Int J Sports Med 2019; 40(08): 535-543
DOI: 10.1055/a-0905-3103
Clinical Sciences
© Georg Thieme Verlag KG Stuttgart · New York

Sleep Hygiene for Optimizing Recovery in Athletes: Review and Recommendations

Kenneth C. Vitale
1   Orthopaedic Surgery, University of California San Diego School of Medicine, La Jolla, United States
Roberts Owens
2   Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of California San Diego School of Medicine, La Jolla, United States
Susan R. Hopkins
3   Medicine and Radiology, University of California San Diego, La Jolla, United States
Atul Malhotra
4   Medicine, Division of Pulmonary and Critical Care Medicine, University of California San Diego, La Jolla, United States
› Author Affiliations
Further Information

Publication History

accepted 22 April 2019

Publication Date:
09 July 2019 (online)


For elite athletes who exercise at a high level, sleep is critical to overall health. Many studies have documented the effects of sleep deprivation in the general population, but few studies exist regarding specific effects in the athlete. This review summarizes the effects of sleep deprivation and sleep extension on athletic performance, including reaction time, accuracy, strength and endurance, and cognitive function. There are clear negative effects of sleep deprivation on performance, including reaction time, accuracy, vigor, submaximal strength, and endurance. Cognitive functions such as judgment and decision-making also suffer. Sleep extension can positively affect reaction times, mood, sprint times, tennis serve accuracy, swim turns, kick stroke efficiency, and increased free throw and 3-point accuracy. Banking sleep (sleep extension prior to night of intentional sleep deprivation before sporting event) is a new concept that may also improve performance. For sports medicine providers, the negative effects of sleep deprivation cannot be overstated to athletes. To battle sleep deprivation, athletes may seek supplements with potentially serious side effects; improving sleep quality however is simple and effective, benefiting not only athlete health but also athletic performance.

  • References

  • 1 Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol 2013; 177: 1006-1014
  • 2 Shaq Attacks Sleep Apnea. Harvard Medical School. Accessed March 9, 2018
  • 3 Simpson NS, Gibbs EL, Matheson GO. Optimizing sleep to maximize performance: Implications and recommendations for elite athletes. Scand J Med Sci Sports 2017; 27: 266-274
  • 4 Fullagar HH, Skorski S, Duffield R, Hammes D, Coutts AJ, Meyer T. Sleep and athletic performance: The effects of sleep loss on exercise performance, and physiological and cognitive responses to exercise. Sports Med 2015; 45: 161-186
  • 5 O’Donnell S, Beaven CM, Driller MW. From pillow to podium: a review on understanding sleep for elite athletes. Nat Sci Sleep 2018; 10: 243
  • 6 Fullagar HH, Duffield R, Skorski S, Coutts AJ, Julian R, Meyer T. Sleep and recovery in team sport: Current sleep-related issues facing professional team-sport athletes. Int J Sports Physiol Perform 2015; 10: 950-957
  • 7 Samuels CH. Jet lag and travel fatigue: A comprehensive management plan for sport medicine physicians and high-performance support teams. Clin J Sport Med 2012; 22: 268-273
  • 8 Harriss DJ, Macsween A, Atkinson G. Standards for ethics in sport and exercise science research: 2018 update. Int J Sports Med 2017; 38: 1126-1131
  • 9 Lastella M, Roach GD, Halson SL, Sargent C. Sleep/wake behaviours of elite athletes from individual and team sports. Eur J Sport Sci 2015; 15: 94-100
  • 10 Leeder J, Glaister M, Pizzoferro K, Dawson J, Pedlar C. Sleep duration and quality in elite athletes measured using wristwatch actigraphy. J Sports Sci 2012; 30: 541-545
  • 11 Chang AM, Aeschbach D, Duffy JF, Czeisler CA. Evening use of light-emitting eReaders negatively affects sleep, circadian timing, and next-morning alertness. Proc Natl Acad Sci USA 2015; 112: 1232-1237
  • 12 Halson S. Stealing sleep: Is sport or society to blame?. Br J Sports Med 2016; 50: 381
  • 13 Mukherjee S, Patel SR, Kales SN, Ayas NT, Strohl KP, Gozal D, Malhotra A. American thoracic society ad hoc committee on healthy sleep. An official american thoracic society statement: the importance of healthy sleep. Recommendations and future priorities. Am J Respir Crit Care Med 2015; 191: 1450-1458
  • 14 Irwin MR. Why sleep is important for health: A psychoneuroimmunology perspective. Annu Rev Psychol 2015; 66: 143-172
  • 15 Killgore WD. Effects of sleep deprivation on cognition. Prog Brain Res 2010; 185: 105-129
  • 16 Patel SR, Malhotra A, White DP, Gottlieb DJ, Hu FB. Association between reduced sleep and weight gain in women. Am J Epidemiol 2006; 164: 947-954
  • 17 Morselli L, Leproult R, Balbo M, Spiegel K. Role of sleep duration in the regulation of glucose metabolism and appetite. Best Pract Res Clin Endocrinol Metab 2010; 24: 687-702
  • 18 Mougin F, Bourdin H, Simon-Rigaud ML, Nguyen Nhu U, Kantelip JP, Davenne D. Hormonal responses to exercise after partial sleep deprivation and after hypnotic drug-induced sleep. J Sports Sci 2001; 19: 89-97
  • 19 Haack M, Lee E, Cohen DA, Mullington JM. Activation of the prostaglandin system in response to sleep loss in healthy humans: Potential mediator of increased spontaneous pain. Pain 2009; 145: 136-141
  • 20 Haack M, Mullington JM. Sustained sleep restriction reduces emotional and physical well-being. Pain 2005; 119: 56-64
  • 21 Haack M, Sanchez E, Mullington JM. Elevated inflammatory markers in response to prolonged sleep restriction are associated with increased pain experience in healthy volunteers. Sleep 2007; 30: 1145-1152
  • 22 Azboy O, Kaygisiz Z. Effects of sleep deprivation on cardiorespiratory functions of the runners and volleyball players during rest and exercise. Acta Physiol Hung 2009; 96: 29-36
  • 23 Blumert P, Crum A, Ernsting M, Volek J, Hollander D, Haff E, Haff G. The acute effects of twenty-four hours of sleep loss on the performance of national-caliber male collegiate weightlifters. J Strength Cond Res 2007; 21: 1146-1154
  • 24 Skein M, Duffield R, Edge J, Short MJ, Mündel T. Intermittent-sprint performance and muscle glycogen after 30 h of sleep deprivation. Med Sci Sports Exerc 2011; 43: 1301-1311
  • 25 Souissi N, Sesboue B, Gauthier A, Larue J, Davenne D. Effects of one night’s sleep deprivation on anaerobic performance the following day. Eur J Appl Physiol 2003; 89: 359-366
  • 26 Takeuchi L, Davis GM, Plyley M, Goode R, Shephard R. Sleep deprivation, chronic exercise and muscular performance. J Ergonomics 1985; 28: 591-601
  • 27 Oliver SJ, Costa RJ, Laing SJ, Silzon JL, Walsh NP. One night of sleep deprivation decreases treadmill endurance performance. Eur J Appl Physiol 2009; 107: 155-161
  • 28 Sinnerton S, Reilly T. Effects of sleep loss and time of day in swimmers. In Maclaren D, Reilly T, Lees A. eds Biomechanics and Medicine in Swimming: Swimming Science IV. London: E and FN Spon; 1992: 399-405
  • 29 Souissi N, Souissi M, Souissi H, Chamari K, Tabka Z, Dogui M, Davenne D. Effect of time of day and partial sleep deprivation on short-term, high-power output. Chronobiol Int 2008; 25: 1062-1076
  • 30 Reyner LA, Horne JA. Sleep restriction and serving accuracy in performance tennis players, and effects of caffeine. Physiol Behav 2013; 120: 93-96
  • 31 Souissi N, Chtourou H, Aloui A, Hammouda O, Dogui M, Chaouachi A, Chamari K. Effects of time-of-day and partial sleep deprivation on short-term maximal performances of judo competitors. J Strength Cond Res 2013; 27: 2473-2480
  • 32 Mejri MA, Yousfi N, Mhenni T, Tayech A, Hammouda O, Driss T, Chaouachi A, Souissi N. Does one night of partial sleep deprivation affect the evening performance during intermittent exercise in Taekwondo players?. J Exerc Rehabil 2016; 12: 47-53
  • 33 Reilly T, Hales A. Effects of partial sleep deprivation on performance measures in females. In: McGraw ED. (ed.). Contemporary Ergonomics. London: Taylor and Francis; 1988: 509-513
  • 34 Reilly T, Piercy M. The effect of partial sleep deprivation on weight-lifting performance. Ergonomics 1994; 37: 107-115
  • 35 Bulbulian R, Heaney J, Leake C, Sucec A, Sjoholm N. The effect of sleep deprivation and exercise load on isokinetic leg strength and endurance. Eur J Appl Physiol Occup Physiol 1996; 73: 273-277
  • 36 Taheri M, Arabameri E. The effect of sleep deprivation on choice reaction time and anaerobic power of college student athletes. Asian J Sports Med 2012; 3: 15-20
  • 37 Pallesen S, Gundersen HS, Kristoffersen M, Bjorvatn B, Thun E, Harris A. The effects of sleep deprivation on soccer skills. Percept Mot Skills 2017; 124: 812-829
  • 38 Reilly T, Deykin T. Effects of partial sleep loss on subjective states, psychomotor and physical performance tests. J Hum Mov Stud 1983; 9: 157-170
  • 39 Wright Jr KP, Drake AL, Frey DJ, Fleshner M, Desouza CA, Gronfier C, Czeisler CA. Influence of sleep deprivation and circadian misalignment on cortisol, inflammatory markers, and cytokine balance. Brain Behav Immun 2015; 47: 24-34
  • 40 Chennaoui M, Arnal PJ, Drogou C, Sauvet F, Gomez-Merino D. Sleep extension increases IGF-I concentrations before and during sleep deprivation in healthy young men. Appl Physiol Nutr Metab 2016; 41: 963-970
  • 41 Lucassen EA, Piaggi P, Dsurney J, de Jonge L, Zhao XC, Mattingly MS, Ramer A, Gershengorn J, Csako G, Cizza G. Sleep Extension Study Group Sleep extension improves neurocognitive functions in chronically sleep-deprived obese individuals. PLoS One 2014; 9: e84832
  • 42 Mah CD, Mah KE, Kezirian E, Dement WC. The effects of sleep extension on the athletic performance of collegiate basketball players. Sleep 2011; 34: 943-950
  • 43 Waterhouse J, Atkinson G, Edwards B, Reilly T. The role of a short post-lunch nap in improving cognitive, motor, and sprint performance in participants with partial sleep deprivation. J Sports Sci 2007; 25: 1557-1566
  • 44 Schwartz J, Simon Jr. RD. Sleep extension improves serving accuracy: A study with college varsity tennis players. Physiol Behav 2015; 151: 541-544
  • 45 Mah CD. Extended sleep and the effects on mood and athletic performance in collegiate swimmers. Sleep 2008; 31 (Suppl.) A128
  • 46 Arnal PJ, Lapole T, Erblang M, Guillard M, Bourrilhon C, Leger D, Chennaoui M, Millet GY. Sleep extension before sleep loss: Effects on performance and neuromuscular function. Med Sci Sports Exerc 2016; 48: 1595-1603
  • 47 Brooks A, Lack L. A brief afternoon nap following nocturnal sleep restriction: Which nap duration is most recuperative?. Sleep 2006; 29: 831-840
  • 48 Gillberg M, Kecklund G, Axelsson J, Akerstedt T. The effects of a short daytime nap after restricted night sleep. Sleep 1996; 19: 570-575
  • 49 Hayashi M, Motoyoshi N, Hori T. Recuperative power of a short daytime nap with or without stage 2 sleep. Sleep 2005; 28: 829-836
  • 50 Kamdar BB, Kaplan KA, Kezirian EJ, Dement WC. The impact of extended sleep on daytime alertness, vigilance, and mood. Sleep Med 2004; 5: 441-448
  • 51 Van Ryswyk E, Weeks R, Bandick L, O’Keefe M, Vakulin A, Catcheside P, Barger L, Potter A, Poulos N, Wallace J, Antic NA. A novel sleep optimisation programme to improve athletes’ well-being and performance. Eur J Sport Sci 2017; 17: 144-151
  • 52 O’Donnell SH, Driller MW. Sleep-hygiene education improves sleep indices in elite female athletes. Int J Exerc Sci 2017; 10: 522
  • 53 Smith RS, Efron B, Mah CD, Malhotra A. The impact of circadian misalignment on athletic performance in professional football players. Sleep 2013; 36: 1999-2001
  • 54 Srinivasan V, Singh J, Pandi-Perumal SR, Brown GM, Spence DW, Cardinali DP. Jet lag, circadian rhythm sleep disturbances, and depression: the role of melatonin and its analogs. Adv Ther 2010; 27: 796-813
  • 55 Buxton OM, Lee CW, L'Hermite-Balériaux M, Turek FW, Van Cauter E. Exercise elicits phase shifts and acute alterations of melatonin that vary with circadian phase. Am J Physiol Regul Integr Comp Physiol 2003; 284: R714-R724
  • 56 Youngstedt SD, Elliott JA, Kripke DF. Human circadian phase-response curves for exercise. J Physiol 2019; 597: 2253-2268
  • 57 Fowler PM, Knez W, Crowcroft S, Mendham AE, Miller J, Sargent C, Halson S, Duffield R. Greater effect of east vs. west travel on jet lag, sleep, and team sport performance. Med Sci Sports Exerc 2017; 49: 2548-2561
  • 58 Thornton HR, Miller J, Taylor L, Sargent C, Lastella M, Fowler PM. Impact of short-compared to long-haul international travel on the sleep and wellbeing of national wheelchair basketball athletes. J Sports Sci 2017; 5: 1-9
  • 59 Forbes-Robertson S, Dudley E, Vadgama P, Cook C, Drawer S, Kilduff L. Circadian disruption and remedial interventions: Effects and interventions for jet lag for athletic peak performance. Sports Med 2012; 42: 185-208
  • 60 Leatherwood WE, Dragoo JL. Effect of airline travel on performance: A review of the literature. Br J Sports Med 2013; 47: 561-567
  • 61 Rowland TW. The Athletes Clock: How Biology and Time Affect Sport Performance. Champaign, IL: Human Kinetics; 2011
  • 62 National Sleep Foundation. Accessed March 9, 2018
  • 63 National Sleep Foundation. Accessed March 9, 2018
  • 64 Sax JK. Dietary supplements are not all safe and not all food: How the low cost of dietary supplements preys on the consumer. Am J Law Med 2015; 41: 374-394
  • 65 Brown GM, Pandi-Perumal SR, Trakht I, Cardinali DP. Melatonin and its relevance to jet lag. Travel Med Infect Dis 2009; 7: 69-81
  • 66 UCSD Center for Pulmonary and Sleep Medicine . Sleep Hygiene Patient Information Handout [Brochure]. San Diego, CA: University of California San Diego; 2017
  • 67 Halson S. Sleep in elite athletes and nutritional interventions to enhance sleep. Sports Med 2014; 44: 13-23