Aug 2, 2019
Creating a sleep-friendly culture
Birdie Cunningham, Dr. Roxanne Prichard, Sarah Moll

If you told an athlete you had a treatment that would reduce the chemicals associated with stress, that would naturally increase human growth hormone, that enhances recovery rate, that improves performance, they would all do it,” Casey Smith, MS, ATC-L, PES, CES, the Head Athletic Trainer for the Dallas Mavericks, told ESPN The Magazine in 2014.

What treatment is Smith referring to? Sleep.

Getting good, consistent sleep is a cornerstone of health and athletic performance, especially for today’s college student-athletes. Across all NCAA divisions, they spend more than 30 hours a week on their sport during the season when travel, training, and team meetings are included. This means they face unique challenges in managing their time and keeping a good sleep schedule. As a result, they are experiencing sleep disturbances and chronic insufficient sleep at epidemic levels.

For years, many coaches and sports medicine professionals have been trying to change this through various educational efforts. But the truth is, simply urging athletes to sleep more doesn’t do much good. You have to get them to buy into what you’re saying, and that might take more than presentations and handouts on the benefits of sleep. It requires building a sleep-friendly culture.

At the University of St. Thomas, we’ve done just that. As staff members at the school’s Center for College Sleep, we started working directly with the athletic teams on campus a few years ago. It was a natural fit: Our athletic department takes student-athlete health, wellness, and performance very seriously, and our sleep center has the resources to help.

The critical step in shifting the culture within the athletic department was getting everyone to understand the enormous impact sleep has both on and off the field. Some of our biggest advocates and allies along the way were St. Thomas’ athletic trainers and strength and conditioning coaches. We held lunch-and-learns to inform them about the science of sleep and signs of poor sleep, as well as provide them with talking points to promote sleep health. Because athletic trainers and strength coaches are often the first line of education and primary witnesses to sleep challenges, they were instrumental in getting athletes on board with our message.

Once teams began to buy in, the results started to show. Team GPAs went up, injury rates went down, and some teams made it further into the postseason than ever before. Coaches also noticed that athletes were more focused during practice and better able to manage stress.

Now, getting a good night’s sleep is the “in” thing to do among our sports teams. Our head football coach is known for taking a nap every afternoon, and athletes jokingly chide each other if they don’t get adequate shut-eye.

We found out firsthand that it’s possible to build an athletics culture where sleep is respected. The key is getting buy-in and enhancing your message with targeted education, assessments, and interventions.

Starting point

Our first step when working with St. Thomas athletes is attacking the stigma that sleep is a sign of weakness, or sleeping more means you are not busy enough, active enough, or popular enough. We use real-life examples of how professional and Olympic athletes sleep to contradict this falsehood.

For instance, we inform our athletes that gold-medal-winning cross-country skier and hometown hero Jessie Diggins sleeps nine to 10 hours a night and takes a 30- to 45-minute recovery nap during the day. LeBron James sleeps 12 hours a night, Tom Brady sleeps nine, and both Roger Federer and Michele Wie aim for 10 to 12.

Next, we use the science of sleep to motivate athletes to change their behaviors. Athletes always hear how important it is to get enough sleep, but they don’t often hear the reasons why. We share the following talking points:

√ Injury rates: One in four varsity athletes will suffer a major injury during their college career. So, one of the best ways to drive home the importance of sleep is to talk about injury rates. Athletes who average five hours of sleep or less a night have an almost 60% increase in injuries compared to those who get about nine hours.

√ Performance: The toxic mindset that one must grind at all hours of the day and night in order to achieve greatness has been ingrained in athletes. But the message that sufficient sleep boosts athletic performance has not been spread as much as it needs to be.

To drive this home, we share results from a 2011 study by Cheri Mah, MD, Clinical and Translational Research Fellow at the University of California San Francisco Human Performance Center and professional athlete sleep consultant. Her team’s research with the Stanford University men’s basketball program measured the effect that getting more sleep had on athletic performance. After sleeping nine to 10 hours a night for five weeks, the players in the study increased their free throw accuracy by 9% and lowered their court-and-a-half sprint by 0.75 seconds. Additionally, players reported lower levels of fatigue and higher levels of physical and mental well-being during practices and games.

√ Reaction time: Delayed reaction time is one of the first signs of sleep deprivation. A 2012 study on student-athletes published in the Asian Journal of Sports Medicine showed a reaction time of 285 milliseconds after a single night of sleep deprivation, compared to a typical time of 245 milliseconds.

Reaction time is one of the easiest signs of sleep deprivation to measure and improve. For many St. Thomas athletes, simply seeing their slowed reaction times is enough to motivate a change in behavior. We recommend athletic trainers record both sleep hours and reaction time in the preseason and periodically throughout the season to make athletes aware of the relationship between the two. Online apps can easily measure reaction time, as can the classic “ruler drop” test.

√ Metabolism: Poor sleep is associated with weight gain, blood sugar irregularities, decrease in resting metabolic rate, loss of lean muscle mass, and night eating. Additionally, partial sleep deprivation alters glucose metabolism, which increases fat storage and leads to a shift in cells using energy from lean muscle rather than fat for fuel. None of these outcomes are good for athletes.

√ Endurance: Cardiovascular endurance is another easy-to-identify, high-impact result of poor sleep. Following insufficient sleep, one study found energy expenditure during submaximal exercise decreased by 3.9%, and maximal aerobic power decreased by 2.9%.

Another area related to this is overall time to exhaustion, which research says can decrease by 10.7% in elite athletes after a night of insufficient sleep. This translates to a whopping 37-second decrease in time to exhaustion. We tell our athletes to think about having an extra 30 seconds before they hit the wall and how much of an impact that could have on winning.

√ Inflammation: Inadequate sleep triggers the sympathetic nervous system, which is our fight or flight response. When this system is over-activated, as it is with chronic insufficient sleep, a variety of physiological changes arise, including inflammation. This can lead to increased aches and pains and slowed healing of persistent injuries.

√ Mental health: The physical benefits of improving sleep are quite profound, but the mental benefits are just as significant. Studies show poor sleep more than triples a student’s risk for developing anxious, depressed, or suicidal thoughts, so we make sure St. Thomas athletes know that prioritizing healthy sleep is a great way to build psychological resilience.

Defining good sleep

Once athletes fully grasp the possible repercussions of insufficient sleep, we educate them about what good sleep actually means. We convey that it involves quantity, consistency and quality.

Regarding quantity, adults generally need between seven and nine hours of sleep every night. However, the exact amount varies quite a bit by individual, as well as by day-to-day energy expenditure.

The best way to determine how much sleep you need is to simply not use an alarm clock for a few days in a row. But when we tell that to St. Thomas athletes, they seem hesitant. Most have used alarm clocks to wake up since middle school and do not believe it’s possible to wake up within seven to nine hours without one.

To ease them into it, we ask them to recall how much they slept during vacation to gauge what their sleep need likely is. They might “catch up” and sleep a few extra hours for the first couple of days, but as their sleep debt is managed, chances are they will naturally wake up after meeting their sleep need.

Once athletes have dialed in their sleep need, we recommend they tack on 30 to 60 additional minutes of sleep opportunity (time in bed). This is because we know the exact amount of sleep needed varies by day. So if a player typically sleeps seven-and-a-half hours a night, we have them block off at least eight hours of sleep time.

We also stress the importance of consistency when it comes to a sleep schedule. As a culture, we tend to stay out later and sleep in on weekends. However, this results in a “phase-shift” termed “social jetlag.” If an athlete generally awakens at 6 a.m. on weekdays, but goes to bed later on the weekends and sleeps until 9 a.m., that’s the bodily equivalent of flying from New York to Los Angeles every week.

This can have a lasting effect. Our bodies produce thousands of different genes every day, and the timing of this gene expression varies by our circadian rhythms. Keeping an irregular sleep schedule means that hundreds of cellular control mechanisms will be out of sync. However, a highly synchronized body will tend to fall asleep more easily at night, wake up naturally in the morning, and have consistent digestion.

Of course, we know that academic and athletic requirements can make it difficult for student-athletes to keep a consistent schedule. There will be times when they stay up late or hanging out with friends.

This is a time-use issue we tackle from two ends. First, we work with athletes and academic support staff to educate about time management and effective studying in small chunks. Other tips to promote consistency include encouraging athletes to stay on the same time zone when traveling and taking advantage of bedtime reminder apps.

Finally, we stress the importance of sleep quality. This starts with the sleep environment, which should be cave-like – cold, quiet and dark. To promote this at St. Thomas, our Wellness Center gives out earplugs and eye masks and assists students in making their own light-blocking curtains. We also recommend white noise apps to mask ambient noise, turning off screens, and putting the “do not disturb” feature on smartphones.

Even with the right environment, there can be a number of barriers to quality sleep. For 5% to 20% of athletes – depending on the sport – this takes the form of a sleep disorder. These are often difficult to diagnose, primarily because the sufferer is unconscious when many of the symptoms occur. We tell athletes that one of the strongest indicators they might have a sleep disorder is nodding off and feeling tired during the day, even when they’ve gotten a good seven to nine hours of sleep. If this is the case, we recommend they contact health services right away for a consultation with a sleep clinician.

Sometimes a barrier to sleep quality is not a disorder but a stimulant. If athletes are feeling wired at bedtime, one culprit might be stimulant use. We educate them on the half-life of caffeine, which is twice as long in women on oral contraceptives, or have them rethink the timing of their ADHD medications.

Effective assessment

It does little good to focus on sleep quantity, consistency, and quality unless we can measure the impact we’re having. We strongly encourage our athletes to use one of the many affordable sleep-tracking apps available to get an approximate idea of their sleep practices. These trackers can really help students connect habits (i.e., exercise, alcohol and other drug use, and meditation) with overall sleep patterns.

However, the trackers are generally better at determining sleep quantity than quality, and there’s a limit to how much detail and practical support they can provide. So, through the Center for College Sleep, we developed the College Sleep Questionnaire (CSQ), an online personalized sleep assessment designed for the college-age population. The CSQ is a 10-minute survey that asks detailed questions about students’ sleep schedules and physiological, environmental, behavioral, and psychological factors that might interfere with sleep. Athletic departments or universities that license the CSQ can add unique questions that are relevant to their respective populations.

The CSQ generates immediate personalized feedback on specific ways to improve sleep, as well as customized information about where to go on campus for supports like medical referrals, sports psychologists, or time management coaching. Each student who takes the CSQ gets a detailed two-page PDF report emailed to them, which they can choose to share with coaches or sports medicine staff.

At St. Thomas, we have athletes take the CSQ in the preseason and set aside time during meetings we have with teams to answer any questions about the results. For example, when the St. Thomas football program implemented the CSQ, one player’s feedback indicated he showed signs of sleep apnea. He followed the suggested course of action provided by the CSQ and made an appointment with our Health Services department. There, he discovered that his enlarged tonsils were interfering with his breathing during sleep. Once they were removed, his sleep and well-being improved dramatically.

Intervention efforts

The collated data from the CSQ can provide a direct path for implementing strategic sleep programming and education for both individuals and teams. With regards to helping specific athletes, we ask them to look hour by hour at their fixed schedule (including classes, athletics, and meals), add in sufficient time for sleep, and think critically about how to use the remaining time.

We encourage them to look for small pockets of time to do high-impact studying or engage in social activities. Academic tutors, counselors, and coaches can be important allies here. On rare occasions when an athlete literally cannot schedule sufficient sleep opportunity, we strategize about the best time to fit in a recovery nap.

On a team-wide basis, we work with the sport coaches on scheduling. Generally, we aim to minimize mandatory early morning workouts whenever possible. For example, with the swim team, we try to make sure athletes who are night people get to sign up for afternoon swim rather than the early morning swim. And we convinced the hockey team to nix their Saturday morning stretch session after late Friday night games.

Further, when teams have a significantly earlier or later game than normal, we help them adjust their sleep schedules

When everyone is on board with sleep initiatives, it creates an environment where athletes can thrive. If you’re struggling to get athletes to buy in to getting a good night’s rest, think more about developing a sleep-friendly culture. Anything you can do to promote healthy sleep will reap benefits – sometimes literally overnight.

Birdie Cunningham, MA, is Associate Director of Health and Wellness at the University of St. Thomas and Director of the school’s Center for College Sleep. She is a member of the NCAA Interassociation Task Force on Sleep and Wellness. Roxanne Prichard, PhD, is Professor of Neuroscience and Psychology at St. Thomas and Scientific Director for the Center for College Sleep. She is also a member of the NCAA Interassociation Task Force on Sleep and Wellness. Sarah Moll is a neuroscience major at St. Thomas and the student leader of the campus Wellness Center’s Sleep Health Promotion Team. The authors can be reached at: [email protected].

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