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6.4 Scott Kutscher
1. B-Debate 2018:
Sleep: The Fourth Pillar of Health
Sleep and Athletic Performance
Scott Kutscher, M.D.
Clinical Assistant Professor
Division of Sleep Medicine
Department of Psychiatry & Behavioral Sciences
Stanford University Medical Center
2. Objectives
o Describe the ways sleep influences performance
o Homeostatic
o Circadian
o Describe how two sleep factors influences performance
o Performance
o Recovery
o Injury
o Outline the three tiers of influence on athlete sleep
o Individual
o Situational
o Organizational/Institutional
3. Sleep Influences Athletic Performance
• The two sleep factors both influence athletic performance…
– Homeostatic sleep drive
• The more you sleep, the better you do
– Circadian advantage
• You do better when performing closer to your peak circadian time
• … In three key ways
– Sleep improves performance
– Sleep reduces injury
– Sleep triggers recovery (sleep = recovery)
• Indirectly, sleep improves performance by influencing mood,
nutrition, endocrine function (GH, cortisol), etc
5. Sleep Deprivation and Plate Discipline
• MLB players susceptible to fatigue due to few scheduled off
days and frequent travel
• Plate discipline: grouped by team, per month
• O-swing%: % of time batter swung at a pitch outside of the
strike zone
• Pitchf/x data
6. Plate Discipline (O-Swing%) By Month 2006-2011
• O-swing%
increased following
a linear
relationship of
0.59% per month
7. • Sleep Extension and Athletic Performance
– 11 players on the Stanford men’s basketball
– 2-4 weeks of baseline sleep
– 5-7 week sleep extension phase
• Players advised to get 10 hours of sleep per night
– If did not achieve 10 hours at night, encouraged to nap during the day
The More You Sleep The Better You Do
9. Sleep Extension and Athletic Performance
Mah et al. Effects of Sleep Extension on Athletic Performance, Sleep 2011
10. Circadian Advantage
• Athletic performance varies throughout the day
• Peak performance consistently demonstrated in the late
afternoon (16:00-20:00)
– Peak force of leg, back, and arm muscles, and grip strength
– Maximal anaerobic power output
– Performance in time trials: running, swimming, cycling
– Maximal oxygen uptake (VO2 max)
• Performance closely mirrors core body temperature
– Performance maximal at CBTmax
– Performance worse at CBTmin
• CBT proportional to level or alertness, and inversely
proportional to melatonin levels
12. Studies of Circadian Advantage
• All NFL games between east coast (EC) and west coast (WC)
teams since 1970
– Records against the point spread for games starting after 8pm ET and
games starting at 1pm and 4pm ET
– Hypothesis: Late start times allow WC teams to play closer to their
CBTmax and peak phase of circadian performance
– WC teams went 143-150 (49%) against the spread in games started
before 8pm ET
– WC teams went 70-36 (66%) against the spread in games started after
8pm ET
Smith, Roger et al. Impact of Circadian Misalignment on Athletic Performance in Professional Football Players, Sleep 2013
13. Studies of Circadian Advantage
• 10 year retrospective study of circadian advantage in MLB
– 5,042 games played between teams on different circadian times (from
1 to 3 hour difference)
– Winning percentage by circadian advantage:
– Home field advantage: 53.7%
Winter, et al. Measuring Circadian Advantage in Major League Baseball, Int J Sports Physiol Performance, 2009
C.A. Games Wins Losses Win%
Total 5042 2620 2422 52.0%
1-hour 3684 1903 1781 51.7%
2-hour 1198 620 578 51.8%
3-hour 160 97 63 60.6%
14. Injury, Recovery, and Longevity
• Studies measuring subjective sleepiness, recovery and injuries
– sleep was consistently listed as the single most important modality for
recovery in a survey of 890 male and female elite team athletes,
regardless of gender, sport, or level of competition
Venter et al. Eur J Sport Sci. 2014
– Athlete and parent perception of excessive training without adequate rest
was related to increased frequency of injuries
– Sleeping <6 hours the night before an injury was related to increased
frequency of some injuries
Lazaro, Luke et al. Clin J Sports Med. 2011
- An increase in sleep resulted in higher perceived recovery status
Sawczuk, et al. J Sports Sci. 2018
• Decreased sleep efficiency and increased SOL are observed 1 week and 1
day before injury occurrence in elite football
Nedelec, et al. J Strength Cond Res. 2017
• Studies measuring subjective sleepiness in athletes
– Higher subjective sleepiness scores were correlated with a lower draft
number among NFL draft prospects
– Higher subjective sleepiness scores were correlated with shorter service
time among MLB players
Winter, C et al. APSS abstract, 2012
15. The Power of Sleep
• A summary of the collective literature:
“All other things being equal, a rested team or athlete
operating at its peak circadian time beats a tired team or
athlete 60% of the time”
20. • In elite football players, sleep duration after a night match:
– Decreased by 157 minutes compared to daytime matches
– Decreased by 181 minutes compared to a training day
– Was associated with poorer subjective feelings of restfulness and
recovery when compared to daytime matches and training days
• Percieved fatigue, sleep quality and DOMS
– Worsened by 35-40% on post-match day compared to pre-match
– Subsequently improved up to 4 days after a match
So what happens if you have another game before 4 days??
21. • NBA teams facing “Schedule Losses”
– Identified by travel, game time, and rest days as placing high burden of
fatigue on athletes
From 2007-2017 teams lost 63% of games
2017-2018 teams have lost 42/54 (78%) of games
11 by 21+ points, 17 by 15+ points
Average point differential of 13.5 points
24. Sleep Health Optimization
• Its more than just sleep disorders!
– Optimizing sleep in the season, pre-season, and off-season, taking in
to account training and travel, and incorporating the help of
individuals and organizations, to reduce injury, speed recovery and
promote longevity, for optimizing excellence in performance
• Requires cooperation of individual athletes, coaches, trainers,
physicians
– But also administrations, committees, governing bodies
– And $$$
• Recent CBAs in professional basketball (NBA) and professional
baseball (MLB) included provisions for more in-season off
days to allow for more rest
25. “We start at 11:30. Don’t think if I see you here at 7:30 I’m going to be impressed. It’s
not going to impress me. Sleep! I’m giving you an opportunity to sleep. Sleep!”
-Joe Girardi, Former Manager, New York Yankees
26. The Pillars of Health
HEALTH
Nutrition/Hydra
tion
Exercise
Mindfulness
Sleep
27. The Gears of Peak Performance
Sleep
Nutrition/Hydration
Mindfulness
Practice/Training
