sleep You have to coach sleep! 5/8/18 My journey into sleep Brandon Marcello, PhD The Only True "Fix-All for Health & Performance

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1 5818 sleep You have to coach sleep! The Only True "Fix-All for Health & Performance Brandon Marcello, brandonmarcellophd.com 1 2 My journey into sleep 3 4 This presentation is about the basics of sleep. Will not be diagnosing sleep-related illnesses. Information will be general sleep knowledge as it pertains to health, wellness, and performance. I m not funny, but I think that I am

DEPARTMENT OF THE NAVY COMMANDER NAVAL SURFACE FORCE UNITED STATES PACIFIC FLEET 2841 RENOOVA ROAD SAN DIEGO CALIFORNIA 92155-5490 COMMANDER NAVAL SURFACE FORCE ATLANTIC IN REPLY REFER TO 5818 High

enough of it leads to: 3 Mile Island chernobyl increased risk of injury and reduced pain threshold greater susceptibility to sickness reduced physical and psychological performance reduced

VALDEZ U.S. NAVY 9 10 1751 MORRIS STREET NORFOLK VIRGINIA 2355 1-2808 U.S. NAVY COMNAVSURFPACINST 3120.2 COMNAVSURFLANTINST 3120.

School Crew Endurance Handbook vl.l, I Oct 2017 (b) U.S. Coast Guard Crew Endurance Management Practices, Jan 2003 NORFOLK VIRGINIA 2355 1-2808 (c) CNAF M-37IO.

COMNAVSURFPACINST To implement a Commander, Naval Surface Forces 3120.2 (CNSF) comprehensive fatigue and endurance management policy for all ships and afloat staffs, both at sea and in port.

These risk factors degrade impact a Sailor's productivity and warfighting capability.

2 DEPARTMENT OF THE NAVY COMMANDER NAVAL SURFACE FORCE UNITED STATES PACIFIC FLEET 2841 RENOOVA ROAD SAN DIEGO CALIFORNIA COMMANDER NAVAL SURFACE FORCE ATLANTIC IN REPLY REFER TO 5818 High performance approach Order of operations Skill Sleep matters Fatigue, resulting from inadequate sleep, has a direct and measurable impact on: Performance Movement Nutrition Sleep 7 8 Not getting enough of it leads to: 3 Mile Island chernobyl increased risk of injury and reduced pain threshold greater susceptibility to sickness reduced physical and psychological performance reduced motivation, learning ability and memory increase in anxiety, irritability and mistakes increase in body fat percentage reverting to old habits poor judgement of distance, speed andor time EXXON VALDEZ U.S. NAVY MORRIS STREET NORFOLK VIRGINIA U.S. NAVY COMNAVSURFPACINST COMNAVSURFLANTINST DEPARTMENT OF THE NAVY NOOZ COMMANDER 30 Nov 2017 NAVAL SURFACE FORCE UNITED STATES PACIFIC FLEET COMNAVSURFPAC INSTRUCTION COMNA VSURFLANT INSTRUCTION RENOOVA ROAD SAN DIEGO CALIFORNIA From: Commander, Naval Surface Force, U.S. Pacific Fleet Commander, Naval Surface Force Atlantic COMMANDER Subi: COMPREHENSIVE FATIGUE AND ENDURANCE MANAGEMENT POLICY NAVAL SURFACE FORCE ATLANTIC 1751 MORRIS STREET Ref: (a) Naval Postgraduate School Crew Endurance Handbook vl.l, I Oct 2017 (b) U.S. Coast Guard Crew Endurance Management Practices, Jan 2003 NORFOLK VIRGINIA (c) CNAF M-37IO.7, 15 1ul2017 COMNAVSURFPAC INSTRUCTION COMNA VSURFLANT INSTRUCTION Again Encl: (1) Individual Ri sk Management Tool IN REPLY REFER TO I. Purpose. COMNAVSURFPACINST To implement a Commander, Naval Surface Forces (CNSF) comprehensive fatigue and endurance management policy for all ships and afloat staffs, both at sea and in port. COMNAVSURFLANTINST a. Sailors are exposed to a variety of operational risk factors including unpredictable schedules, NOOZ long work days, and heavy workloads. These risk factors degrade impact a Sailor's productivity and warfighting capability. This instruction codifies and consolidates several years of CNSF 30 guidance Nov regarding 2017 individual readiness, the circadian rhythm implementation message, waterfront briefings to ships in fleet concentration areas, and training sessions at Surface Warfare Officers School Command. This instruction provides Type Commander policy, commander's intent, and specific direction to achieve optimal crew endurance, performance, and safety. b. The desired end state of this crew endurance policy is to ensure Sailors are adequately rested for safe, professional shipboard operations to deliver enhanced warfighting effectiveness by reducing conditions that contribute to fatigue, impaired health, decreased performance, and mishap potential. 2. Scope and Applicability. All CNSF immediate superiors in command, ships, and craft shall From: Commander, Naval Surface Force, U.S. Pacific Fleet implement this policy, tailor best practices, and train their staffs and crews on its content. Commander, Naval Surface Force Atlantic 3. Discussion Subi: a. Crew endurance is the ability to maintain sustained, optimal warfighting performance while enduring job-related physical, psychological, and environmental challenges. COMPREHENSIVE FATIGUE AND ENDURANCE MANAGEMENT POLICY b. A critical tenet of crew endurance is circadian rhythm. The human circadian rhythm is the internal 24-hour biological clock that controls sleep and wake cycles, and affects levels of alertness. This clock mechanism influences sleep by controlling the timing of «sleep gates" and l.l PROJECT ALCHEMY Holistic Human-Performance Framework 11 UNCLASSIFIED FOR PUBLIC RELEASE 12 2

5818 Human Performance Anchors 105 Elements Cognitive Physical Social Emotional

RELEASE 13 14 1 st -Order Connections The most important area is the role of sleep

Alertness and ability to maintain focus and attention 2.

Energy and Motivation 5. Control, coordination, impulsiveness 6.

Getting enough though, improves: motivation recovery of muscle strength sprint

3 5818 Human Performance Anchors 105 Elements Cognitive Physical Social Emotional Multiple Interactions UNCLASSIFIED FOR PUBLIC RELEASE UNCLASSIFIED FOR PUBLIC RELEASE st -Order Connections The most important area is the role of sleep in facilitating an optimal level of waking function 1. Alertness and ability to maintain focus and attention 2. Cognitive performance including learning, memory, and creativity 3. Mood 4. Energy and Motivation 5. Control, coordination, impulsiveness 6. Pain Element Node UNCLASSIFIED FOR PUBLIC RELEASE Stages of Healthy Sleep Getting enough though, improves: motivation recovery of muscle strength sprint speeds muscle glycogen (stored energy in muscle) cortisol (stress) regulation motor skill (movement) development (swingpitch mechanics) memory consolidation (retention of scouting reports)

alert 19 20 Healthy Circadian Rhythm Sleep Debt sleep 12 sleep 2 4 6 8 10 noon 2 4 6 8 10 12 chronically obtaining less sleep than your body needs builds a sleep debt over time sleep debt is

your sleep duration. be patient: reducing your sleep debt takes more than one night or weekend of good sleep!

4 5818 Paying back what you owe? Sleep Debt Simplified sleep debt need 8 hours and got 7 hours = 1 hour of sleep debt need to get 9 hours tonight to pay back that 1 hour how do I know if I have sleep debt drowsiness is red alert Healthy Circadian Rhythm Sleep Debt sleep 12 sleep noon chronically obtaining less sleep than your body needs builds a sleep debt over time sleep debt is manageable at first, but over time, it becomes overwhelming pay back your sleep debt for optimal functioning and sports performance, you should eliminate your sleep debt by gradually extending your sleep duration. be patient: reducing your sleep debt takes more than one night or weekend of good sleep! sleep urge sleep need Study: Sleep extension with swimmers After extending time in bed to 10hrnight for several weeks collegiate swimmers showed improvements of +8% 15m sprint speed +20% reaction time off the block +10% +19% 00.4 turn time efficiency kickstrokes Extended Sleep and the Effects on Mood and Athletic Performance in Collegiate Swimmers; Mah CD,Mah KE, Dement WC, Psychiatry and Behavioural Sciences, Stanford University, CA 23 4

5818 Study: Sleep extension with basketball players Study: Sleep extension with basketball players After extending time in bed to 10hrsnight for several weeks, collegiate basketball players showed a:

5 hr sleep Source: The Effects of Sleep Extension on the Athletic Performance of Collegiate Basketball Players; Mah CD, Mah KE, Dement WC, Kezirian, EJ, Psychiatry and Behavioral Sciences, Stanford

Stanford University, CA In the outfield, that s a difference of 10 over 15s.

After 3 years: Performance in strike zone judgement consistently worsens over the course of each MLB season, despite the inputs of frequent practice and repetition.

72% 39% 14% of players with normal sleep traits were still playing of players with poor sleep traits were still playing of players with severe sleep issues were still playing Source: Predicting Major

Christopher Validation of a Statistical Model Predicting Possible Fatigue Effects in Major League Baseball; Kutscher, Scott.

5 5818 Study: Sleep extension with basketball players Study: Sleep extension with basketball players After extending time in bed to 10hrsnight for several weeks, collegiate basketball players showed a: +9% improvement in free throw shooting accuracy They were faster too..7s faster sprint over 95 yards +9.2% 8.5 hr sleep improvement in 3pt field goal shooting accuracy 6.5 hr sleep Source: The Effects of Sleep Extension on the Athletic Performance of Collegiate Basketball Players; Mah CD, Mah KE, Dement WC, Kezirian, EJ, Psychiatry and Behavioral Sciences, Stanford University, CA Source: The Effects of Sleep Extension on the Athletic Performance of Collegiate Basketball Players; Mah CD, Mah KE, Dement WC, Kezirian, EJ, Psychiatry and Behavioral Sciences, Stanford University, CA In the outfield, that s a difference of 10 over 15s Study: Impact of fatigue on MLB strike zone judgement Study: Sleepiness & predicting career longevity in baseball 30 MLB teams were tracked from Winter tracked 80 MLB players. After 3 years: Performance in strike zone judgement consistently worsens over the course of each MLB season, despite the inputs of frequent practice and repetition. Researchers hypothesized that this decline is the result of fatigue. 72% 39% 14% of players with normal sleep traits were still playing of players with poor sleep traits were still playing of players with severe sleep issues were still playing Source: Predicting Major League Baseball (MLB) Player Career Longevity via Sleepiness Measurements; Winter, W. Christopher Validation of a Statistical Model Predicting Possible Fatigue Effects in Major League Baseball; Kutscher, Scott Study: Injuries in adolescent athletes Study: Sleep Restriction on Testosterone Levels Injuries have been shown to be related to sleep less than 6 hours the night before the injury occurred sleep= testosterone 24yr old healthy men who slept less than 5hrs a night for a week, registered a 15% drop in testosterone. That s like aging 15yrs. 1.7x greater risk for injury compared to athletes that obtained 8 hours of sleep. Key for: strength and muscle mass, energy and concentration, bone density, libido Source: Milewski MD, Skaggs DL, Bishop GA, et al. Chronic lack of sleep is associated with increased sports injuries in adolescent athletes. J Pediatr Orthop 2014;34(2): PMID: Effect of 1 Week of Sleep Restriction on Testosterone Levels in Young Healthy MenRachel Leproult, PhD; Eve Van Cauter, PhD

5818 Brain Health Sleep and the Brain During sleep, the brain bathes itself in cerebrospinal fluid to get rid of waste products

Alzheimer s and other neurological disorders Rested Fatigued 31 31 32 SHORT SLEEP = MORE COLDS Chances (%) of catching a cold when

2% <5 hours sleep mythology Source: Prather et al, 2015 33 Sleep Mythology Average Person you can get too much sleep naps are bad

6 5818 Brain Health Sleep and the Brain During sleep, the brain bathes itself in cerebrospinal fluid to get rid of waste products The brain will also clean out toxic proteins which can impair healthy aging of the brain, and cause brainrelated diseases such as Alzheimer s and other neurological disorders Rested Fatigued SHORT SLEEP = MORE COLDS Chances (%) of catching a cold when exposed to the virus if you re not sleeping enough 17.2% >7 hours 22.7% 6-7 hours 30% 5-6 hours 45.2% <5 hours sleep mythology Source: Prather et al, Sleep Mythology Average Person you can get too much sleep naps are bad 8 hours of sleep is ideal older people don t need as much sleep storing up sleep for the week ahead alcohol helps you sleep Some People Most People Some People

5818 Athletes need a lot of sleep to perform their best When you go to sleep matters too 9-10 hrnight 8-10 hrnight <24 yr

before 1am is best. After 3am almost always guarantees a poor sleep.

versa. The primary fuel source during activity are carbohydrates.

later time. Individuals who are sleep deprived tend to crave carbohydrates.

7 5818 Athletes need a lot of sleep to perform their best When you go to sleep matters too 9-10 hrnight 8-10 hrnight <24 yr old 25+ yr old When you go to bed affects the quantity, quality, and restorative value of your sleep Falling asleep before 1am is best. After 3am almost always guarantees a poor sleep Stay calm after one bad-night s rest Sleep Nutrition Interaction Your sleep can influence what you eat, and vice versa. The primary fuel source during activity are carbohydrates. Sleep deprivation alters the ability of the body to metabolize and store carbohydrates for recovery, as well as use for a later time. Individuals who are sleep deprived tend to crave carbohydrates. Certain foods can have an adverse effect, keeping you awake at night. Large quantities of food consumed late at night can also contribute to a restless night. If you food is keeping you up at night, check in with an RD sleep strategies Be sure you re asking the right questions 7

5818 Readiness Questionnaires and Training Monitors 43 44 Resolve Daily

It is important to recognize whether or not you are a worrier Before going

This can bring a sense of closure, which sometimes can stop the process of

using technology in the bedroom, even an hour before going to bed.

8 5818 Readiness Questionnaires and Training Monitors Resolve Daily Dilemmas Outside of the Bedroom Lark or Owl? It is important to recognize whether or not you are a worrier Before going to bed, make a worry list, and write a brief action item beside each concern This can bring a sense of closure, which sometimes can stop the process of re-thinking the same situation over and over, all night long 45 What is this thing called blue light? The Bedroom is not an office Bright = light 46 Melatonin levels Be wary of using technology in the bedroom, even an hour before going to bed. Alertness is enhanced either because the bright light emitted suppress melatonin levels andor because the content presented on these devices is engaging and exciting

9 Other strategies Reasons some athletes don t get enough sleep Planning around biological clock Sleep disorders insomnia, sleep apnea Scheduling practices, training and meetings games long distance travel, time zone shifting media or promotional commitments eating, commuting, time off Lifestyle Environmental sleep hygiene alcohol, drugs, caffeine noise, air quality, light exposure stress

5818 Establish a Bedtime Routine Strategies for

Quiet and Comfortable Sleep Environment Turn off

music Stretch Dark room, with temperature around

white-noise Ear plugs and sleep mask can aid

by 10:30pm Read a relaxing book for 30-45 minutes

Symptoms Adaptation Time to New Time Zone West to

10 5818 Establish a Bedtime Routine Strategies for winding down for a good nights sleep Create a Quiet and Comfortable Sleep Environment Turn off all screens Take a hot shower Listen to relaxing music Stretch Dark room, with temperature around 67 F 19 C Mask unwanted sounds with fan or other white-noise Ear plugs and sleep mask can aid sleep Lay out clothes for the next day Go to bed by 10:30pm Read a relaxing book for minutes Jet Lag Shift Work What is Jet Lag? Symptoms Adaptation Time to New Time Zone West to East or East to West? How do I beat it? supplementation 60 10

11 5818 sleep technologies 62 Rise Science Readiband Whoop Band Charge 2 They tend to underestimate sleep disruptions and overestimate total sleep times and sleep efficiency in normal individuals Sleep is important to every human being: There is no exception. takeaways Sleep impacts the physical, cognitive, social, and emotional domains. Consistency is key Routine, routine, routine. You have to coach sleep! 66 11

12 5818 What to watch. Jeff Iliff resources One More Reason to Get a Good Night s Sleep Russell Foster Why Do We Sleep? 68 For you For your clients (and you) Have or having kids?... Who @AASMorg

13 5818 It is a common experience that a problem difficult at night is resolved in the morning after the committee of sleep has worked on it. - John Steinbeck Thank you and good night

Sleep for Athletes. How Much Sleep Are Athletes Getting? How Much Is Needed?

Sleep for Athletes. How Much Sleep Are Athletes Getting? How Much Is Needed? Sleep for Athletes Lindsay Thornton How Much Sleep Are Athletes Getting? How Much Is Needed? 2 Broadly, adults need 5-10 hours of sleep per night Genes play a role short sleepers (consistently sleep under