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      Does Elite Sport Degrade Sleep Quality? A Systematic Review

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          Abstract

          Background

          Information on sleep quality and insomnia symptomatology among elite athletes remains poorly systematised in the sports science and medicine literature. The extent to which performance in elite sport represents a risk for chronic insomnia is unknown.

          Objectives

          The purpose of this systematic review was to profile the objective and experienced characteristics of sleep among elite athletes, and to consider relationships between elite sport and insomnia symptomatology.

          Methods

          Studies relating to sleep involving participants described on a pre-defined continuum of ‘eliteness’ were located through a systematic search of four research databases: SPORTDiscus, PubMed, Science Direct and Google Scholar, up to April 2016. Once extracted, studies were categorised as (1) those mainly describing sleep structure/patterns, (2) those mainly describing sleep quality and insomnia symptomatology and (3) those exploring associations between aspects of elite sport and sleep outcomes.

          Results

          The search returned 1676 records. Following screening against set criteria, a total of 37 studies were identified. The quality of evidence reviewed was generally low. Pooled sleep quality data revealed high levels of sleep complaints in elite athletes. Three risk factors for sleep disturbance were broadly identified: (1) training, (2) travel and (3) competition.

          Conclusion

          While acknowledging the limited number of high-quality evidence reviewed, athletes show a high overall prevalence of insomnia symptoms characterised by longer sleep latencies, greater sleep fragmentation, non-restorative sleep, and excessive daytime fatigue. These symptoms show marked inter-sport differences. Two underlying mechanisms are implicated in the mediation of sport-related insomnia symptoms: pre-sleep cognitive arousal and sleep restriction.

          Electronic supplementary material

          The online version of this article (doi:10.1007/s40279-016-0650-6) contains supplementary material, which is available to authorized users.

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          Most cited references79

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          Monitoring Training Load to Understand Fatigue in Athletes

          Shona L. Halson (2014)
          Many athletes, coaches, and support staff are taking an increasingly scientific approach to both designing and monitoring training programs. Appropriate load monitoring can aid in determining whether an athlete is adapting to a training program and in minimizing the risk of developing non-functional overreaching, illness, and/or injury. In order to gain an understanding of the training load and its effect on the athlete, a number of potential markers are available for use. However, very few of these markers have strong scientific evidence supporting their use, and there is yet to be a single, definitive marker described in the literature. Research has investigated a number of external load quantifying and monitoring tools, such as power output measuring devices, time-motion analysis, as well as internal load unit measures, including perception of effort, heart rate, blood lactate, and training impulse. Dissociation between external and internal load units may reveal the state of fatigue of an athlete. Other monitoring tools used by high-performance programs include heart rate recovery, neuromuscular function, biochemical/hormonal/immunological assessments, questionnaires and diaries, psychomotor speed, and sleep quality and quantity. The monitoring approach taken with athletes may depend on whether the athlete is engaging in individual or team sport activity; however, the importance of individualization of load monitoring cannot be over emphasized. Detecting meaningful changes with scientific and statistical approaches can provide confidence and certainty when implementing change. Appropriate monitoring of training load can provide important information to athletes and coaches; however, monitoring systems should be intuitive, provide efficient data analysis and interpretation, and enable efficient reporting of simple, yet scientifically valid, feedback.
          Article 0 comments Cited 485 times – based on 0 reviews     Review now
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            A cognitive model of insomnia.

            A.G. Harvey (2002)
            Insomnia is one of the most prevalent psychological disorders, causing sufferers severe distress as well as social, interpersonal, and occupational impairment. Drawing on well-validated cognitive models of the anxiety disorders as well as on theoretical and empirical work highlighting the contribution of cognitive processes to insomnia, this paper presents a new cognitive model of the maintenance of insomnia. It is suggested that individuals who suffer from insomnia tend to be overly worried about their sleep and about the daytime consequences of not getting enough sleep. This excessive negatively toned cognitive activity triggers both autonomic arousal and emotional distress. It is proposed that this anxious state triggers selective attention towards and monitoring of internal and external sleep-related threat cues. Together, the anxious state and the attentional processes triggered by it tricks the individual into overestimating the extent of the perceived deficit in sleep and daytime performance. It is suggested that the excessive negatively toned cognitive activity will be fuelled if a sleep-related threat is detected or a deficit perceived. Counterproductive safety behaviours (including thought control, imagery control, emotional inhibition, and difficulty problem solving) and erroneous beliefs about sleep and the benefits of worry are highlighted as exacerbating factors. The unfortunate consequence of this sequence of events is that the excessive and escalating anxiety may culminate in a real deficit in sleep and daytime functioning. The literature providing preliminary support for the model is reviewed and the clinical implications and limitations discussed.
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              Sleep and athletic performance: the effects of sleep loss on exercise performance, and physiological and cognitive responses to exercise.

              Hugh H K Fullagar, Sabrina Skorski, Rob Duffield … (2015)
              Although its true function remains unclear, sleep is considered critical to human physiological and cognitive function. Equally, since sleep loss is a common occurrence prior to competition in athletes, this could significantly impact upon their athletic performance. Much of the previous research has reported that exercise performance is negatively affected following sleep loss; however, conflicting findings mean that the extent, influence, and mechanisms of sleep loss affecting exercise performance remain uncertain. For instance, research indicates some maximal physical efforts and gross motor performances can be maintained. In comparison, the few published studies investigating the effect of sleep loss on performance in athletes report a reduction in sport-specific performance. The effects of sleep loss on physiological responses to exercise also remain equivocal; however, it appears a reduction in sleep quality and quantity could result in an autonomic nervous system imbalance, simulating symptoms of the overtraining syndrome. Additionally, increases in pro-inflammatory cytokines following sleep loss could promote immune system dysfunction. Of further concern, numerous studies investigating the effects of sleep loss on cognitive function report slower and less accurate cognitive performance. Based on this context, this review aims to evaluate the importance and prevalence of sleep in athletes and summarises the effects of sleep loss (restriction and deprivation) on exercise performance, and physiological and cognitive responses to exercise. Given the equivocal understanding of sleep and athletic performance outcomes, further research and consideration is required to obtain a greater knowledge of the interaction between sleep and performance.
              Article 0 comments Cited 220 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Luke Gupta:
                ORCID: http://orcid.org/0000-0002-8319-0596
                (+44)7889736313 , luke.gupta@eis2win.co.uk
                Journal
                Journal ID (nlm-ta): Sports Med
                Journal ID (iso-abbrev): Sports Med
                Title: Sports Medicine (Auckland, N.z.)
                Publisher: Springer International Publishing (Cham )
                ISSN (Print): 0112-1642
                ISSN (Electronic): 1179-2035
                Publication date (Electronic): 29 November 2016
                Publication date PMC-release: 29 November 2016
                Publication date (Print): 2017
                Volume: 47
                Issue: 7
                Pages: 1317-1333
                Affiliations
                [1 ]Physiology Department, English Institute of Sport, Bisham, Nr. Marlow, SL7 1RR UK
                [2 ]ISNI 0000 0004 1936 8542, GRID grid.6571.5, Clinical Sleep Research Unit, School of Sport, Exercise and Health Sciences, , Loughborough University, ; Loughborough, LE11 3TU UK
                Author information
                http://orcid.org/0000-0002-8319-0596
                Article
                Publisher ID: 650
                DOI: 10.1007/s40279-016-0650-6
                PMC ID: 5488138
                PubMed ID: 27900583
                SO-VID: 635fee24-c471-4ca3-9c6a-31eb5b1d7d77
                Copyright © © The Author(s) 2016
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                Categories
                Subject: Systematic Review
                Custom metadata
                issue-copyright-statement © Springer International Publishing AG 2017

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