Brander. For the next 10 minutes I'm going to give a super condensed overview of the issue of sleep in athletes. I'm really sorry I can't be there in person, COVID travel restrictions and all, but I have my contact information here. If you have any questions feel free to reach out to me at any time and I can be very responsive. So here's a quick overview of the field of sleep athletics. First of all there's this issue of sleep in neurophysiology where sleep is controlled by actually two different systems in the brain. You have the sleep active system and then the wake active system and these operate separately but in relationship to each other to induce and protect sleep and also to maintain wakefulness when you're awake. There's a third system in the brain too. That's the circadian system. The circadian system is also really involved in sleep-wake regulation in terms of telling your body when it's predisposed to sleep in a biological night versus when it should be awake in a biological way. Sleep is a very dynamic process across the night. Here's a stereotypical image of sleep stages across the night. This is a perfect night of sleep with no awakenings during the night which actually never really happens. Most adults will actually wake up 10 to 20 times during the night but they'll remember one to three but this is a textbook example of sleep cycles across the night. You see stage one and two which are more light sleep and deep sleep periods mostly in the first half of the night and cycles ending with REM periods which start out shorter and get longer as the night goes on. So sleep is a very dynamic process. Each of these sleep stages has many different functions and they work together to optimize health and performance. So a full night of sleep isn't just about the amount of sleep you're getting it's also about the quality of that sleep. Sleep problems are prevalent among athletes. Poor sleep is a risk factor for poor mental health in athletes. Poor sleep impairs athletic performance. Screening for sleep problems in athletes is problematic and it's not done enough yet there are screening tools we could be using. Sleep interventions in athletes there aren't that many of these out there and most of these are done sort of haphazardly without much support. So I'm going to talk a little bit about what that would look like and there's also policy initiatives and physician statements I'm going to mention. So what sort of sleep disturbances do you see in athletes? So you see a lot of insomnia disorder. This is difficulty falling asleep or waking up during the night and having trouble getting back to sleep. Often it can be driven by stress. By the way, insomnia disorder is highly treatable mostly using non-medication approaches. Not talking about sleep hygiene, I'm talking about cognitive behavioral therapy for insomnia, stimulus control, sleep compression therapies, etc. It can be very effective for treating insomnia athletes. Sleep apnea, it's much more common in the U.S. population than most people think. It's not just a disorder of overweight men who are older, though it's most common there. A lot of athletes who especially have bigger necks and higher body mass, like football players and sometimes baseball players, will have high rates of sleep apnea, which again is highly treatable even though it dramatically can impair health and performance if left untreated. Circadian rhythm disorders are also prevalent, especially in younger adults, which make up the population of a lot of elite athletes where they tend to be more phase-delayed, they can experience social jet lag, etc. Then there's other sleep disorders. There's narcolepsy, restless leg syndrome, periodic limb movements, etc. There's a wide range of sleep disorders and many of them don't get often picked up by most practitioners because they're not training them. It's important to know that sleep disorders exist in athletes and that they're highly treatable even though they impair performance. Insufficient sleep is not a sleep disorder, it's just that they're not getting enough. A lot of athletes are experiencing insufficient sleep. I'll show you a little bit of data on this and this is a problem because it impairs performance and health and well-being. Then there's also excessive daytime sleepiness, which is the other side of the coin. Excessive daytime sleepiness is associated with inability to maintain wakefulness during the day and is usually driven by insufficient quality sleep and lack of sleep. The amount of sleep recommended for adults is about seven hours or more. Here are two position statements on the topic. I was involved in the one on the left for the American Academy of Sleep Medicine and Sleep Research Society. The one on the right was the National Sleep Foundation. Both came to the same conclusions. Athletes might actually need a little bit more because of the degree of strain they're putting on their body, the amount of recovery they need. The prevalence of insufficient sleep is high. Here's some NCAA data showing that only about one in five college student athletes are getting the recommended eight hours. Remember, seven hours for most adults, but college students are sort of at the transition between adolescence and young adulthood. They may need a little more, but even if you extend to seven hours, you're looking at, in most cases, the majority of student athletes are not even getting the minimum recommended seven hours. This is important because sleep connects to performance in a lot of ways. Obviously, we don't have time to go into all these, but poor sleep health can represent insufficient sleep duration, poor sleep quality, fatigue and sleepiness during the day, suboptimal sleep timing where you're not in your biological night, irregular sleep schedules where you're waking up very early on some days and sleeping in on others, and also sleep and circadian disorders that need to be diagnosed and treated. These collectively could lead to impaired athletic performance, including reduced muscular strength and speed, injuries and concussion risk, reaction time and vigilance issues where they're slowed down, poor decision making and reduced creativity, problems with learning and memory, and impaired mental health. Athletes really need these to function optimally. I'm not going to go into all of these, obviously, but there's literature on all of them. This review I've cited points to a lot of this. Here's an image from a recent consensus statement on sleep in athletes, just talking about all the different factors that can influence sleep health in athletes that we need to keep in mind. At the center we have sleep disturbance, we have sport-related factors like environments and timing of training and travel and competition and things like that, but there are also non-sport related factors that are involved like social demands, attitudes, beliefs and other commitments. So we do have evidence that working on sleep can improve performance. One of the most famous studies was done about 10 years ago now with Stanford Men's Basketball showing that they increased sleep time by quite a lot and it made them faster. It increased their free throw percent by nine percent and same with their three-point percentage. It was dramatic improvements just by increasing sleep time. They also improved sleepy individuals. Other sports have shown this too. Here's an example from tennis showing that semi-pro tennis players, when their sleep is optimal versus reduced, their serving accuracy is dramatically affected and even if when their sleep was reduced to five hours, if they were caffeinated, it was still impaired. The caffeine rescued some performance benefits but not all. This is endemic in a lot of this literature showing that caffeine does not rescue sleep deprivation. It can improve some aspects of performance but not some of the more complex tasks. Here's one of my favorite studies from baseball showing that a simple daytime sleepiness screening tool that was administered at the start of the 2010 season when followed up in December of 2012 predicted who was going to still be in major leagues and you can see here the higher score on the sleepiness scale, the more likely you were to no longer be playing in the major leagues. It's practically a dose response here. This shows that sleepy players do not perform well no matter what sport they're in. Here's some data on concussions. Using that study as inspiration, we assessed a few measures of sleep in the summer before the fall semester in about 200 college student athletes. Then we followed them up a year later to see who got concussions. What we showed was that the typical concussion risk factors were relevant. Things like whether they've had a concussion before, what sport they play, a male versus female, but we found that sleepiness and insomnia were actually not only strong predictors of incident concussion, they outperformed the other predictors. So having sleepy or having baseline insomnia independently led to increased concussion injuries. So what do we do? Screening is super important and referral to sleep medicine if they have a sleep disorder, you suspect a sleep disorder, get them tested, get them treated. You want to screen for sleep problems and deal with them. You want to also start with some education and culture change. There's a lot to learn about sleep. There's a lot of ways that it can improve performance and there's a lot of things under our control about sleep that we don't think about. A lot of people say, well, I can't improve my sleep because I'm not in control of my schedule. There are a lot of things we can control. I don't have the data here because this presentation is too short, but we did some interventions in college student athletes that showed that we were able to increase sleep time by over an hour without even asking them to spend a whole lot of extra time in bed. We just made their sleep more efficient, for example. And also change in the culture. It's not about sleep is a waste of time or it's inefficient time. Actually, sleep is the other part of recovery and training. Sleep is where you get stronger. Sleep is where you recover, repair, and learn. And so sleep is a critical part of training and recovery. So you have these attitudes like this, which we need to fight, that sleep is more than just a waste of time. Tracking and optimization, not going to get into that rabbit hole, but there's a lot of tools out there that can help you track, but be careful that just measurement alone is often not enough. You might have to have more education and feedback and behavioral interventions. So what should those interventions look like? Well, they're still being developed. Anyone who tells you they have something that's proven and well-studied, don't believe it. We're still sort of developing strategies, but we have a lot of strategies that we can try and we can use coming from the future. And I very briefly in the last minute want to just take you on a whirlwind tour of some other things that you could read and look into to learn more. There's the NCAA Mental Health Best Practices, the IOC Mental Health Position Statement, the NCAA Sleep and Wellness Task Force, the International Consensus Recommendations, and some review papers. So the NCAA came out with these Mental Health Best Practices documents. Sleep actually plays a big part in here. If you look into it, there's some sleep screening tools. This book, Mind, Body, and Sport, freely available, has a whole chapter on sleep. And then in their online newsletter, they followed up and they had me write an article about sleep screening. The consensus document from the IOC focused on mental health, but I helped develop the sleep section in here. This is actually a pretty sizable section on sleep performance. The NCAA actually has the first sleep-focused position statement with some recommendations. This international consensus statement also just came out that I was able to contribute to, looking at recommendations for athletes internationally, in general. And then here's a couple of review papers that I've worked on that provide broad overviews of sleep and athletics, all the stuff I didn't have time to do today. And coming soon, we have the first textbook in the field, Sleep and Sport, that I'm co-editing with Dr. Amy Acy. So sorry for going through this so quickly, but here's my contact information. If you have any questions about sleep and sport or how to develop a sleep health program or how to integrate sleep into your programs, just let me know. I'm really sorry I couldn't be there in person, but I look forward to contacting the organization and hearing from all of you soon. So thanks a lot.

sleep in athletes

neurophysiology of sleep

sleep disturbances

quality sleep

athlete performance