Gabrielle Herman, PT, DPT, CMPT

 The three pillars of health include diet, exercise, and sleep. Optimizing all three is critical to exercise recovery as well as overall health and well-being. Ignoring one pillar often causes the other two pillars to suffer. For example, someone that is sleep deprived may perform poorly in exercise or begin to crave unhealthy foods. These negative effects of sleep deprivation must be addressed regularly by sports medicine providers as well as general practitioners as there are clear negative effects of sleep deprivation on performance in athletes such as accuracy, reaction time, endurance, submaximal strength as well as cognitive functions including judgement and decision-making.

 Sleep Deprivation in Elite Athletes

High level athletes are known to get less total sleep than non-athletes due to demanding training and competition schedule and travel and time zone changes. Stress and anxiety before an upcoming game or match may also hinder an athlete from getting a healthy sleep. In addition to this, the significant increase in smartphone and electronic devices further interrupt sleep schedules with possible negative impacts on melatonin production from blue-light emissions.

Negative Effects of Sleep Deprivation

  • Neurocognitive, metabolic, immunologic, and cardiovascular dysfunctions are shown in general population
  • Physical effects in athletes:
  • Decreased running performance
  • Decreased muscle glycogen concentration
  • Reduced submaximal strength
  • Decreased soccer kicking skills
  • Decreased tennis serve accuracy
  • Decreased time to exhaustion

Positive Effects of Sleep Extension

  • Restoration of sleep and sleep extension can improve the following
  • Sprint times
  • Tennis serve accuracy
  • Swim and kick stroke efficiency and swim spring
  • Basketballs shooting accuracy
  • Time to exhaustion
  • Psychomotor vigilance tasks, alertness, vigor, and mood
  • Decreased sleepiness and fatigue
  • Newer studies demonstrate a nap the day following a night of sleep deprivation may be beneficial
  • A new concept of “banking sleep” which is a sleep extension prior to a night of sleep deprivation in a pilot study improved motor performance
  • Most studies agree upon increasing sleep by 2 hours with the goal of 9 hours for elite athletes
  • Future research is needed to further detail the benefits of banking sleep

Top Ten Recommendations for Healthy Sleep Hygiene

  1. Don’t go to bed until you are sleepy
  2. Regular bedtime routine/rituals help you relax and prepare body for sleep
    • Warm bath
    • Reading a book
  3. Try to get up at the same time every morning (including weekends and holidays)
  4. Try to get a full night’s sleep every night and avoid daytime naps (if you must nap, limit to 1 hour and avoid nap after 3 pm)
  5. Use the bed for sleep and intimacy only; not for any other activities including TV, phone use, or laptop
  6. Avoid caffeine if possible, if must use, avoid after lunch
  7. Avoid alcohol is possible, if must use, avoid right before bed
  8. Don’t smoke or use nicotine, ever
  9. Consider avoiding high-intensity exercise right before bed
  10. Make sure bedroom is quiet, as dark as possible, and a little on the cool side rather than warm

Additional Sleep Hygiene Recommendations

  1. Avoid blue light emitted from screens at least 2 hours before bed
  2. Get bright, natural sunlight upon awakening – some suggest at least a 10,000 lux lamp if you cannot get natural sunlight
  3. Don’t hit the snooze button, it does not improve sleep quality
  4. If you have difficulty waking up, some suggest a dawn-simulator alarm clock
  5. If you must use a computer at night, consider installing blue-light reducing software or wear blue-light blocking glasses
  6. Higher Carbohydrate foods at night may actually improve sleep, as well as high protein including tryptophan. High fat intake may disrupt sleep. Inadequate total caloric intake during the day may impair sleep at night.
  7. Topical magnesium (salt bath, topical mineral oil, or oral magnesium may help if you are deficient
  8. Melatonin naturally occurring in foods (Tart cherry juice, raspberries, goji berries, walnuts, almonds, tomatoes) may potentially improve sleep, but avoid artificial melatonin supplements
  9. Don’t fall asleep to the T.V. Sleep studies show you frequently wake up during the night and have poor quality sleep.
  10. Herbal supplements are largely unknown with potential serious side effects, and may be on the USADA-prohibited list or result in positive banned substance test for athletes
  11. Consider reducing fluid intake before bed so you don’t get up to go to the bathroom (Only if you maintain enough hydration during the day)
  12. Cooling body temperature may improve sleep. Some suggest keeping the room between 60-70 degrees; however, keep hands and feet warm
  13. Check your mattress – it may be too old and have allergens (most last 9-10 years)
  14. Recovery from exercise should not only focus on muscle recovery. Reducing mental fatigue is just as important for health sleep. Reduce external stressors in your life.


Vitale, K. C., Owens, R., Hopkins, S., Malhotra, A., Sleep Hygiene for Optimizing Recovery in Athletes: Review and Recommendations. Int J Sports Med. August 2019: 40(8): 535–543. doi:10.1055/a-0905-3103