quantity (5).

High-performance athletes, particularly adolescent and young adult athletes, are routinely exposed to greater physical, psychological, and neuromuscular stressors that require a delicate balance of recovery, including appropriate sleep (5). Athletes are at higher risk for sleep impairment for several reasons. Sleep deprivation is the most common sleep disorder, in general (6,7), and the frequency of both early morning and/or evening training sessions can decrease sleep duration, resulting in acute and cumulative sleep deprivation. A minimum of 7 h of sleep per day is ideal for optimal health in adults; adolescents require a minimum of 8 h of sleep per day (6,7) (Table). Traveling across time zones for competitions can have negative effects on circadian rhythms, particularly west to east travel. In general, it is prudent to allow at least 1 d for each time zone crossed for full resolution of jet lag symptoms (8,9). Additional studies have shown that between 50% and 80% of all athletes experience poor sleep quality during periods of heavy training and particularly on the nights before and after competition (5,10–12). Poor sleep quality and quantity can negatively affect cognitive and physical performance, perceived exertion, injury risk, and mental health (2–4). All of the above, along with increased pain, decreased task execution tolerance, and decreased cognitive and motor function (e.g., increased reaction times), are consistently correlated with increased injury risk in athletes (13–16).

Daytime restorative napping, a common strategy that can reduce sleep debt, can improve short-term memory, alertness, and accuracy during reaction-time tests and should be incorporated, when necessary. Other sleep hygiene recommendations include maintaining consistent bedtimes, avoiding evening light exposure from technology and electronic devices, limiting caffeine intake, maintaining adequate hydration, and having a relaxation-focused bedtime routine (17,18).

National Sleep Foundation Sleep Duration Recommendations byAge (23).

Athletes with mental health disorders and sport-related concussion (SRC) often display symptoms of disordered sleep. Sleep disturbance is a common complaint in concussed athletes with up to 50% reporting sleep-related issues, including insomnia, difficulty falling asleep, and impaired sleep quality. Sleep disturbance may hinder concussion recovery and can worsen psychiatric illness, memory, and social functioning (19). Unfortunately, inadequate sleep the night before neurocognitive concussion testing can lead to increased symptom scores, impeding return to play (20).

Sleep quality and mental health impact each other (21). Sleep impairment can lead to increased stress, negative mood, and exacerbation of mental illnesses, such as anxiety or depression. Conversely, the presence of mental illness can cause sleep disturbances. Optimizing sleep appears to improve overall mental health (21,22). Compensatory strategies, restorative approaches, and cognitive rehabilitation should be incorporated into comprehensive treatment plans for SRC patients and athletes with mental health disorders.

Good sleep hygiene that includes adequate sleep duration, quality, and timing appears to be a crucial factor in athlete health, performance, adaptation, recovery, and injury prevention. Athletes must increase their awareness of sleep importance and develop strategies to maintain proper sleep regulation throughout training and competition.


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