SLEEP, JET LAG & Athletic Performance January 26, 2017-OMA Sports Med Cathy J Campbell MD

SLEEP, JET LAG & Athletic Performance January 26, 2017-OMA Sports Med Cathy J Campbell MD

Disclosures The only disclosure I have to make is that I won the Provincial NS Championships in the 200 meter sprint in 1971 with very little sleep

Team Physician Duties/check lists Periodic Health Maintenance Exams Cancer screening (Paps, testicular exams) Heart disease prevention(bp, cholesterol, ecg) Immunizations (Tetanus, Hepatitis A/B,?travel) Bone health/doping/eating disorders/lifestyle habits/drugs/alcohol/vision/stis/oral health Sleep Assessment/management/jet lag SCAT5 plus Pre-participation exams

OBJECTIVES OF TALK 1. To be able to describe the effects of sleep and lack 1. To be able to describe the effects of sleep and lack of sleep on various aspects of athletic performance 1. To describe the effects of sleep and lack of sleep on athletic performance 2. To describe ways of improving sleep hygiene for athletes and team members 3. To provide useful information and tools for the team physician in managing sleep and jet lag 2. To describe ways to improve sleep hygiene and quality of sleep for the athletes and team members 3. To provide useful tools for the team physician in managing sleep and jet lag of sleep on various aspects of athletic performance

Effects of Sleep Loss on Athletes and their Performance

Effects of Sleep Loss on Athletes 1. Injury Risk 2. Illness Susceptibility 3. Pain Tolerance 4. Effects on Athletic Performance

1. Injury Risk Greatest risk for injury resulted when training load increased and sleep duration decreased at the same time Examples: training camps or competition travel?decreased reaction time?decreased attention/cognitive function?

2. Illness Susceptibility Decreased sleep is immunosuppressive and increases susceptibility to URIs Individuals with <7 hours of sleep were 3 x more likely to develop infection then those with > 8 hours of sleep (Cohen et al, 2009)

Sleep duration (measured by wrist actigraphy) averaged over a 7-day period before virus exposure is associated with percentage of participants who subsequently developed a cold. (Prather et al, 2015)

3. Pain Tolerance Increased pain tolerance is important for athletes Allows athlete to train more intensely, compete with greater focus and engage more fully in rehab after injury

3. Pain tolerance Decreased pain tolerance with less sleep 8% decrease in pain threshold tolerance after a single night of total sleep deprivation (Onen, 2001) Extending sleep for four nights in adults with inadequate habitual sleep duration increased pain tolerance 20% (Roehrs, 1989)

4. Sleep and Athletic Performance Endurance Performance Time to Exhaustion in Elite Cysclists: decreased 51 secs following sleep restriction and --- increased 14 seconds after sleep extension (Mah,CD,unpublished data,2018)-private correspondence 1 night of sleep deprivation decreased treadmill endurance performance (Oliver et al, 2009)

4. Sleep and Athletic Performance Accuracy/Reaction Time: A single night of 5 hours of sleep in tennis players was associated with a decrease of serving accuracy of 53% (Reyner et al, 2013)

Patterns of Performance Degradation and Restoration during Sleep Restriction and Recovery (Belenky, 2003) Slower Reaction time Even with recovery sleep, reaction speed still impaired

Sleep and Performance Faster sprint time by 0.7 seconds Baseline-16.2 seconds End Sleep Extension- 15.5 seconds (Mah CD, 2011)

Sleep and Performance Sprint time improved Shooting accuracy improved: Free throw accuracy increased by 9% (p<0.001) 3 point field goal accuracy increased by 9.2% PVT, Sleepiness and Mood all better too (Mah CD, 2011)

4. Sleep and Athletic Performance Learning and Executive Function Sleep is critical for memory consolidation Especially important in university athletes with demands of school work and team practices

Strategies to improve sleep 1. Obtain Adequate Total Sleep Duration 2. 2 week sleep diary http://yoursleep.aasmnet.org/pdf/sleepdiary.pdf- see next slide

Strategies to improve sleep cont 3. Maintain healthy sleep habits/hygiene: ideal room-dark, cool and comfortable avoid using electronics in bedroom limit electronic devices at least 1 hour before bedtime avoid caffeine after lunch/limit alcohol use CBTI (cognitive behavioural therapy) for insomnia

Strategies to improve sleep cont. Avoid early am and late evening trainingnot always possible Antihistamines and melatonin possibly Equivocal results with daytime naps 7-9 hours per night

Jet Lag

Disruption of the body s circadian rhythm Heart rate, hormonal excretions, body temperature and other functions are circadian and fluctuate throughout the day What is Jet Lag?

Minimizing Jet Lag Impact It takes 1 day for each time zone crossed Pre-adapt sleep/wakefulness patterns and practice times to those of the destination and allow 3 days at destination to adjust to competition environment

Travel Management Program Pre Flight Modified training intensity and volume Adjust training time to destination time zone Flight choice Travel bag-check list Get sufficient sleep before travel begins!

Travel Management Program In Flight Plans Checklists to athletes Adjust watches Eyeshades, earplugs, noise canceling devices Water/Food Pharmaceuticals? Clothing/pillow/compre ssion stockings

Travel Management Program Arrival Plans Exposure to light Light workouts +/- melatonin +/- caffeine Jet lag calculators on linehttp://www.jetlagrooster.com/

On trans meridian flights >5 zones eastward, immediate release preparation in dose range of.5-5 mg Preflight.5-1.5 mg Post flight 3-5 mg take 30 minutes at bedtime on night of travel then for 2-3 nights on arrival Melatonin y Hormone secreted from Pineal gland Dark=more melatonin Light=less melatonin Infant>elderly. (Samuels, C, 2012)signals the body to prepare for sleep. Light decreases melatonin pro duction and signals the body to prepare for being awake.

Melatonin-Precautions Side Effects/Adverse Reactions Vivid dreams/nightmares Daytime use causes drowsiness Stomach cramps, dizziness, headache, irritability Seizures in kids? Drug Interactions Antidepressants, BP meds, NSAIDS, Be Careful!

Light Therapy Devices

Travel Management Program (Samuels,C. Clinical Journal of Sport Medicine 2012)

THE END BOOM---