A novel sleep optimisation programme to improve athletes' well-being and performance

Behavioral interventions and behavior change techniques used to improve sleep outcomes in athlete populations: A scoping review

BACKGROUND

Athletes display a high prevalence of undesired sleep characteristics that may affect both performance and wellbeing.

OBJECTIVES

This scoping review aimed to identify and map the existing evidence of behavioral sleep interventions and their effects on sleep outcomes in athletes, and retrospectively code the behavior change techniques (BCTs) implemented using the Behavior Change Technique Taxonomy (BCTTv1).

METHODS

Conducted following the JBI methodology for scoping reviews, four online databases were used to identify prospective interventions with at least one behavioral component in competitive athletes, and reporting a sleep outcome pre- and post-intervention.

RESULTS

Thirty-three studies met the inclusion criteria, encompassing 892 participants with a median age of 23. Five intervention categories were identified (education, mind-body practices, direct, multi-component, and other), with each demonstrating mixed efficacy but the potential to improve sleep outcomes. The BCTs varied in type and frequency between each category, with only 18 unique BCTs identified across all studies.

CONCLUSIONS

The varied efficacy of previous studies at improving sleep outcomes may be attributed to the lack of behavior change theory applied during intervention development. Designing interventions following a targeted specification of the behavioral problem, and the integration of corresponding BCTs should be considered in future research.

A game-based learning approach to sleep hygiene education: a pilot investigation

Introduction

Sleep hygiene education (SHE) consists of environmental and behavioral practices primarily intended to reduce sleep problems. Currently considered ineffective as a stand-alone treatment, the manner in which the education is typically delivered may be ineffective for the acquisition of new knowledge. The purpose of this study was to determine if a more engaging teaching medium may improve the efficacy of sleep hygiene education. This study examined the use of game-based learning to teach SHE to individuals with sleep problems.

Methods

35 participants played the SHE games for 30 days. Differences in pre- and post-state anxiety and sleep quality measures were examined.

Results

Participants had significant improvements in sleep quality and state anxiety after using the app for 30 days, although scores for the majority of patients remained elevated.

Discussion

This pilot investigation provides initial evidence for the efficacy of a game-based approach to SHE.

The effects of sleep deprivation and extreme exertion on cognitive performance at the world-record breaking Suffolk Back Yard Ultra-marathon

Using a prospective observational design, this study investigated the hypothesis that competing in the Suffolk Back Yard Ultra-marathon, would result in impaired cognitive performance and examined whether pre-race sleep patterns could mitigate this. Fifteen runners (1 female) volunteered to undertake this study and eleven males were included in the final analysis. Before the race and after withdrawal participants completed the following cognitive performance tasks: 2 Choice Reaction Time (2CRT), Stroop, and the Tower Puzzle. Pre-race sleep strategies were subjectively recorded with a 7-day sleep diary. Following race withdrawal, reaction time increased (Δ 77±68 ms; p = 0.004) in the 2CRT and executive function was impaired in the Stroop task (Interference score Δ -4.3±5.6 a.u.; p = 0.028). Decision making was not affected in the Tower Puzzle task. There was a significant correlation between the pre-race 7-day average sleep scores and both 2CRT Δ throughput (r = 0.61; p = 0.045) and 2CRT Δ RT (r = -0.64; p = 0.034). This study supports the hypothesis that running an ultra-marathon, which includes at least one night of sleep deprivation, impairs cognitive performance and provides novel evidence suggesting good sleep quality, in the week prior to an ultra-marathon, could minimise these effects.

The Impact of Daytime Napping Following Normal Night-Time Sleep on Physical Performance: A Systematic Review, Meta-analysis and Meta-regression

BACKGROUND

Daytime napping is used by athletes as a strategy to supplement night time sleep and aid physical performance. However, no meta-analytical overview regarding the impact of napping following a night of normal sleep (7-9 h) on physical performance is available.

OBJECTIVE

The aim of this study was to evaluate the effect of daytime napping following normal night-time sleep on physical performance in physically active individuals and athletes.

METHODS

This systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Seven electronic databases (i.e., PubMed, Web of Science, Scopus, SPORTDiscus, CINAHL, SCIELO, and EBSCOhost) were used to search for relevant studies that investigated the impact of daytime napping, following normal night-time sleep, on physical performance in physically active individuals and athletes, published in any language, and available before September 01, 2022. Studies that included assessments of any physical performance measures were included. QualSyst was used to assess the methodological quality of the studies.

RESULTS

Of 18 selected articles, 15 were of strong quality and 3 were of moderate quality. Compared with no-nap conditions, physically active individuals and athletes who napped experienced an increase in highest distance (effect size [ES] 1.026; p < 0.001) and total distance (ES 0.737; p < 0.001), and a decrease in fatigue index (ES 0.839, p = 0.008) during the 5-m shuttle run test (5MSRT). However, napping yielded no effect on muscle force (ES 0.175; p = 0.267). No effect of napping was found in one study that measured sprint performance and in two studies that measured performance during the 30-s Wingate test. Two of three studies reported an increase in jump performance after napping. Two of three studies reported an increase in repeated sprints after napping. One study reported an increase in upper-body power performance after napping, and napping was beneficial for endurance performance in one of two studies.

CONCLUSION

Following normal sleep, napping is beneficial for the performance of the 5MSRT, with no significant effect on muscle force. No firm conclusions can be drawn regarding other physical performance measures due to the limited number of studies.

Fundamentals or Icing on Top of the Cake? A Narrative Review of Recovery Strategies and Devices for Athletes

The sport and athletic performance industry has seen a plethora of new recovery devices and technologies over recent years, and it has become somewhat difficult for athletes, coaches, and practitioners to navigate the efficacy of such devices or whether they are even required at all. With the increase in recovery devices and tools, it has also become commonplace for athletes to overlook more traditional, well-established recovery strategies. In this narrative review, we discuss recovery strategies in relation to the hierarchy of scientific evidence, classifying them based on the strength of the evidence, ranging from meta-analyses through to case studies and reports. We report that foam rolling, compression garments, cryotherapy, photobiomodulation, hydrotherapy, and active recovery have a high level of positive evidence for improved recovery outcomes, while sauna, recovery boots/sleeves, occlusion cuffs, and massage guns currently have a lower level of evidence and mixed results for their efficacy. Finally, we provide guidance for practitioners when deciding on recovery strategies to use with athletes during different phases of the season.

The Impact of Multisession Sleep-Hygiene Strategies on Sleep Parameters in Elite Swimmers

PURPOSE

Short sleep duration and poor sleep quality are common in swimmers. Sleep-hygiene strategies demonstrated beneficial effects on several sleep parameters. The present study assessed the impact of a multisession sleep-hygiene training course on sleep in elite swimmers.

METHODS

Twenty-eight elite swimmers (17 [2] y) participated. The sleep-hygiene strategy consisted of 3 interventions. Sleep was measured by actigraphy for 7 days before the beginning of the intervention (baseline), after the first collective intervention (postintervention), after the second collective intervention (postintervention 2), and, finally, after the individual intervention (postintervention 3). The Epworth Sleepiness Scale (ESS) was completed concurrently. Swimmers were classified into 2 groups: nonsomnolent (baseline ESS score ≤ 10, n = 13) and somnolent (baseline ESS score ≥ 11, n = 15).

RESULTS

All swimmers had a total sleep time of <8 hours per night. Sixty percent of swimmers were moderately morning type. Later bedtime, less time in bed, and total sleep time were observed in the somnolent group compared with the nonsomnolent group at baseline. An interaction between training course and group factors was observed for bedtime, with a significant advance in bedtime between baseline, postintervention 2, and postintervention 3 for the somnolent group.

CONCLUSIONS

The present study confirms the importance of implementing sleep-hygiene strategies, particularly in athletes with an ESS score ≥11. A conjunction of individual and collective measures (eg, earlier bedtime, napping, and delaying morning training session) could favor the total sleep time achieved.

Effects of a Sleep Hygiene Strategy on Parameters of Sleep Quality and Quantity in Youth Elite Rugby Union Players

PURPOSE

To assess the effects of a sleep hygiene strategy on parameters of sleep quality and quantity in youth elite rugby union players.

METHOD

Eleven male players (age: 19.0 [1.4] y) undertook a sleep hygiene strategy composed of 2 theoretical sessions and 3 practical sessions over a 4-week period. Sleeping time, time in bed, total sleep time, sleep latency (SL), sleep efficiency (SE), wake after sleep onset, and wake bouts were recorded with an actigraphic device during the 4-week sleep hygiene strategy (baseline) and during 4 weeks after the last intervention (postintervention).

RESULTS

At baseline, the overall group reported poor sleep quantity (total sleep time = 6:27 [0:30] min), but sleep quality was considered acceptable (SL = 0:18 [0:08] min and SE = 77.8% [5.8%]). Postintervention, the overall group showed a small improvement in SL (d = -0.23 [-0.42 to -0.04], P = .003) and SE (d = 0.30 [0.03 to 0.57], P = .0004). For individual responses, sleeping time, time in bed, and total sleep time were positively influenced in only 4, 3, and 5 players, respectively. For parameters of sleep quality, SL and SE were positively influenced in a majority of players (n = 7 and 8, respectively). The magnitude of difference between baseline and postintervention was strongly associated with baseline values in SE (r = -.86; P = .0005) and wake after sleep onset (r = -.87; P = .0007).

CONCLUSION

A sleep hygiene strategy is efficient to improve sleep quality but not sleep quantity in young rugby union players. The strategy was more efficient in players with lower initial sleep quality and should be implemented prior to a high cumulative fatigue period.

Reliability and validity of the Chinese version of the Athens insomnia scale for non-clinical application in Chinese athletes

Purpose

This study aimed to revise and examine the reliability and validity of the Chinese version of the Athens Insomnia Scale for Non-clinical Application (AIS-NCA) among Chinese athletes. Additionally, the study tested the scale in non-athlete individuals with similar sleep management practices to further analyze its cultural specificity among Chinese athletes and make preliminary inferences about its applicability in other Chinese populations.

Methods

Four hundred twenty-six Chinese professional athletes and 779 high school students participated in this research. Both athletes and students were divided into two parallel groups for exploratory and confirmatory factor analyses. Additionally, three athlete samples and one student sample were established for reliability and validity assessments. Among athletes, the Pittsburgh Sleep Quality Index, the Epworth Sleepiness Scale, the Athlete Sleep Screening Questionnaire, and the Warwick-Edinburgh Mental Well-Being Scale were employed to evaluate convergent and discriminant validity. Re-test reliability was evaluated at intervals of 1 and 2 weeks. In the case of students, convergent and discriminant validity were tested using the Pittsburgh Sleep Quality Index and the General Self-Efficacy Scale, with re-test reliability assessed at two-week intervals.

Results

The Chinese version of the AIS-NCA consists of six items, categorized into two dimensions: sleep problems and daytime functioning. This structure explained 65.08% (athletes) and 66.22% (students) of the variance. Confirmatory factor analysis revealed good model fit, with values of χ2/df = 2.217, CFI = 0.975, AGFI = 0.929, TLI = 0.953, and RMSEA = 0.076 among athletes, and χ2/df = 3.037, CFI = 0.979, AGFI = 0.947, TLI = 0.961, and RMSEA = 0.072 among students. The scale demonstrated a reasonable degree of measurement invariance. The overall scale and two subscales exhibited strong reliability and validity among athletes. Similar results in terms of reliability and validity were also observed within the student sample.

Conclusion

The Chinese version of the AIS-NCA shows promise as an assessment tool for evaluating the sleep quality of Chinese athletes. It effectively captures both sleep-related concerns and daytime functionality within the athlete population. The scale demonstrates solid reliability and validity in professional athletes and holds potential for application across various other demographic groups in China.

The effect of short-term cranial electrotherapy stimulation on sleep quality in athletes: A pilot study

BACKGROUND

To verify the effect of a 5-day cranial electrotherapy stimulation (CES) intervention on sleep quality in professional athletes.

METHODS

25 professional athletes with poor sleep quality participated in the study. Athletes belonging to the CES group (12 athletes) received a 5-day CES intervention, and those in the control group did not receive any intervention. Objectively and subjected assessed sleep quality was measured 1 week before and after the intervention using an Actigraphy activity recorder, Pittsburgh sleep quality index (PSQI), and Insomnia Severity Index (ISI).

RESULTS

Objectively measured sleep efficiency increased after CES intervention (P = .013), while the difference between the pretest and posttest of the control group was not significant. For total sleep time (TST), the main effects and interaction were not significant. However, the analysis on wake after sleep onset showed wake after sleep onset decreased after CES intervention (P = .015). No significant interaction was found in subjectively assessed sleep quality but only revealed an improvement in both groups.

CONCLUSION

The CES intervention of 30 minutes per day for 5 consecutive days enhanced objective sleep quality in athletes with sleep quality problems. The intervention increased sleep efficiency by lowering awake time after falling asleep.

The Impact of Sleep Interventions on Athletic Performance: A Systematic Review

BACKGROUND

Sleep is essential for maximal performance in the athletic population. Despite that, the sport context has many factors that can negatively influence athletes' sleep and subsequent recovery.

OBJECTIVES

The purpose of this systematic review was to synthesize the most recent literature regarding sleep interventions aimed at improving sleep and subsequent performance in athletes.

METHODS

The present systematic review was conducted based on the PRISMA guidelines and the PICOS approach. The search was conducted in May 2022 using the electronic database PubMed, SPORTDiscus via EBSCOhost, and Web of Science. Once extracted, studies were included if they met the following criteria: (1) participants were athletes of individual or team sports; (2) implemented an intervention aimed at improving sleep; (3) measured at least one objective performance/recovery outcome; and (4) reported the relationship between sleep and performance.

RESULTS

The search returned 1584 records. Following the screening, a total of 25 studies met our inclusion criteria. All the included articles were intervention studies published between 2011 and 2021. The included studies implemented various sleep interventions, such as sleep hygiene, naps, sleep extension, light manipulation, cold water immersion, mindfulness, or a combination of two or more strategies. Sleep extension and naps were the most representative and most effective strategies to improve sleep and performance. Mindfulness and light manipulation demonstrated promising results, but more studies are needed to confirm these findings. Sleep hygiene, removing electronic devices at night, and cold water immersion had no effects on sleep and subsequent performance/recovery, but these results are based on a few studies only.

CONCLUSION

While acknowledging the limited amount of high-quality evidence reviewed, it appears that increasing sleep duration at night or through napping was the most effective interventions to improve physical and/or cognitive performance. Protocol Registration This protocol was registered in the International Platform of Registered Systematic Review and Meta-Analysis Protocols (INPLASY) on May 11, 2022, with the registration number INPLASY202250069.

Efficacy of sleep extension therapy using a remote support system in university students with increased social jetlag: a parallel, single-blind, randomized controlled trial

Purpose

The efficacy of sleep extension therapy using a remote support system (SET-R) was investigated in university students with increased social jetlag (SJL).

Methods

For this two-arm parallel randomized controlled trial, we recruited Japanese university students with SJL ≥ 60 min. The SET-R provided an individualized sleep schedule for gradual sleep extension using email and sleep hygiene education, stimulus control therapy, and progressive muscle relaxation as web content. The control group was sent an email that encouraged them to record their sleep. The duration of the intervention program was two weeks. The primary outcome was the mean change in SJL two weeks later, assessed using the Munich ChronoType Questionnaire (MCTQ). The other outcomes included Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale (ESS), Insomnia Severity Index, Patient Health Questionnaire-9 (PHQ-9), and sleep quiz. A follow-up survey was conducted 6 months after the intervention.

Results

Of 54 students, 26 were assigned to an intervention group and 28 to a control group. The difference in the mean change in SJL between the two groups (n = 26, n = 27) at two weeks was statistically significant (27.7 min, P = 0.048). The scores for the ESS, PHQ-9, and sleep quiz were improved in the intervention group relative to the control group. At the 6-month follow-up point, the difference in the mean change in SJL between the two groups (n = 22, n = 27) was not statistically significant, but scores for the PHQ-9, and sleep quiz remained significant.

Conclusions

This study demonstrated the efficacy of the SET-R among university students with increased SJL.

Trial Registration

The study was registered with the UMIN Clinical Trials Registry (UMIN000042634, 2021/02/01).

Sleep and Sport Performance

SUMMARY

Elite athletes and coaches believe sleep is the most important recovery strategy and widely consider it critical to optimal performance. Despite this perceived importance, there are numerous circumstances that can reduce sleep quantity and quality in athletic populations. Because of the effects of sleep loss on various physical, neurophysiological, and cognitive parameters, such perturbations can have consequences for performance and recovery outcomes. Although peer-reviewed literature examining the interaction between sleep, performance, and recovery in athletes is increasing, understanding of these issues remains equivocal. Perhaps most pertinently, the effect of sleep on sport performance does not align with a one-size-fits-all approach and rather depends on numerous factors such as type of sport, scheduling, time of the season, and the intraindividual requirements for sleep. The relationship between brain plasticity and memory, which in turn can influence learning processes and long-term memory consolidation, suggests that sleep may play an important role in learning new skills and tactics for both elite and developing athletes. The aim of this special issue review was to analyze the evidence of sleep loss on sport performance and recovery, with a specific focus on elite athletes. An assessment of these sleep-compromising situations that elite athletes may face during a typical season and practical considerations for alleviating these issues is also provided to further the understanding for medical professionals, scientists, and applied sporting practitioners alike.

Prevalence and risk factors of poor subjective sleep quality in elite judo athletes

This study aimed to determine the prevalence and risk factors of poor subjective sleep quality in elite judo athletes. A subjective cross-sectional questionnaire survey was conducted with 106 elite judo athletes who participated in the training camp of the Japanese national team. Eighty-six respondents (men: 52.3%; average age: 22.9 ± 3.1 years) with complete responses were included in the analysis (valid response rate: 81.1%). Subjective sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). The prevalence of poor sleep quality (PSQI score ≥ 5.5), the mean PSQI score, and subscale scores were investigated. Relationships between poor sleep quality and attributes, lifestyle habits, competition-based activities, and psychological distress were explored using Fisher's exact tests and multivariate logistic regression analysis. Thirty-five respondents (40.7%) reported poor sleep quality. The percentage and subscale scores of the respondents for sleep latency, sleep duration, and daytime dysfunction were higher than those of the population of Japanese national-level athletes. The mean PSQI score of the respondents was similar to that of some elite athlete populations but higher than those of others. Multivariate logistic regression analysis revealed that psychological distress was associated with poor sleep quality. In conclusion, the prevalence of poor subjective sleep quality in elite judo athletes was suggested to be similar or higher among elite athlete population. Sleep latency, sleep duration, and daytime dysfunction status were worse in elite judo athletes than in Japanese national-level athletes. Psychological distress was a risk factor for poor subjective sleep quality in elite judo athletes.

Supplementary Information

The online version contains supplementary material available at 10.1007/s41105-023-00444-6.

Interventions to increase sleep duration in young people: A systematic review

This systematic review explored the outcomes of current interventions to increase sleep duration in healthy young people (14-25 years). Nine databases were systematically searched, and 26 studies were included in this review. Quality assessment of the included studies was evaluated using two tools: the Newcastle-Ottawa scale, and Cochrane Risk of Bias. The interventions incorporated a range of strategies including behavioral (46.2%), educational (26.9%), a combination of behavioral and educational (15.4%), and other strategies such as physical therapy (11.5%). The findings indicate that behavioral and combination interventions were consistently effective in increasing sleep duration in healthy young people. Educational interventions alone were less effective at increasing young people's sleep duration. Of all the included studies, only one randomized control trial but none of the non-randomized trials were rated as good quality. Our findings suggest a combination of strategies with an emphasis on personalization of intervention could possibly maximize the chances of success at improving sleep duration in healthy young people. More high-quality studies with long-term assessments (≥ 6 months) should be conducted to test the efficacy and durability of interventions to increase sleep duration in young people, as well as the clinical implications to mental and physical health.

Evaluation of a Brief Sleep Intervention Designed to Improve the Sleep, Mood, and Cognitive Performance of Esports Athletes

This study evaluated a brief sleep intervention designed to improve the sleep, mood, and cognitive performance of professional electronic sports (esports) athletes from three major esports regions (i.e., Asia, North America, and Oceania). Fifty-six esports athletes from South Korea (N = 34), the United States (N = 7), and Australia (N = 15) completed the study. Participants completed an initial 2-week pre-intervention phase to establish a baseline, followed by a 2-week intervention phase that involved a group sleep education class, 1:1 session with a trained clinical psychologist, and daily biofeedback. A wrist activity monitor and daily sleep diary were used to monitor sleep during both phases, while at pre- and post-intervention, participants completed a battery of sleep and mood questionnaires and underwent cognitive performance testing. Sleep knowledge increased from pre- to post-intervention (d = 0.83 [95% CI −1.21, −0.43], p =< 0.001), while there were modest improvements in sleep diary estimates (i.e., sleep onset latency (Mdiff = −2.9 min, p = 0.02), sleep onset time (Mdiff = −12 min, p = 0.03), and sleep efficiency (Mdiff = 1.1%, p = 0.004)) and wrist activity monitor estimates (i.e., sleep onset time (Mdiff = −18 min, p = 0.01)). Insomnia severity scores decreased significantly (d = 0.47 [95% CI 0.08, 0.84], p = 0.001), while sleepiness scores increased but not meaningfully (d = 0.23 [95% CI −0.61, 0.14], p = 0.025). However, there was no significant change in mood (i.e., depression and anxiety) or cognitive performance scores (i.e., mean reaction time or lapses). Sleep interventions for esports athletes require further investigation. Future research should examine whether a stepped-care model, whereby increasing therapeutic input is provided as needed, can optimize sleep, mood, and cognitive performance outcomes.

An Individualized Intervention Increases Sleep Duration in Professional Athletes

ABSTRACT

Sargent, C, Lastella, M, Schwerdt, S, and Roach, GD. An individualized intervention increases sleep duration in professional athletes. J Strength Cond Res 35(12): 3407-3413, 2021-Athletes typically obtain less sleep than is generally recommended for healthy adults. The aim of this study was to determine whether individualized feedback could increase sleep duration in professional cricket players in the 3 weeks before the start of the domestic season. Players were randomly assigned to a control group (i.e., no individual feedback; n = 8) or an intervention group (i.e., individual feedback about bedtime, wake time, and sleep duration; n = 7). Night-time sleep and daytime naps were monitored using wrist activity monitors in conjunction with self-report sleep diaries for 1 week before, and 1 week after, the feedback intervention. Cumulative sleep duration was calculated as the sum of the sleep duration for a night-time sleep episode and any naps that occurred on the following day. Differences in cumulative sleep duration before and after the intervention were examined using a mixed-effects analysis of variance. There was an interaction between group and week for cumulative sleep duration (p = 0.039; η2 = 0.6; large). The average cumulative sleep duration was longer (+36 minutes) in the intervention group in week 2 compared with week 1. Individualized feedback can be used to increase sleep duration in professional cricket players. In future, it will be important to determine whether improvements in sleep duration can be maintained throughout the season.

Behavioral interventions to extend sleep duration: A systematic review and meta-analysis

The goal of this study was to examine the effects of behavioral sleep extension interventions on sleep duration outcomes in children and adults ≥ age 12. We conducted a systematic literature review, article extraction and meta-analysis. Our search yielded 42 studies from 14 countries. The majority of studies (n = 19) enrolled adults, 10 studies enrolled college students, 13 enrolled children (high school or middle school aged). Results from the meta-analysis demonstrated behavioral sleep extension resulted in a significantly higher sleep duration as compared to control group or baseline, with pooled standardized mean difference (SMD) that was similar for both two-arm 0.80 (95 % CI 0.28 to 1.31; p < 0.01; I2 = 99.2%) and one-arm studies 0.75 (95% CI 0.39 to 1.11; p < 0.01; I2 = 86%), and there was significant heterogeneity among both study types. Subgroup analyses revealed that studies with direct interventions on sleep duration (i.e., specified the sleep schedule) had larger effects compared to indirect methods (coaching, educational approaches) and a greater number of curriculum components was associated with smaller effects. Results of this review demonstrate that sleep extension studies are effective at extending sleep in a variety of populations but improving the description of intervention methods and use of more rigorous study designs will improve the quality and reproducibility of this area of research.

High sleep quality can increase the performance of CrossFit® athletes in highly technical- and cognitive-demanding categories

BACKGROUND

In current sports science, the important role of sleep quality for health and peak performance is well acknowledged. More precisely, it is evident that the negative combination of stressful factors, low resources, and bad sleep habits causes short-term performance losses as well as long-term health consequences. As the maximization of human performance consisting of multiple fixed workloads is the main motivation in CrossFit® (CF), the aim of the present study was to investigate the influence of high sleep quality on performance in CrossFit® athletes (CFA) and the different training categories that are addressed in CF.

METHODS

In total, 149 CFA (81 females, 68 males; 32.01 ± 7.49 years old, 2.56 ± 1.77 active years in CF) filled in the online survey comprising the Pittsburgh Sleep Quality Index (PSQI) and CF performance-specific questions.

RESULTS

It was found that CFA with high sleep quality reported higher values in all performance-related outcomes. Especially in Hero-/Girl-Workouts (χ2 = (1, n = 83) = 9.92, p = .002, φ = 0.37) and Gymnastics (χ2 = (1, n = 129) = 8.74, p = .003, φ = 0.28), performance differed significantly between good and poor sleeping CFA. Since those CF categories are highly technical- and cognitive-demanding high sleep quality seems to play a fundamental role in complex motor skill learning and performance development.

CONCLUSIONS

These results reveal for the first time the positive effects of high sleep quality for performance in CFA and could be used as basis for future studies. Future research should also develop and empirically test suitable interventions to foster high sleep quality in CFA.

TRIAL REGISTRATION

The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Ethics Committee of University of the Federal Armed Forces Munich, Germany (06/04/2018).

The Impact of Chronotype on the Sleep and Training Responses of Elite Female Australian Footballers

The primary aims of the present study were to examine the impact of chronotype on sleep/wake behaviour, perceived exertion, and training load among professional footballers. Thirty-six elite female professional football player's (mean ± SD: age, 25 ± 4 y; weight, 68 ± 7 kg) sleep and training behaviours were examined for 10 consecutive nights during a pre-season period using a self-report online player-management system and wrist activity monitors. All athletes completed the Morningness-Eveningness Questionnaire (rMEQ) on the first day of data collection. Eleven participants were morning types, seventeen participants were intermediate types, and three participants were evening types. Separate linear mixed models were conducted to assess differences in sleep, perceived exertion, and training behaviours between chronotype groups. Morning types woke up earlier (wake time: 07:19 ± 01:16 vs. 07:53 ± 01:01, p = 0.04) and reported higher ratings of perceived exertion compared to intermediate types (6.7 ± 1.1 vs. 5.9 ± 1.2, p = 0.01). No differences were observed between chronotype groups for bedtime, time in bed, total sleep time, sleep efficiency, training duration, or training load. In circumstances where professional female football players are required to train at a time opposing their natural circadian preference (e.g., morning type training in the evening), their perceived exertion during training may be higher than that of players that are training at a time that aligns with their natural circadian preference (e.g., evening type training in the evening). It is important for practitioners to monitor individual trends in training variables (e.g., rating of perceived exertion, training load) with relation to athlete chronotype and training time. Future research should examine the relationship between chronotype, training time, and rating of perceived exertion across different training durations.

Deconstructing athletes' sleep: A systematic review of the influence of age, sex, athletic expertise, sport type, and season on sleep characteristics

PURPOSE

This systematic review aimed to describe objective sleep parameters for athletes under different conditions and address potential sleep issues in this specific population.

METHODS

PubMed and Scopus were searched from inception to April 2019. Included studies measured sleep only via objective evaluation tools such as polysomnography or actigraphy. The modified version of the Newcastle-Ottawa Scale was used for the quality assessment of the studies.

RESULTS

Eighty-one studies were included, of which 56 were classified as medium quality, 5 studies as low quality, and 20 studies as high quality. A total of 1830 athletes were monitored over 18,958 nights. Average values for sleep-related parameters were calculated for all athletes according to sex, age, athletic expertise level, training season, and type of sport. Athletes slept on average 7.2 ± 1.1 h/night (mean ± SD), with 86.3% ± 6.8% sleep efficiency (SE). In all datasets, the athletes' mean total sleep time was <8 h. SE was low for young athletes (80.3% ± 8.8%). Reduced SE was attributed to high wake after sleep onset rather than sleep onset latency. During heavy training periods, sleep duration and SE were on average 36 min and 0.8% less compared to pre-season and 42 min and 3.0% less compared to in-season training periods, respectively.

CONCLUSION

Athletes' sleep duration was found to be short with low SE, in comparison to the general consensus for non-athlete healthy adults. Notable sleep issues were revealed in young athletes. Sleep quality and architecture tend to change across different training periods.

Complete sleep evaluation of top professional cross-country mountain bikers athletes

BACKGROUND

Despite growing interest in athletes' sleep, few studies have focused on professional athletes, especially in individual sports. Moreover, limited investigations included female athletes. This study aims to evaluate sleep chronotype, as well as objective and subjective sleep characteristics in male and female professional cross-country mountain bikers.

METHODS

Thirteen athletes (7 males and 6 females) of the French national team took part in this study. The Chronotype was assessed by the Horne and Östberg Morningness-Eveningness Questionnaire and sleep by actigraphy for one month, by ambulatory polysomnography (PSG) for one night and by the Pittsburgh Sleep Quality Index.

RESULTS

Most athletes (77 %) are classified as moderately morning type and a minority of athletes (23 %) are intermediate type. Athletes sleep on average 8 hours per night and during the night recorded by PSG, N3 and REM sleep stages represented 21.2 ± 3.4 % and 20.9 ± 3.1 % of the total sleep time, respectively. These good sleep parameters were confirmed by subjective data with 77 % good sleepers. Except the poorer subjective sleep quality in female athletes (5.7 ± 1.6) compared to male athletes (2.6 ± 1.7, p < 0.05), no significant sex difference was found for all characteristics evaluated.

CONCLUSIONS

The professional status of these athletes and the organization of mountain bike calendar may explain their good sleep characteristics.

Sleep Quality in Chilean Professional Soccer Players

Recent research has shown that good sleep quality has a positive effect on physical performance. However, sleep quality in Chilean professional soccer players is unknown. The purpose of this study was to determine sleep quality in Chilean professional soccer players. It was a cross-sectional, explanatory study with observable variables. The sample consisted of 94 Chilean male soccer players belonging to four professional clubs. The main variable was the Sleep Quality Index, evaluated through the Pittsburgh questionnaire (Spanish version). After estimating sleep quality individually, the four professional soccer clubs’ comparison was performed through a one-factor ANOVA. The Pearson test was used to relate the questionnaire variables; the significance level was p < 0.05. In the global analysis of the Pittsburgh Sleep Quality Index, a value of 4.75 ± 2.29 on a scale of 0–21 was observed, with no significant differences between the clubs evaluated (p > 0.05). Based on the results obtained, Chilean male professional soccer players present good sleep quality. However, the high values of “sleep latency” and “sleep disturbances” are indicators that should be worked on by the multidisciplinary team of each professional club. They should develop strategies to improve sleep hygiene, encourage good sleep, and fall asleep efficiently.

How Much Sleep Does an Elite Athlete Need?

PURPOSE

Anecdotal reports indicate that many elite athletes are dissatisfied with their sleep, but little is known about their actual sleep requirements. Therefore, the aim of this study was to compare the self-assessed sleep need of elite athletes with an objective measure of their habitual sleep duration.

METHODS

Participants were 175 elite athletes (n = 30 females), age 22.2 (3.8) years (mean [SD]) from 12 individual and team sports. The athletes answered the question "how many hours of sleep do you need to feel rested?" and they kept a self-report sleep diary and wore a wrist activity monitor for ∼12 nights during a normal phase of training. For each athlete, a sleep deficit index was calculated by subtracting their average sleep duration from their self-assessed sleep need.

RESULTS

The athletes needed 8.3 (0.9) hours of sleep to feel rested, their average sleep duration was 6.7 (0.8) hours, and they had a sleep deficit index of 96.0 (60.6) minutes. Only 3% of athletes obtained enough sleep to satisfy their self-assessed sleep need, and 71% of athletes fell short by an hour or more. Specifically, habitual sleep duration was shorter in athletes from individual sports than in athletes from team sports (F1,173 = 13.1, P < .001; d = 0.6, medium), despite their similar sleep need (F1,173 = 1.40, P = .24; d = 0.2, small).

CONCLUSIONS

The majority of elite athletes obtain substantially less than their self-assessed sleep need. This is a critical finding, given that insufficient sleep may compromise an athlete's capacity to train effectively and/or compete optimally.

The Sleep of Elite Australian Rules Footballers During Preseason: A Comparison of Men and Women

PURPOSE

Australian football has elite men's (Australian Football League; AFL) and women's (Australian Football League Women's; AFLW) competitions. This study compared AFL and AFLW players' sleep and characterized players' sleep in the context of current sleep recommendations.

METHODS

A total of 70 players (36 AFL, 34 AFLW) had their sleep monitored via actigraphy over a 10-day preseason period. Sleep outcomes and their intraindividual variation, were compared between AFL and AFLW players using linear mixed models. Proportions of players sleeping ≥7 and ≥8 hours per night, and achieving ≥85% sleep efficiency, were compared using chi-square analyses.

RESULTS

Compared with AFL players, AFLW players slept less (7.9 [0.5] vs 7.1 [0.6] h, P = .000), had lower sleep efficiency (89.5% [2.8%] vs 84.0% [4.4%], P = .000), and greater intraindividual variation in sleep efficiency (3.1% [0.9%] vs 5.1% [2.1%], P = .000). A total of 47% of AFLW versus 3% of AFL players averaged <7 hours sleep (χ2 = 18.6, P = .000). A total of 88% of AFLW versus 50% of AFL players averaged <8 hours sleep (χ2 = 11.9, P = .001). A total of 53% of AFLW versus 14% of AFL players averaged <85% sleep efficiency (χ2 = 12.1, P = .001).

CONCLUSIONS

AFLW players slept less and had poorer sleep quality than AFL players. Many AFLW players do not meet current sleep duration or sleep quality recommendations. Research should test strategies to improve sleep among Australian rules footballers, particularly among elite women.

A Combined Sleep Hygiene and Mindfulness Intervention to Improve Sleep and Well-Being During High-Performance Youth Tennis Tournaments

PURPOSE

To investigate the effects of combined sleep hygiene recommendations and mindfulness on actigraphy-based sleep parameters, perceptual well-being, anxiety, and match outcomes during high-performance junior tennis tournaments.

METHODS

In a randomized crossover design, 17 high-performance junior tennis players completed the baseline, control, and intervention (INT) conditions across 3 separate weeks. The baseline consisted of unassisted, habitual sleep during a regular training week, and the control was unassisted sleep during a tournament week. The players attended a sleep education workshop and completed a nightly sleep hygiene protocol during a tournament week for the INT. Analysis was performed on the weekly means and on the night prior to the first match of the tournament (T-1).

RESULTS

Significant differences were observed for increased time in bed, total sleep time, and an earlier bedtime (P < .05) across the INT week. These parameters also significantly improved on T-1 of the INT. A moderate effect size (P > .05, d > 1.00) was evident for decreased worry on T-1 of the INT. Small effect sizes were also evident for improved mood, cognitive anxiety, and sleep rating across the INT week. The match performance outcomes remained unchanged (P > .05).

CONCLUSIONS

Sleep hygiene INTs increase the sleep duration of high-performance junior tennis players in tournament settings, including the night prior to the tournament's first match. The effects on perceptual well-being and anxiety are unclear, although small trends suggest improved mood, despite no effect on generic match performance outcomes.

A critical review on sleep assessment methodologies in athletic populations: factors to be considered

A growing body of research focus on athletes' sleep in order to investigate the effects of sleep in sports performance and recovery or the prevalence of sleep disorders in athletes. At the same time, several sleep monitoring tools have been developed and used in athletic populations for fulfilling these purposes. This review aimed to provide critical assessment to the most used by athletes' methodological approaches and compared them with the gold standard approach. Advantages and disadvantages of the various sleep monitoring tools were critically discussed. Literature related to aspects of athletes' sleep was reviewed. From the shortlisted studies, several factors that seem to affect sleep in athletes were identified using objective methods such as polysomnography/electroencephalography and actigraphy. These factors were associated to sleep (eg such as sleep environment, familiarization procedures and napping) and daily habits (eg nutrition, fluid consumption, alcohol and caffeine intake, tobacco use). The selected studies that evaluated sleep objectively were screened according the reporting rates of these variables. The majority of the screened studies were found to underreport these variables. Practical issues were addressed and recommendations about reporting sleep-related factors were made in order to improve studies' quality assessment and allow for more robust comparisons between studies.

Sleep Monitoring in Athletes: Motivation, Methods, Miscalculations and Why it Matters

It is increasingly recognised that many athletes have poor sleep quantity and/or quality despite the advances in knowledge regarding the importance of sleep for an athletic population. The majority of research in sleep assessment and treatment (within the general population) focuses on the medical disorder insomnia, and therefore may not be specifically relevant for athletes. Further, there are currently no guidelines for the standardisation of assessment, intervention, feedback and behaviour change strategies in athletes. This review outlines potential reasons for sleep disturbances in athletes, advantages and disadvantages of a range of methods to assess sleep (polysomnography, activity monitoring, consumer sleep technology, sleep diaries and questionnaires), considerations for the provision of feedback, a description of potential interventions and behaviour change challenges and strategies. The objective of this review is to provide practitioners with the latest scientific evidence in an area rapidly progressing in awareness, consumerism and athlete engagement.

Global Research Output on Sleep Research in Athletes from 1966 to 2019: A Bibliometric Analysis

This study examined sleep research in athletes published between 1966 and 2019, through a bibliometric analysis of research output in the Scopus database. Following a robust assessment of titles, the bibliometric indicators of productivity for studies included in the final analysis were: Distribution of publications and citations (excluding self-citations), top ten active journals, countries, institutions and authors, single- and multi-country collaboration, and 25 top-cited papers. Out of the 1015 papers, 313 were included in the final analysis. The majority of the papers were research articles (n = 259; 82.8%) and published in English (n = 295; 94.3%). From 2011, there was a dramatic increase in papers published (n = 257; 82.1%) and citations (n = 3538; 91.0%). The number of collaborations increased after 2001, with papers published through international (n = 81; 25.9%) and national (n = 192; 61.3%) collaboration. Australia was the most prolific country in terms of number of publications (n = 97; 31.0%), and citations (n = 1529; 15.8%). In conclusion, after the beginning of the twenty-first century, the scientific production on sleep research in athletes has seen significant growth in publication and citation output. Future research should focus on interventions to improve sleep in athletes.

Mental Health Issues and Psychological Factors in Athletes: Detection, Management, Effect on Performance, and Prevention: American Medical Society for Sports Medicine Position Statement

The American Medical Society for Sports Medicine convened a panel of experts to provide an evidence-based, best practices document to assist sports medicine physicians and other members of the athletic care network with the detection, treatment, and prevention of mental health issues in competitive athletes. This statement discusses how members of the sports medicine team, including team physicians, athletic trainers, and mental health providers, work together in providing comprehensive psychological care to athletes. It specifically addresses psychological factors in athletes including personality issues and the psychological response to injury and illness. The statement also examines the athletic culture and environmental factors that commonly impact mental health, including sexuality and gender issues, hazing, bullying, sexual misconduct, and transition from sport. Specific mental health disorders in athletes, such as eating disorders/disordered eating, depression and suicide, anxiety and stress, overtraining, sleep disorders, and attention-deficit/hyperactivity disorder, are reviewed with a focus on detection, management, the effect on performance, and prevention. This document uses the Strength of Recommendation Taxonomy (SORT) to grade level of evidence.

Gender differences in sleep patterns and sleep complaints of elite athletes

OBJECTIVE

The present study aimed to investigate the gender differences for sleep complaints, patterns and disorders of elite athletes during preparation for the Rio 2016 Olympic Games.

METHODS

The study included 146 athletes from the Brazilian Olympic Team (male: n=86; 59%; female: n=60; 41%). The assessment of the Olympic athletes' sleep took place in 2015, during the preparation period for the Rio Olympic Games. The athletes underwent a single polysomnography (PSG) evaluation. Sleep specialists evaluated the athletes and asked about their sleep complaints during a clinical consultation. In this evaluation week, the athletes did not take part in any training or competitions.

RESULTS

The prevalence of sleep complaints was 53% of the athletes during the medical consultation, the most prevalent being insufficient sleep/waking up tired (32%), followed by snoring (21%) and insomnia (19.2%). In relation to the sleep pattern findings, the men had significantly higher sleep latency and wake after sleep onset than the women (p=0.004 and p=0.002, respectively). The sleep efficiency and sleep stages revealed that men had a lower percentage of sleep efficiency and slow wave sleep than the women (p=0.001 and p=0.05, respectively).

CONCLUSION

Most athletes reported some sleep complaints, with men reporting more sleep complaints than women in the clinical evaluation. The PSG showed that 36% of all athletes had a sleep disorder with a greater reduction in sleep quality in men than in women.

Acute sleep hygiene strategy improves objective sleep latency following a late-evening soccer-specific training session: A randomized controlled trial

The aim of this study was to evaluate the effects of sleep hygiene (SH) education on sleep quality in soccer players after a late-evening small-sided-game (SSG) training session. Twenty-nine non-professional players were recruited and allocated to either an experimental group (EG, n = 17) that received SH education, or a control group (CG, n = 12). SSG consisted of 3 × 4 min in a 4vs4, with 3 min of recovery and was performed at 8.00 p.m. Sleep quality was monitored via actigraphy and sleep diary entries before (PRE) and two nights after (POST1, POST2) the SSG. Sleep latency (SL) differed between the two groups at POST1 (4.9 ± 5.4 vs. 15.5 ± 16.1 for EG and CG, respectively; p = 0.017, effect size [ES] = 2.0); SL values were lower at POST1 compared to PRE for the EG (-47%; p = 0.021, ES = 0.6). Subjective sleep quality was better in the EG than the CG at POST1 (8.6 ± 1.0 vs. 7.1 ± 2.0 for EG and CG, respectively; p = 0.016, ES = 0.9) with a significant improvement over PRE-values (+11.0%, p = 0.004, ES = 0.8). Although SL and subjective sleep quality did not decrease significantly from POST1 to POST2 values at POST2 no longer differed significantly form baseline and, hence, indicate that observed effects may be short-lasting. No other objective sleep indices were influenced by late-evening training or SH practices implemented by the EG. Soccer players may benefit from acute SH strategies to reduce the time to sleep onset after late-evening training sessions.

Identifying Meaningful Patient Outcomes After Lower Extremity Injury, Part 1: Patient Experiences During Recovery

CONTEXT

Determining meaningful aspects of health is crucial for outcome assessment; however, limited literature exists on the aspects of health that are deemed meaningful by the athletic patient population.

OBJECTIVE

To identify experiences and meaningful outcomes after lower extremity (LE) musculoskeletal injury among collegiate athletes.

DESIGN

Qualitative study.

SETTING

University laboratory.

PATIENTS OR OTHER PARTICIPANTS

A purposive sample of 20 athletes (10 men, 10 women; age = 20.1 ± 1.83 years) from a National Collegiate Athletic Association Division I institution in the Midwest who had sustained an LE injury.

DATA COLLECTION AND ANALYSIS

Semistructured face-to-face interviews and inductive data analysis were conducted. Trustworthiness of the data was established using member checks and peer debriefing.

RESULTS

Four themes emerged from the data, revealing that physical changes, psychological changes, personal and lifestyle changes, and support were the most meaningful outcomes among athletes with an LE injury. The 4 themes were associated with 21 subthemes, indicating the complexity with which LE injury affects individuals.

CONCLUSIONS

Our findings demonstrate the importance of caring for the whole person. Athletic trainers must broaden their focus to provide the best patient care and consider the person's activities and life demands outside of athletic participation. The themes identified in this study provide a basis for selecting appropriate health markers and outcome measures.

Behavioral Modification Enhances the Benefits from Structured Aerobic and Resistance Training

Behavioral modification (BM) is a strategy designed to sustain or restore well-being through effects such as enhanced relaxation, reduced stress, and improved sleep. Few studies have explored the role of BM delivered in the context of fitness programs for healthy adults. Thus, the purpose of this investigation was to examine whether BM combined with aerobic and resistance training programs would improve health and fitness measures more than the exercise training alone. Thirty-two healthy fitness club members (19 men) were randomized to receive a BM program (n=15) or an equal-attention (EA) control (n=17). BM consisted of twelve, 10-min education sessions between a trained fitness professional and the participant, coupled with weekly, individualized relaxation, stress reduction, and sleep improvement assignments. All participants engaged in 1 h of coached resistance training and remotely guided aerobic exercise thrice weekly for 12 weeks. Fitness measures (aerobic performance, body composition, muscle strength and endurance, lower-body power), sleep characteristics, and heart rate variability (HRV) were obtained at baseline and after the 12-week program. BM resulted in greater improvements in aerobic performance (increased maximum oxygen uptake, metabolic (lactate) threshold, and percent of maximum oxygen uptake at which metabolic threshold occurred), peak and average lower-body power, and body composition (decreased body fat percentage and fat mass) compared to EA. BM also positively influenced parasympathetic tone through increased High-frequency HRV. BM resulted in greater improvements in fitness measures, body composition, and heart rate variability compared with EA. These findings have intriguing implications regarding the role of BM in augmenting health and physical performance.

Sleep Hygiene for Optimizing Recovery in Athletes: Review and Recommendations

For elite athletes who exercise at a high level, sleep is critical to overall health. Many studies have documented the effects of sleep deprivation in the general population, but few studies exist regarding specific effects in the athlete. This review summarizes the effects of sleep deprivation and sleep extension on athletic performance, including reaction time, accuracy, strength and endurance, and cognitive function. There are clear negative effects of sleep deprivation on performance, including reaction time, accuracy, vigor, submaximal strength, and endurance. Cognitive functions such as judgment and decision-making also suffer. Sleep extension can positively affect reaction times, mood, sprint times, tennis serve accuracy, swim turns, kick stroke efficiency, and increased free throw and 3-point accuracy. Banking sleep (sleep extension prior to night of intentional sleep deprivation before sporting event) is a new concept that may also improve performance. For sports medicine providers, the negative effects of sleep deprivation cannot be overstated to athletes. To battle sleep deprivation, athletes may seek supplements with potentially serious side effects; improving sleep quality however is simple and effective, benefiting not only athlete health but also athletic performance.

Wake up call for collegiate athlete sleep: narrative review and consensus recommendations from the NCAA Interassociation Task Force on Sleep and Wellness

Sleep is an important determinant of collegiate athlete health, well-being and performance. However, collegiate athlete social and physical environments are often not conducive to obtaining restorative sleep. Traditionally, sleep has not been a primary focus of collegiate athletic training and is neglected due to competing academic, athletic and social demands. Collegiate athletics departments are well positioned to facilitate better sleep culture for their athletes. Recognising the lack of evidence-based or consensus-based guidelines for sleep management and restorative sleep for collegiate athletes, the National Collegiate Athletic Association hosted a sleep summit in 2017. Members of the Interassociation Task Force on Sleep and Wellness reviewed current data related to collegiate athlete sleep and aimed to develop consensus recommendations on sleep management and restorative sleep using the Delphi method. In this paper, we provide a narrative review of four topics central to collegiate athlete sleep: (1) sleep patterns and disorders among collegiate athletes; (2) sleep and optimal functioning among athletes; (3) screening, tracking and assessment of athlete sleep; and (4) interventions to improve sleep. We also present five consensus recommendations for colleges to improve their athletes’ sleep.

Inter-relationship between sleep quality, insomnia and sleep disorders in professional soccer players

Objective

Insufficient sleep duration and quality has negative effects on athletic performance, injury susceptibility and athlete development. This study aimed to assess the sleep characteristics of professional Qatar Stars League (QSL) soccer players.

Methods

In a cross-sectional study, QSL players (n=111; 23.7±4.8 years) completed three questionnaires to screen sleep disorders: (1) Pittsburgh Sleep Quality Index (PSQI), (2) Insomnia Severity Index (ISI) and (3) Epworth Sleepiness Scale (ESS). Poor sleep quality was defined as PSQI≥5, excessive daytime sleepiness was defined by ESS>8 and insomnia was defined as ISI≥11.

Results

The prevalence of poor sleep quality (PSQI≥5) was 68.5%, with subthreshold insomnia (ISI≥11) 27.0% and daytime sleepiness 22.5% (ESS>8). Sleep quality was positively associated with insomnia (r=0.42, p<0.001) and daytime sleepiness (r=0.23, p=0.018). Age, anthropometry, body composition and ethnicity were not associated with any of the reported sleep quality parameters.

Conclusion

The prevalence of poor sleep quality (68.5%) reported should concern practitioners. Increasing awareness of the importance of sleep relative to athletic performance, recovery, injury and illness appears prudent. Further, regular qualitative/quantitative sleep monitoring may help target subsequent evidence-informed interventions to improve sleep in those demonstrating undesirable sleep traits.

Sleep practices implemented by team sport coaches and sports science support staff: A potential avenue to improve athlete sleep?

OBJECTIVES

The primary aims of the present study were to assess the sleep hygiene knowledge of high performance team sport coaches and sports science support staff; the sleep practices these individuals implement with athletes; and the barriers to the more frequent use of these practices.

DESIGN

Cross-sectional observational study.

METHODS

A sample of 86 Australian coaches and sports science support staff working within high performance team sport volunteered to complete a four-part questionnaire, including the Sleep Beliefs Survey used to assess sleep hygiene knowledge.

RESULTS

Overall sleep hygiene knowledge was adequate (15.3±2.9, score range 0-20; mean±SD), however knowledge of sleep-wake cycle behaviours (score 4.9±1.6 out of 7) and thoughts and attitudes about sleep (3.6±1.0 out of 5) were inadequate. Over half (56%) of coaches and support staff had monitored athlete sleep, while 43% had promoted sleep hygiene. Lack of resources (response range 44-60%) and knowledge (16-41%) were the two main barriers to the implementation of sleep monitoring and sleep hygiene practices.

CONCLUSIONS

Team sport coaches and sports science support staff have adequate overall sleep hygiene knowledge, yet some specific areas (e.g. sleep-wake cycle behaviours) warrant improvement. There appear to be limited sleep practices implemented with athletes, particularly regarding the promotion of sleep hygiene. The development of educational sleep resources for coaches and support staff to implement with athletes may help address the identified barriers and improve sleep knowledge.

Which parameters to use for sleep quality monitoring in team sport athletes? A systematic review and meta-analysis

Background

Sleep quality is an essential component of athlete's recovery. However, a better understanding of the parameters to adequately quantify sleep quality in team sport athletes is clearly warranted.

Objective

To identify which parameters to use for sleep quality monitoring in team sport athletes.

Methods

Systematic searches for articles reporting the qualitative markers related to sleep in team sport athletes were conducted in PubMed, Scopus, SPORTDiscus and Web of Science online databases. The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. For the meta-analysis, effect sizes with 95% CI were calculated and heterogeneity was assessed using a random-effects model. The coefficient of variation (CV) with 95% CI was also calculated to assess the level of instability of each parameter.

Results

In general, 30 measuring instruments were used for monitoring sleep quality. A meta-analysis was undertaken on 15 of these parameters. Four objective parameters inferred by actigraphy had significant results (sleep efficiency with small CV and sleep latency, wake episodes and total wake episode duration with large CV). Six subjective parameters obtained from questionnaires and scales also had meaningful results (Pittsburgh Sleep Quality Index (sleep efficiency), Likert scale (Hooper), Likert scale (no reference), Liverpool Jet-Lag Questionnaire, Liverpool Jet-Lag Questionnaire (sleep rating) and RESTQ (sleep quality)).

Conclusions

These data suggest that sleep efficiency using actigraphy, Pittsburgh Sleep Quality Index, Likert scale, Liverpool Jet-Lag Questionnaire and RESTQ are indicated to monitor sleep quality in team sport athletes.

PROSPERO registration number

CRD42018083941.

Sleep-Related Issues for Recovery and Performance in Athletes

The body of research that reports the relevance of sleep in high-performance sports is growing steadily. While the identification of sleep cycles and diagnosis of sleep disorders are limited to lab-based assessment via polysomnography, the development of activity-based devices estimating sleep patterns provides greater insight into the sleep behavior of athletes in ecological settings. Generally, small sleep quantity and/or poor quality appears to exist in many athletic populations, although this may be related to training and competition context. Typical sleep-affecting factors are the scheduling of training sessions and competitions, as well as impaired sleep onset as a result of increased arousal prior to competition or due to the use of electronic devices before bedtime. Further challenges are travel demands, which may be accompanied by jet-lag symptoms and disruption of sleep habits. Promotion of sleep may be approached via behavioral strategies such as sleep hygiene, extending nighttime sleep, or daytime napping. Pharmacological interventions should be limited to clinically induced treatments, as evidence among healthy and athletic populations is lacking. To optimize and manage sleep in athletes, it is recommended to implement routine sleep monitoring on an individual basis.

Effects of training and competition on the sleep of elite athletes: a systematic review and meta-analysis

Objectives

To characterise the sleep of elite athletes and to identify factors associated with training and competition that negatively affect sleep.

Design

Prognosis systematic review.

Data sources

Three databases (PubMed, SCOPUS and SPORTDiscus) were searched from inception to 26 February 2018.

Eligibility criteria for selecting studies

Included studies objectively reported total sleep time (TST) and/or sleep efficiency (SE) in elite athletes. Studies were required to be observational or to include an observational trial.

Results

Fifty-four studies were included. During training, many studies reported athletes were unable to achieve TST (n=23/41) and/or SE (n=16/37) recommendations. On the night of competition, most studies reported athletes were unable to achieve TST (n=14/18) and/or SE (n=10/16) recommendations. TST was shorter (60 min) the night of competition compared with previous nights. SE was lower (1%) the night of competition compared with the previous night. TST was shorter the night of night competition (start ≥18:00; 80 min) and day competition (20 min) compared with the previous night. SE was lower (3%–4%) the night of night competition but unchanged the night of day competition compared with previous nights. Early morning training (start <07:00), increases in training load (>25%), late night/early morning travel departure times, eastward air travel and altitude ascent impaired sleep.

Conclusion

Athletes were often unable to achieve sleep recommendations during training or competition periods. Sleep was impaired the night of competition compared with previous nights. Early morning training, increases in training load, travel departure times, jet lag and altitude can impair athletes’ sleep.

PROSPERO registration number

CRD42017074367.

From pillow to podium: a review on understanding sleep for elite athletes

Sleep is considered vital to human health and well-being, and is critical to physiological and cognitive functioning. Elite athletes experience high training and competition demands, and are often exposed to various factors, situations, and environments that can cause sleep impairments. Previous research has shown that athletes commonly experience sleep loss in the lead up to and following competition, which could have significant impacts on their preparation, performance, and recovery. In particular, the results from previous research show significant reductions in total sleep time (~1:40 h:min) and significant increases in sleep latency (~45 minutes) following evening competition. Napping is common in both the training and competition setting in athletes; however, research on the effect of napping on physiology and performance is limited. In contrast, research on strategies and interventions to improve sleep are increasing in the athletic population, with sleep hygiene research resulting in significant improvements in key sleep indices. This review investigates the physiological importance of sleep in athletes, current tools to monitor athletes' sleep, the role of sleep for cognitive functioning and athletic performance, the prevalence of sleep disturbances and the potential mechanisms causing sleep disturbances, the role of napping, and different intervention strategies to improve sleep.

The Variability of Sleep Among Elite Athletes

Practicing sport at the highest level is typically accompanied by several stressors and restrictions on personal life. Elite athletes’ lifestyle delivers a significant challenge to sleep, due to both the physiological and psychological demands, and the training and competition schedules. Inter-individual variability of sleep patterns (e.g., sleep requirements, chronotype) may have important implications not only for recovery and training schedules but also for the choice of measures to possibly improve sleep. This article provides a review of the current available literature regarding the variability of sleep among elite athletes and factors possibly responsible for this phenomenon. We also provide methodological approaches to better address the inter-individual variability of sleep in future studies with elite athletes. There is currently little scientific evidence supporting a specific influence of one particular type of sport on sleep; sleep disorders may be, however, more common in strength/power and contact sports. Sleep behavior may notably vary depending on the athlete’s typical daily schedule. The specificity of training and competition schedules possibly accounts for the single most influential factor leading to inconsistency in sleep among elite athletes (e.g., “social jet lag”). Additionally, athletes are affected by extensive exposure to electric light and evening use of electronic media devices. Therefore, the influence of ordinary sleep, poor sleep, and extended sleep as important additional contributors to training load should be studied. Future experimental studies on sleep and elite sport performance should systematically report the seasonal phase. Boarding conditions may provide a good option to standardize as many variables as possible without the inconvenience of laboratory. The use of interdisciplinary mixed-method approaches should be encouraged in future studies on sleep and elite sport. Finally, high inter- and intra-individual variability in the athletes’ sleep characteristics suggests a need for providing individual responses in addition to group means.

The Effects of Sleep Extension on Sleep, Performance, Immunity and Physical Stress in Rugby Players

(1) Background: The purpose of the present study was to examine the efficacy of sleep extension in professional rugby players. The aims were to: (i) characterise sleep quantity in elite rugby players and determine changes in immune function and stress hormone secretion during a pre-season training programme; (ii) evaluate the efficacy of a sleep extension intervention in improving sleep, markers of physical stress, immune function and performance. (2) Methods: Twenty five highly trained athletes from a professional rugby team (age (mean ± SD) 25 ± 2.7 years; height 1.87 ± 0.07 m; weight 105 ± 12.1 kg) participated in a six week pre-post control-trial intervention study. Variables of sleep, immune function, sympathetic nervous activity, physiological stress and reaction times were measured. (3) Results: Sleep extension resulted in a moderate improvement in sleep quality scores ([mean; ± 90% confidence limits] −24.8%; ± 54.1%) and small to moderate increases in total sleep time (6.3%; ± 6.3%) and time in bed (7.3%; ± 3.6%). In addition, a small decrease in cortisol (−18.7%; ± 26.4%) and mean reaction times (−4.3%; ± 3.1%) was observed following the intervention, compared to the control. (4) Conclusions: Professional rugby players are at risk of poor sleep during pre-season training, with concomitant rises in physical stress. Implementing a sleep extension programme among professional athletes is recommended to improve sleep, with beneficial changes in stress hormone expression and reaction time performance.

Poor sleep is related to lower general health, increased stress and increased confusion in elite Gaelic athletes

OBJECTIVES

Persistent poor sleep is associated with a range of adverse health outcomes. Sleep is considered the main method of recovery in athletes; however, studies report that a significant number of athletes are getting insufficient sleep. The purpose of this study was to assess the sleep profiles of elite Gaelic athletes and to compare wellbeing in those with poor sleep and those with good sleep.

METHODS

69 elite Gaelic athletes completed questionnaires, including the Pittsburgh Sleep Quality Index (PSQI), Subjective Health Complaints Inventory (SHC), Nordic Musculoskeletal Questionnaire (NMQ), stress subscale of the Depression Anxiety Stress Scale (DASS), the tension-anxiety, anger-hostility and confusion-bewilderment subscales of the Profile of Mood States (POMS) as well as the catastrophising subscale of the Coping Strategies Questionnaire (CSQ). Participants were categorised into poor sleepers (PSQI ≥5) and good sleepers (PSQI <5) and outcome measures of health and wellbeing were analysed between the two groups.

RESULTS

47.8% of athletes were poor sleepers. Self-reported sleep duration was 7.5 ± 0.6 h per night. 63.7% of poor sleepers took >30 min to fall asleep, compared to 5.6% of good sleepers. Poor sleepers had significantly lower general health (SHC) (p = 0.029), increased stress (DASS) (p = 0.035) and increased confusion (POMS-subscale) (p = 0.005). There was no significant difference between groups for number of painful body parts (NMQ) (p = 0.052), catastrophising (CSQ) (p = 0.287), overall mood (POMS) (p = 0.059), or POMS subscales of anger (p = 0.346) or tension (p = 0.593).

CONCLUSION

Nearly 50% of elite Gaelic athletes report poor sleep. There is a significant relationship between poor sleep and lower general health, increased stress and increased confusion, and these factors may interact with each other. Monitoring of and interventions to enhance sleep may be required to improve athletes' wellbeing.