In this guest post, Paul Marlow, a leading advocate in mental health, shares the importance of acknowledging World Mental Health Day 2020, on Saturday, October 10th, sleep health, and immunity in the time of COVID-19.
Professional athletes, and especially aspiring pro athletes, have always done what it takes to get from point A to point B, from one game to the next, with long hours on buses and airplanes and sleep often more neglected than a visiting team mascot. That’s just how it was in pro sports, players sleeping when and how they could, often taking what it takes, from alcohol to medication (and too often a mixture of both) to get the rest required to perform next.
Today’s elite athletes are presumably much more finely tuned and aware of the impacts of poor sleep, not to mention the potential performance consequences of using prescribed or over the counter medications, herbal preparations, and/ or alcohol to get their sleep. However, recent research suggests athletes are still more likely to use (and possibly abuse) sleep medications than those in other professions.
Given the inextricable link between sleep and human performance, elite athletes at every level, weighed with gruelling travel, practice and game time pressures, feel the need for Zzzs, especially in season. But if not carefully managed, under doctor supervision, the quest for a quick sleep fix using sleep aids is often no fix at all when it comes to actual performance. And the route that some athletes are still taking to get that sleep is downright dangerous.
While debate about the effectiveness of each approach is ongoing, there is a wide-variety of both established and emerging sleep aid options available, from nutritional substances to prescription drugs, for managing professional athletes struggling to sleep. All of them require careful consideration and planning with a qualified medical expert.
Most over the counter (OTC) sleep medications are not on the 2016 World Anti-Doping Agency list. However, there are ongoing concerns about their use among elite athletes hoping to realize the performance advantages of improved sleep. In fact, Olympic champions have have been placed into drug rehabilitation due in part to dependence on sleep medication. And at least one high profile Olympic nation recently banned all sleep medication use by their Olympic athletes once selected for Rio 2016. (Taylor, Lee et al)
First and foremost, when it comes to sleep aids of any type, athletes, coaches and training staff have to be strictly aware of and compliant with the medical regulations in each of their sports:
NFLPA Drug Policies
Major League Baseball Joint Drug Prevention and Treatment Program
NBA Collective Bargaining Agreement
NHL Collective Bargaining Agreement
World Anti-Doping Agency’s (WADA) Prohibited List
All of these regulations are in a state of constant flux and need to be regularly and carefully reviewed by players and coaches for compliance. One minor slip can mean severe consequences that will cost athletes far more than a night’s sleep.
One might expect to find mythically strong athletes like Mike Trout or J.J. Watt downing protein drinks rather than sipping on cups of hot tea. However, as the importance of sleep comes further to light, bone china and the high pinky might not just be for the monarchy after all. According to some sports scientists, natural sleep aids like vitamin supplements and yes, herbal teas, should be considered among the first lines of treatment for athletes struggling with sleep.
“The holistic, individualized approach to solving sleep issues in elite athletes is important,” says sports scientist Alan Hsieh. “Trying sleep aid teas with ingredients like valerian root and lemon balm, or making adjustments to diet, sleep environment and routine should always come before sedative-hypnotic prescription drugs, for example. There are a lot of different natural options out there that can potentially make a difference to elite athletes dealing sleep problems. Those should be a starting point.”
Elite athletes don’t have to look hard to find some of those solutions claiming to help combat sleep trouble ‘naturally’. Many haven’t been comprehensively investigated in peer-reviewed scientific literature and rely on subjective results. And the advertising that proclaims effectiveness rely mostly on subjective, anecdotal reports. However, subjectivity plays when it comes to the mysteries of sleep, and a wide variety of natural sleep aids can be easily purchased at drug and health food stores.
Natural sleep aids reported to have some benefit include tart cherry juice, magnesium and calcium, hops, L-theanine, passionflower, kava, St. John’s wort, lysine, chamomile tea, lavender, skullcap, magnolia bark, 5-hydroxytryptamine, and Gamma-Aminobutyric Acid (GABA).
Melatonin is a hormone directly linked to sleep and circadian rhythm in humans. It is derived from serotonin and secreted by the pineal gland, especially in response to darkness. Many of the products listed above are said to help stimulate melatonin production, but again validated scientific proof is scarce. Melatonin is also available in supplemental, over-the-counter pill forms in the United States and Canada and carefully-timed administration has been endorsed by the American Academy of Sleep Medicine for its benefits in helping shift workers, for example.
Melatonin skeptics point toward the relatively limited amount of quantitative data to support its benefits to athletes struggling with sleep.
Proponents point toward melatonin’s use for elite athletes in combating jet lag, for example, as the effects are said to help adjust circadian rhythm by ‘resetting’ the sleep cycle. It’s also favoured because of limited lingering cognitive and psychomotor side effects. However, in addition to grogginess if not used with the correct timing in order, more significant side effects of the use of melatonin in elite athletes include is its tendency to cause reductions of blood pressure; this is especially important in light of relatively lower blood pressures among athletes. Also, it should be noted that melatonin is not recommended by the American Academy of Sleep Medicine as an effective treatment for chronic insomnia.
There is more and more research linking nutrition and sleep. In fact, researchers such Dr. Brandon Marcello report that without proper sleep management, even the most elite nutrition plan for athletes can be rendered nearly useless.
“Nutrition can make a good athlete great, or a great athlete good,” says Marcello, who has implemented successful high-performance training programs for professional, Olympic and collegiate athletes. “When built upon proper sleep habits, these two components can provide both an optimal training response, and improved performance.”
Once again, there is no clear scientific evidence that any macronutrient either enhances or inhibits alertness or sleepiness. However, many foods are reported to increase the production of melatonin and tryptophan, the amino acid that helps stimulate serotonin production. As such healthy, natural foods including tuna, kale, walnuts etc should be carefully considered as part of any plan to try and help athletes improve their sleep.
Doctor should know best when it comes to using sleep medications, for elite athletes or anybody else. But this is not always the case and employing the knowledge of a dedicated sleep expert is becoming more and more common among elite sports teams. Careful diagnosis and ongoing medical monitoring are critical to prescription drug use for sleep trouble, particularly because it’s often key to more significant health issues (depression, anxiety, injury, sleep apnea, etc).
Many athletes have sleep-related health issues and can benefit from detailed monitoring and medical intervention. Learn more about monitoring and managing sleep here.
However, under a qualified doctor’s supervision, when all the natural solutions have been exhausted, there is often no other choice than prescription medication for helping athletes who are dealing with diagnosed sleep disorders. This is especially relevant for those with more severe bouts of measurable insomnia or prolonged sleep deprivation related to unavoidable circadian disruptions (i.e., from travel) or environmental factors such as noise, heat, uncomfortable sleep surfaces, crowded sleep environments, etc..
Many prescription sleep drugs have been tested by scientists who work with military pilots, for example, with the benefits measured in terms of performance in complex flight operations involving both physical and cognitive dexterity. Several compounds have proven both safe and effective when used properly. In fact, according to researchers, performance after sleep induced with these medications is often far superior to performance after the disrupted or shortened sleep that occurs without the sleep aids.
A recent book co-authored by Dr. John Caldwell and Ian C. Dunican reports competitive and performance advantages for athletes using sleep medication under careful monitoring. Titled “Managing Sleep and Jet Lag for Optimal Performance” the book helps outline how high performance athletes dealing with sleep deficiencies can be treated using either Zolpidem (Ambien) or Temazepam (Restoril).
“It is very hard to fall asleep 2-3 hours earlier than usual, and going to bed very late in the (new) destination time zone may not be a good option when the competition or training schedule precludes sleeping late the next morning,” write the authors. “In these cases, it is perfectly safe and reasonable to use a short-acting sleep medication for the first 2-3 days in a new time zone.”
According to Dr. Caldwell, the possible risks associated with sleep medications need to be weighed against the risks of insufficient sleep in the absence of these drugs.
“Particularly in people who use these medications on an infrequent basis, the benefits of better sleep often far outweigh any potential and minor long-term concerns,” says Dr. Caldwell.
Additionally, there are plenty of non-prescription sleep medications on the market and many variations of their use among performance athletes. But just because they can be bought in store without a prescription, doesn’t mean these sleep aids should be taken carelessly. Most of these OTC products include various doses of Diphenhydramine or Doxylamine, which can be very strong hypnotics and can linger in the system and produce lingering sleepiness or sedation. And coaches need to be aware of the possibility that these easy-to-acquire sleep meds may be abused, with bootlegged concoctions like purple drank leading to often catastrophic results for high performance athletes.
However, as part of a careful sleep monitoring and management plan for elite athletes, OTC sleep aids may also prove a useful short term solution if their administration is properly timed and they’re used under appropriate medical supervision.
It has to be noted that there are serious concerns among many in the scientific community about the dangers of altering sleep patterns with prescription, and especially over the counter sleep medications especially. Some of these medications have been linked not only to lingering impacts on motor and cognitive function but to cancer and even death. Thus, taking sleep reporting compounds should not be taken lightly, especially for athletes leading up to competition. At the very least the impacts on athlete’s sleep need to be carefully measured and monitored while using sleep aids.
And on the heels of a significant recent spike in interest regarding the impacts of sleep on human performance, many in the research world are calling for deeper examinations into how to effectively utilize sleep medication for elite athletes. Findings continue to point toward significant performance benefits from carefully managing sleep.
Learn more about monitoring and managing the power of sleep in performance athletes here.
Interested in learning more about data-driven fatigue management?
or for a comprehensive overview of the scientific link between sleep and athletic performance, download our free Science of Sleep eBook.
Sleep in Elite Athletes and Nutritional Interventions to Enhance Sleep
Managing Sleep and Jet Lag for Optimal Performance
The International Athlete—Advances in Management of Jet Lag Disorder and Anti-Doping Policy
With the MLS season in full swing, the NHL Stanley Cup Final and NBA Final underway, and #Euro2016 set to kick off, timing couldn’t be more perfect for the fifth annual Seattle Sounders Sports Science Weekend. On June 9-11, 2016 the brightest minds and most accomplished innovators in sports will convene in the Emerald City to share their latest performance insights.
Once again, Fatigue Science will be in the mix at the Sounders Sports Science Weekend, this time along with our friend Dr. Brandon Marcello. Marcello will take centre stage to educate all on the unbreakable bond between sleep and nutrition for high performance athletes.
“Nutrition can make a good athlete great, or a great athlete good,” says Marcello, who has implemented successful high-performance training programs for professional, Olympic and collegiate athletes. “When built upon proper sleep habits, these two components can provide both an optimal training response, and improved performance.”
Marcello’s nutrition presentation highlights Day 2 (Friday, June 10, 12-12:45 PST) of the packed sports performance program, which also features the latest methodologies in training, strength & conditioning, performance coaching, and data analytics. This session on the symbiotic relationship between sleep and nutrition will be of great interest to pro, college, club, or high school coaches working at the highest level of any team sport.
“Within this talk,” adds Marcello. “I will discuss the foundational components of high-performance nutrition, and go into depth regarding supplements, nutrient timing, meal composition, nutritional myths, and methods of educating the athlete.”
Learn more about the importance of sleep and nutrition in performance sports.
Interested in learning more about data-driven fatigue management?
or for a comprehensive overview of the scientific link between sleep and athletic performance, download our free Science of Sleep eBook.
Our friend and collaborator Ian Dunican (@Sleep4Perform) recently spoke with SleepHub about using sleep to help elite athletes reach peak performance. Dunican talks in detail about using Fatigue Science’s Fatigue Avoidance Scheduling Tool (FAST) to help Super Rugby teams plan for and manage fatigue. He believes this has the potential to translate into greater success on the field of play.
“There’s definitely a relationship between how much sleep these athletes are getting and how they perform,” Dunican tells Dr. David Cunnington. “The recovery period, in particular, is really, really interesting.”
Dunican points out that he’s working with Super Rugby team the Perth Western Force, one of sports most traveled teams, to find ways to improve performance and recovery by measuring and optimizing sleep.
“It’s really interesting during Super Rugby competition because (Western Force) may have games back-to-back or they may have to travel from Perth to South Africa and back to Perth to New Zealand, and now with Japan as well,” says Dunican. “So the recovery is a vital piece of the overall performance of the team. And more time in the gym and more time on the field during the week is not necessarily translating into better performance in the game in that win/loss metric. So given the ample opportunity for sleep, recovery during those times is really key.”
Dunican adds that without actively facilitating key rest periods during those difficult portions of the schedule, athletes are not going to be able to recover mentally or physically. That’s because the lack of sleep stunts the body’s ability to naturally produce testosterone or human growth hormone, for example, which athletes require to recover from the rigours of their particular sport. According to Dunican, however, new technology is playing a key role in pushing performance.
“We’ve been using a lot of bio mathematical modelling,” says Dunican. “We’re using FAST from Fatigue Science in Vancouver, Canada. We’ve been using that to model last season, where we take the training times, the game times, a sample of actigraphy data and put that into FAST.”
With help from Fatigue Science technology Dunican is able to extrapolate out to an effectiveness measure to show the team’s players and coaches.
“Using those measures we’ve been able to model various countermeasures for next season such as changing flights, training times, increases in sleep, manipulations in sleep environment and so on,” says Dunican. “And we’re able to demonstrate from a modelling perspective what these changes might bring about. So next season we’ll be actually deploying those measures with the coach and the performance coach and then hopefully climbing the ladder to show that sleep can actually help you win.”
Ian Dunican (@Sleep4Perform) has 18 year’s international experience as a leader in project management, business improvement and health, safety, within the mining industry and military. He’s currently undertaking PhD research at University of Western Australia (UWA) and Australian Institute of Sport (AIS) investigating, among other things, the impact of evening use of electronic devices on sleep and next day athletic performance, the effects of jet lag and transmeridian travel on athletic performance, and the prevalence of sleeping disorders amongst professional Rugby players.
Interested in learning more about data-driven fatigue management?
or for a comprehensive overview of the scientific link between sleep and athletic performance, download our free Science of Sleep eBook.
The National Sleep Foundation recently released its 2014 Sleep Health Index, which reports the findings of a survey conducted with over 1250 Americans.
The survey found that people, in general, don’t appear to be setting themselves up for a healthy sleep!
Only 47% of people reported that their bedrooms were ‘very quiet’, 36% reported their rooms were ‘very dark’, and 56% reported their mattresses were ‘very comfortable’.
If you haven’t prioritized all three of these, you could improve the quality and quantity of the sleep you’re getting with a few small changes:
1. Shhhh…. – The sounds of urban living and noise from roommates or partners with different work/sleep schedules can interrupt an otherwise restful and restorative sleep. You can make your sleep environment appear quieter (without moving to the rural countryside) by hanging heavy drapery on your windows and turning on a fan or other white noise machine while sleeping. Good quality, comfortable ear plugs can also be purchased inexpensively and can help dampen the sounds of a snoring partner or unexpected thunderstorm.
2. Create a cave – Before the light bulb was invented and the world started operating 24 hours a day, people went to sleep at night when it got dark – the way biology intended for us. Even if your eyes are shut, small amounts of light from a flickering television or poorly shaded window can impact your sleep quality. Creating a ‘very dark’ sleep environment is pretty easy. Start with black-out drapery (like they have in hotel rooms) for your window, then keep glowing devices (like TV’s and mobile phones) out of your bedroom. Still not dark enough? Purchase an eye shade to block out unavoidable light sources at home or while traveling.
3. Build a better bed – If your sleep is restless or you’re waking up with muscle stiffness or aches, it might be time for a new bed. Replacing an older or uncomfortable mattress isn’t a small expenditure, but budgeting to acquire a good quality mattress is an investment that will pay dividends in improving the quality of your sleep and how you feel for the rest of the day.
If you’ve already set yourself up for a good sleep, and still not feeling rested after 7 or 8 hours of rest, you may want to speak with your doctor about sleep health. How does your sleep environment currently compare to those surveyed for the Sleep Health Index?
Science says…‘Better go back to bed’
This week, sleep advocate and Huffington Post editor-in-chief, Arianna Huffington, released a substantial blog post rounding up some of the recent coverage in the media around the importance of sleep. (To her point, there have been a few great pieces in New York Times.)
One of the studies she refers to indicates that people who sleep 6 hours per night for two weeks are equally as fatigued as someone who has stayed up for 48 hours. We can also demonstrate and expand on the point visually using our FAST software (which was developed by US military to understand the effects of fatigue on performance). Arianna’s concern, is that our 24 hour world and unbalanced lifestyles are not only a detriment to our own health, but every organization’s bottom line and the economy as a whole. She is is not alone in this thinking.
According to studies, almost 30% of adult Americans are sleeping 6 hours a night or less on a regular basis. Would you expect to perform your best at work after staying up for 24 or 48 hours? Probably not. So why do people think they are able to function optimally on 6 hours of regular sleep? This is because of a natural human phenomenon known as ‘renorming’. Renorming means that we are only able to compare how we feel today to how we felt yesterday or the day before. If someone who regularly sleeps 8 hours a night stays up for 24 hours, the deterioration of how they feel will be evident to them. If someone else decides to forgo their 8 hours per night to sleep 6 hours a night over a period of two weeks, the decline in how they feel and perform would be gradual enough that they might not even notice – But, science shows, both of these individuals will suffer similar declines in their performance and reaction time.
The FAST grid below demonstrates the performance of someone over a two week period of time who is getting 6 hours of sleep, from midnight to 6 AM. The blue arrow shows the gradual decline in performance over time.
FAST schedule grid showing performance decline over time.
What we are able to show using FAST software, is that by 3 PM on Monday (indicated by the black arrow) this person’s effectiveness has decreased 19%, their reaction time has decreased 24% and they are 3 times more likely to suffer an excessively long lapse in reaction time (sometimes referred to as a microsleep) than someone who is well rested.
Simply put, those who sleep only 6 hours a night, will not perform to their full potential at work and because of ‘renorming’, they won’t even realize it.
We often talk about the dangers of fatigue in the workplace for people who are working in safety sensitive operations, and the difference a small percentage drop in performance can make on an elite athlete’s game – but we can use science to demonstrate that no organization and, by association, no economy is immune to the costs associated with lost productivity caused by human fatigue.
Interested in learning more about data-driven fatigue management?
or download our free eBook on the Science of Sleep for industrial workforces
