Sleep. Basic concepts and applications for athletes. Michael A. Grandner PhD MTR

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1 Sleep Basic concepts and applications for athletes Michael A. Grandner PhD MTR Director, Sleep and Health Research Program Director, Behavioral Sleep Medicine Program Assistant Professor of Psychiatry, Psychology, & Medicine University of Arizona

2 Sleep is a problem for athletes Many athletes don t sleep well Overall poor sleep quality scores were about double of controls (5.0 vs 2.6) (Samuels et al) Problems arise due to: Scheduling Constraints Travel and Jet Lag Training and Competition Over-Scheduling Beliefs and Attitudes About Sleep Increased Sleep Needs

3 Two main regulators of sleep Sleep Drive This process builds pressure for sleep the longer you are awake And then the pressure goes away when you sleep Biological Clock This process regulates the rhythms of your body and keeps them in line It tries to keep you awake during the day and sleeping at night Borbely, 1982

4 Measuring sleep Polysomnography Actigraphy Sleep diaries Screening Questionnaires

5 Sleep stages (light sleep) Stage 1 Very light sleep, easy to wake Transition stage Sleep starts and other movements Stage 2 Light sleep, but real sleep Makes up about 50% or more of adult sleep Largely involved in actively keeping you cut off from the environment so you can maintain sleep

Sleep stages (deep sleep) Stage 3 & 4 Often lumped together Called slow wave sleep or deep sleep This is the most restful part of sleep where a lot of repairing goes on

6 Sleep stages (deep sleep) Stage 3 & 4 Often lumped together Called slow wave sleep or deep sleep This is the most restful part of sleep where a lot of repairing goes on Major peak of HGH and cell division Muscles relaxed This is mostly finished after 4-5 hours in adults Hence the myths of only needing this much Should be 15-20% of the night

7 Sleep stages (REM) The misunderstood sleep stage REM is light sleep, and the brain is very similar to waking But it is very important for memory and emotion Your body becomes actively paralyzed and limp Major peak of protein synthesis Increased cerebral blood flow This is where most of the dreams happen

8 Sleep stages across the night

9 Sleep metrics Time in and out of bed, and total time in bed (TIB) Sleep latency: How long it takes to fall asleep (SL) Number of awakenings (NWAK) Wake time after sleep onset (WASO) Laying in bed before getting up (EMA) Calculating Total Sleep Time (TST) Calculating Sleep Efficiency (TST/TIB)

10 Circadian rhythms The word comes from: Circa = circle = around Dia = day Circadian = around the day These are the 24-hour rhythms that control many biological processes

11 Health and wellness Odds Ratio vs Normal Sleep Obesity Hypertension Diabetes (all p values <0.0001) 1.00 Very Short Short Normal Long

Drowsy Driving Odds Ratio of Drowsy Driving 6.5 5.5 4.5 3.5 2.5 1.5 Complete Sample Unadjusted Adjusted Odds Ratio of Drowsy Driving 4.5 4.0 3.5 3.0 2.5 2.0 1.5 1.0 Never Insufficient Unadjusted Adjusted 0.

12 Drowsy Driving Odds Ratio of Drowsy Driving Complete Sample Unadjusted Adjusted Odds Ratio of Drowsy Driving Never Insufficient Unadjusted Adjusted Hours 6 Hours 7 Hours 8 Hours 9 Hours 10 Hours Hours 6 Hours 7 Hours 8 Hours 9 Hours 10 Hours Maia, Grandner, Findley, and Gurubhagavatula et al., 2013

13 Training and recovery People who don t sleep well tend to get injured more often and experience more accidents Due to effects on the brain and body Sleep is critical for recovery and repair Sleep loss elevates cortisol and other stress hormones Deep sleep is important for building and repairing muscle Sleep is necessary for recovery from injury and training Sufficient sleep is important to avoid overtraining Studies have shown how sleep is important for regulating cells throughout the body, including the brain, heart, muscles, lungs, etc. Sleep is also critical for forming and consolidating memories

14 Sleep and mental health Sleep is critical for emotion regulation Sleep problems are a major contributor to depression and anxiety disorders Sleep loss increases sensations of pain and increases feelings of disability Insomnia and lack of sleep are a major risk factor for suicide!

15 Grandner, Hale, Moore & Patel, 2010 Societal Level Public Policy, Globalization, Technology, Economics, Environment, Geography Social Level Family, Home, Work, School, Neighborhood, Social Groups, Race/Ethnicity, Socioeconomic, Religion, Culture Individual Level Genetics, Behavior, Psychology, Health, Environment SLEEP Adverse Health Outcomes General Health Human Performance Cardiovascular Health Metabolic Health Immunologic Function Mental Health Cancer Pain

16 Questions? Michael Grandner PhD MTR

17 Colin Greening

18 Dr. James Maas Author of Power Sleep and Sleep to Win

19 Why do I care about sleep?

20 It s a long season!

21 Meditation

22 Nutrition

23 Put down my ipad before bed?

24 Changing time zones

25 Sleep Habits F.lux on my computer and Night Shift on my iphone Tart Cherry Juice after games Sleep well TWO nights before a game Train your mind the bed is for sleep!

26 Over 500 professional games played 6 games lost due to injury during my career I didn t lose one game to injury this past season 31 years old

27 Why do I care?

28 Key Issues for Sleep and Performance in Athletes Michael Grandner and Colin Greening

29 Issue #1: How to fall asleep

Removing barriers to sleep An irregular schedule makes sleep more difficult A regular routine may counter against this Getting plenty of light during the day will also help Make your bedroom ideal

30 Removing barriers to sleep An irregular schedule makes sleep more difficult A regular routine may counter against this Getting plenty of light during the day will also help Make your bedroom ideal for sleep Cool, dark, and comfortable Working around families and kids Electronic devices don t help you sleep Using a mobile device right before bed increases the likelihood of insufficient sleep duration and inadequate sleep quality

31 10 sleep commandments Thou shalt keep a regular schedule Thou shalt exercise regularly but not too late at night Thou shalt get light during the day and avoid it at night Thou shalt keep your bedroom cool, dark and comfortable Thou shalt not go to bed too hungry or too full Thou shalt not drink excessive liquids in the evening Thou shalt not ingest caffeine, nicotine and alcohol at night Thou shalt not go to bed angry or worried or upset Thou shalt get rid of the clock Thou shalt not nap too long or too late during the day

32 How to turn your mind off Many people with insomnia have trouble turning their mind off and don t know why But the truth is, most of the time, this is a result of accidentally programming your brain to do this in bed! What happens is, for one reason or another, something causes us to spend time awake in bed But even when that original cause is gone, the insomnia takes on a life of its own because you trained your brain to be awake in bed To fix this, you need to re-program your brain: re-train it to sleep One of the simplest (but effective!) ways to do this is called Stimulus Control But if these things don t work, you might need to get some help from an insomnia specialist

33 Stimulus control: Get out of bed! Sleep Sex Television Movie Radio Reading Eating Working Arguing Worrying Talking Doing bills Smoking Thinking Ruminating Planning Clockwatching Rehearsing Replaying Texting

34 Issue #2: Travel and jet lag

35 Frequent travel across time zones Any bright light at night (especially blue/green light) can disturb sleep because it disrupts your body clock It tricks your body into thinking that it s daytime and makes it harder to get to sleep When your body clock gets disrupted, you can experience more than just sleep problems Many of the usual symptoms of sleep loss, or just feeling off This also happens when you cross time zones and don t get time to adjust ( jet lag )

36 Tips for travel Naturally it takes about 24 hours per time zone to recover East-West travel is easier Except for night games You can make this faster Avoid bright light when you are trying to send a night signal Get bright light when you want to send a morning or early evening signal Melatonin is a biological opposite of light

38 Issue #3: Wearables and sleep trackers

39 Fitness / sleep trackers Promising technology, built on history of actigraphy Newer devices are including other sensors Addition of heart rate for sleep stages Some degree of accuracy Some devices are better than others Not validated for clinical use Often massively overestimate sleep Other limitations People get tired of wearing them after several weeks Changing technology

40 Are they worth the expense? What do you expect to get from the data? What behavioral changes do you expect to see? How important is accuracy? Does using the device cause more problems? Which devices are the best? And what does that even mean? What are the technical specs on the devices?

41 Issue #4: Pre-game insomnia

42 Pre-game insomnia Anticipatory insomnia refers to when you can t sleep before some event that keeps your physiologic or mental arousal up at night This could be anything But often occurs before competition The important thing to remember is that your performance tomorrow is NOT primarily driven by your sleep tonight Rather you should consider your sleep over the past week Think about banking sleep beforehand

ProjectREST Recovery Enhancement & Sleep Training

ProjectREST Recovery Enhancement & Sleep Training Michael A. Grandner PhD MTR Director, Sleep and Health Research Program Director, Behavioral Sleep Medicine Program Asst Prof of Psychiatry, Psychology,