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Ask Stanford Med: Cheri Mah responds to questions on sleep and athletic performance

US Open TennisWhether you're a student-athlete superstar or the mayor of your local gym, chances are your performance on the field, court or treadmill could be influenced by the way you sleep. So for this installment of Ask Stanford Med, we’ve asked Cheri Mah, a researcher with the Stanford Sleep Disorders Clinic and Research Laboratory, to respond to questions on sleep and athletic performance. Below are her answers, along with some tips to help you get the most out of your nightly slumber. We hope this will help you consider which of your own sleep practices are working, and what you might want to reconsider.

Michelle asks: Can you give a summary of your  research to date showing that sleep might help athletes? And what kind of studies are you working on now?

For past few years, William Dement, MD, PhD, and I have been studying the impact of sleep extension on the athletic performance in elite athletes. My interest in specifically studying sleep duration and sleep quality in athletes stems from a study in 2002. By chance, several Stanford swimmers were in our study, and although we weren't investigating athletic performance, they mentioned that they had set several personal records in their last swim meet!

Over subsequent years, we've examined the impact of sleep extension across many sports at Stanford including basketball, football, tennis, and swimming to compare similarities and differences across sports. Our findings from men's basketball published in 2011 indicate that several weeks of sleep extension improves reaction time, mood, levels of daytime sleepiness, and specific indicators of athletic performance including free throws, 3 point field goals, and sprint time. These findings suggest that sleep duration is likely an important component of peak performance.

Additionally, our study suggests that significantly reducing an accumulated sleep debt from chronic sleep loss may require more than one night or weekend of recovery sleep. Although sleep is frequently overlooked and often the first to be sacrificed, sleep duration and sleep quality should be important daily considerations for athletes aiming to perform at their best.

Currently, we're continuing our research on sleep extension and examining the impact on different aspects of performance in various sports. We're  also investigating the habitual sleep habits and patterns of elite athletes. Since each sport has it's own unique culture and training, we're  interested in examining the similarities as well as differences across sports among the Stanford student-athlete population.

Emily asks: What sort of sleep-related work have you done with Stanford athletes over the years? What kind of feedback have you gotten from the students?

Aside from research,  I've worked over the years with various teams and athletes at Stanford to help improve and optimize their sleep and recovery.

For many athletes, it's their first time diving deep into the impact of sleep on performance - they had never before focused on their sleep as an important component of their daily training beyond being told to "get a good night of sleep" before a game or competition. Many of the athletes I work with are surprised at the difference sleep can have on their training, performance, and even schoolwork! For many, it's their first experience having a strategic approach to optimizing sleep and tracking their progress through a season. It's often only in hindsight - after they've significantly reduced their sleep debt over several weeks - that many athletes realize they were operating at a sub-optimal level. Additionally, athletes often realize after extending their sleep that they need more hours of sleep than they previously thought to perform at their best. Some athletes have gone on to play at the professional level and have even been advocates of the importance of sleep on sports performance.

Several coaches have been quite interested in improving sleep and recovery in their team. They're often aware that their athletes aren't  properly rested and thus have been interested in both educating their athletes and implementing strategies to improve their team's recovery. Some coaches have also consulted me on their travel schedules to minimize jet lag and optimize performance on the road.

Dr. Dement and I are also part of the Stanford Performance Enhancement Alliance, which serves Stanford athletes through a multidisciplinary approach to sports performance.

Matthew asks: If I normally sleep only six hours per night, without the use of coffee or an alarm clock, how can I get myself to sleep more to improve my athletic performance?

It's often easier for people to change their bedtime than their wake time. Try moving back your bedtime by 30 minutes every few days to gradually increase your sleep duration. It can be helpful to set a daily alarm on your phone to help remind you of your targeted bedtime. For example, set the alarm one hour before bedtime, which gives you 30 minutes to wrap things up for the day, and 30 minutes to wind down before bed. Also, evaluate your sleep habits (see below) and approach to sleep, which can aid in helping you obtain healthy and adequate sleep.

Mahesh Bhavana asks: Two situations before my question: 1. I participate in multiple day cycling events and at the end of each day even after strenuous activity, I sometimes have trouble sleeping 6-8 hours. 2. As a part of my training, I attend a spinning class or even a yoga class to stretch in the evening. I always have trouble sleeping after 1-1.5 hours of rigorous exercise in the evening. In both the above situations, the next day is less effective in my performance, due to lack of sleep but incomplete physical recovery from the activity. Any suggestions on how to get the required sleep and rest in either of these situations?

Good sleep hygiene is critical for quality sleep and recovery in athletes. A strong foundation of good sleep habits is essential and is especially helpful when you may have difficulty sleeping during competition or post-exercise. Our bodies like regularity, so start by evaluating whether you have a regular approach to sleep. Then, ask yourself if you're following these tips on sleep hygiene:

 1. Optimize your sleep environment – make your bedroom dark, quiet, and cool. A sleep environment conducive to quality sleep is important both at home and on the road.

2. Maintain a consistent sleep schedule. Our bodies like regularity so prioritize the same bedtime and wake time every day.

3. Establish a regular 20-30 minute routine before bed – try reading, journaling, listening to music. A regular routine before sleeping can help your body wind down and anticipate sleep.

4. Reduce liquid consumption 2 hours before bed. Stay hydrated during the daytime, but reduce liquids before sleeping. Make it part of your routine to stop by the bathroom before turning out the lights to reduce awakenings at night.

5. Difficulty sleeping or have a racing mind? Try 30 minutes of stretching before your 20-30 minute routine before bed. Utilize this time to process your thoughts on practice/game before winding down to sleep.

Andrew Kloak asks: As I cross through my mid-40s, I notice that I need more sleep than I used to. I feel tired at around 9 p.m. so I honor that and go to bed soon after on those nights. I awake around the same time 5:30 a.m. Is that typical or should I make some adjustments to my routine? I’ve always been a race horse of an athlete (i.e. I’m better in action than staying in the barn). I play volleyball, run, ride my bike and lift weights each week.

Sleep patterns change as you age; however, the hours of sleep that your body needs does not. As you age, you often spend more time in lighter stages of sleep than deep sleep, and many individuals report having a harder time falling asleep or staying asleep. Additionally, a shift in sleep patterns as you age is commonly called advanced sleep phase syndrome – individuals tend to sleep earlier in the evening and wake earlier in the morning than when they were younger. That said, the shift in your sleep schedule is normal.

Previously: Last day to submit questions on sleep and athletic performance to Stanford expertAsk Stanford Med: Cheri Mah taking questions on sleep and athletic performanceA slam dunk for sleep: Study shows benefits of slumber on athletic performanceCould game time affect a baseball player’s at-bat success? and Want to be like Mike? Take a nap on game day

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