The importance of a good night sleep

Our understanding of the science of sleep mirrors our understanding of the human brain: we are only just scratching the surface in what we currently know. Yet we know enough to know “how we sleep” affects every aspect of our lives and performance on the sporting field.


It took for me to have children (who didn’t sleep at night!!), to really appreciate the impact of poor quality sleep on cognitive function, immune ability and physical performance! This article will examine the impact that sleep deficit has on performance and injury, with a future article discussing how to improve sleep. 


Why do we sleep? 


It was once thought that the brain simply “shuts-down” during sleep, yet we now know that there are much more complex activities happening. One way to explain what occurs is “brain housekeeping”: the brain performs checks, repairs and cleaning toxins (beta-amyloid amongst others) [1] that build up during the day. In addition to this, good sleep promotes tissue repair, immune function and hormonal and metabolic rebalancing [2, 3]. 


How do we measure sleep? 


There are continued advancements in technology for quantifying sleep quality. Currently the gold standard is a sleep study conducted in the lab via polysomnography which measures multiple variables including brain waves (EEG), breathing, heart rate and rhythm, muscle activity, eye movement and blood oxygen saturation. 


One could argue, however, that sleeping in a lab connected to multiple machines might not give an accurate result when compared to the individuals “natural” environment [4]. Enter the portable sleep monitoring devices. With the rise of popularity in these devices (FitBit, Oura ring, ReadiBand) and phone apps, the question has to be raised on their accuracy. Most devices are similar in that they are based on the same type of sensor (accelerometer and/or noise). Ultimately, sleep is best tracked through polysomnography, but these devices offer much more accessible and convenient options for casual users to track their activity. Multiple studies [5-8] conclude that wrist monitors can be quite accurate when it comes to estimating information such as total time asleep, sleep percentage, and how long after sleep waking occurs. 


It has been my personal experience with sleep monitoring on both myself and my patients, that if you wake in the morning and you feel tired, you haven’t had ideal sleep quality/quantity. Whilst it’s nice to be able to put an objective measure on everything, sometimes subjective measures can be just as useful, as previously discussed in Saw et al’s study on training response [9]. At a basic level, recording when you went to bed, when you woke, and subjectively measuring how rested you feel in the morning can give you a good indication of your sleep quality. 


How sleep much is normal? 


The National Sleep Foundation’s recommendation for young adults (18-25 years) and adults (26-64 years) is between 7-9 hours. From the research, we see that athletes commonly average below 7 hours [10]. A recent questionnaire based study found that 50% of highly trained and elite athletes were identified as “poor” sleepers, with 28% experiencing daytime sleepiness [11]. 


For athletic individuals, sleep is paramount when considering the training response, which requires a balance between stress, fatigue and recovery[12]. Therefore athletes should look to promote recovery which would then decrease their stress/fatigue state. Sleep is surprisingly often overlooked by athletes themselves as a cause of fatigue [13]. Poor sleep quantity and/or poor quality appears to exist in many athletic populations, which can be due to a combination of scheduling of training sessions and competition, travel fatigue, and impaired sleep-onset due to increased arousal post competition. 


Effects of Sleep on injury and performance 


We previously briefly mentioned the benefits of sleep, but what about the detrimental effects of decreased sleep? 


Injury and Sleep


Milewski et al’s study on adolescent athletes found those who sleep on average less than 8 hours per night have 1.7 times greater risk of being injured than those who slept more than 8 hours [14].


In another study on elite adolescent athletes, von Rosen et al found that sleeping more than 8 hours during a week reduced risk of injury by 61% [15]. 


Illness and Sleep


A range of metabolic and immunologic process are negatively affected by poor sleep [16]. 


Reduced sleep quantity was associated with increased incidence of illness within the next 7 days in competitive male AFL players [17] 


Those who sleep less than 5 hours are 4.5 times more likely to suffer a cold vs those who sleep 7 hours [18]. 


Performance and Sleep


Reductions in motor and cognitive performance, reaction times, and mood state/emotional stability are often observed in sleep-deprived athletes [19]. 


Poor sleep quality, particularly during high training loads and competition periods, has been identified as a marker of under recovery and an early sign of overreaching [20]. 


Brandt et al’s study on Brazilian athletes revealed a relationship between poor sleep quality and lost matches during a competition[21]. 


Silva et al found a correlation between sleep duration and competition performance in elite gymnasts [22].Napping improves running performance in those endurance runners that had less than 7 hours sleep [23]. 


This information should hopefully highlight to you the reader on the importance of sleep, and get you starting the conversation (if you haven’t already) with your athletes about their sleep habits. In our next instalment, we will discuss what can be done in those with suboptimal sleeping habits.


The Importance of Sleep first published by Luke Nelson on May 3, 2019. Original article can be found here.


References 

1. Shokri-Kojori, E., et al., beta-Amyloid accumulation in the human brain after one night of sleep deprivation. Proc Natl Acad Sci U S A, 2018. 115(17): p. 4483-4488. 

2. Bryant, P.A., J. Trinder, and N. Curtis, Sick and tired: does sleep have a vital role in the immune system? Nature Reviews Immunology, 2004. 4: p. 457. 

3. Fullagar, H.H., et al., Sleep and athletic performance: the effects of sleep loss on exercise performance, and physiological and cognitive responses to exercise. Sports Med, 2015. 45(2): p. 161-86. 

4. Kolling, S., et al., Sleep-Related Issues for Recovery and Performance in Athletes. Int J Sports Physiol Perform, 2019. 14(2): p. 144-148. 

5. Martin, J.L. and A.D. Hakim, Wrist actigraphy. Chest, 2011. 139(6): p. 1514-1527. 

6. Marino, M., et al., Measuring sleep: accuracy, sensitivity, and specificity of wrist actigraphy compared to polysomnography. Sleep, 2013. 36(11): p. 1747-55. 

7. Blackwell, T., et al., Comparison of sleep parameters from actigraphy and polysomnography in older women: the SOF study. Sleep, 2008. 31(2): p. 283-91. 

8. Sargent, C., et al., The validity of activity monitors for measuring sleep in elite athletes. J Sci Med Sport, 2016. 19(10): p. 848-53. 

9. Saw, A.E., L.C. Main, and P.B. Gastin, Monitoring the athlete training response: subjective self-reported measures trump commonly used objective measures: a systematic review. British Journal of Sports Medicine, 2015. 

10. Gupta, L., K. Morgan, and S. Gilchrist, Does Elite Sport Degrade Sleep Quality? A Systematic Review. Sports Med, 2017. 47(7): p. 1317-1333. 

11. Swinbourne, R., et al., Prevalence of poor sleep quality, sleepiness and obstructive sleep apnoea risk factors in athletes. Eur J Sport Sci, 2016. 16(7): p. 850-8. 

12. Bird, S., Implementation of Recovery Strategies: 100-Point Weekly Recovery Checklist. Vol. 16. 2011. 16-19. 

13. Venter, R.E., Perceptions of team athletes on the importance of recovery modalities. Eur J Sport Sci, 2014. 

14 Suppl 1: p. S69-76.14. Milewski, M.D., et al., Chronic lack of sleep is associated with increased sports injuries in adolescent athletes. J Pediatr Orthop, 2014. 34(2): p. 129-33. 

15. von Rosen, P., et al., Too little sleep and an unhealthy diet could increase the risk of sustaining a new injury in adolescent elite athletes. Scand J Med Sci Sports, 2016. 

16. Scott, W.A., Maximizing performance and the prevention of injuries in competitive athletes. Curr Sports Med Rep, 2002. 1(3): p. 184-90. 

17. Fitzgerald, D., et al., The influence of sleep and training load on illness in nationally competitive male Australian Football athletes: A cohort study over one season. J Sci Med Sport, 2019. 22(2): p. 130-134. 

18. Prather, A.A., et al., Behaviorally Assessed Sleep and Susceptibility to the Common Cold. Sleep, 2015. 38(9): p. 1353-9. 

19. Walters, P.H., Sleep, the Athlete, and Performance. Strength & Conditioning Journal, 2002. 24(2): p. 17-24. 

20. Bird, S., Sleep, Recovery, and Athletic Performance: A Brief Review and Recommendations. Vol. 35. 2013. 43-47. 

21. Brandt, R., G.G. Bevilacqua, and A. Andrade, Perceived Sleep Quality, Mood States, and Their Relationship With Performance Among Brazilian Elite Athletes During a Competitive Period. J Strength Cond Res, 2017. 31(4): p. 1033-1039. 

22. Silva, M.R. and T. Paiva, Poor precompetitive sleep habits, nutrients’ deficiencies, inappropriate body composition and athletic performance in elite gymnasts. Eur J Sport Sci, 2016. 16(6): p. 726-35. 

23. Blanchfield, A.W., et al., The influence of an afternoon nap on the endurance performance of trained runners. European Journal of Sport Science, 2018. 18(9): p. 1177-1184.