…from theory to evidence-based intervention

WEIGHT MANAGEMENT INJURY IMMUNE FUNCTION

COGNITIONEXERTION

LEARNING RECOVERY

SLEEP?

RECOVERY

FOCUS & ATTENTION

MOOD

HORMONES

MEMORY & SKILL

LEARNING

ATHLETE

NON-ATHLETE

Leeder et al. 2012

RESEARCH AIMS - AGENDA

°C

1 2 3 4

CHARACTERIZE SLEEP ‘SLEEP THIEVES’ SLEEP &PERFORMANCE

OPTIMIZE SLEEP

1. CHARACTERIZING SLEEP OF ELITE ATHLETES

3 2 1 1 2 3 4 5 6 7

n = 98

RESULTS |GENERAL SLEEP QUALITY

All

M (SD)

# Athletes

≥ [cutoff]

Demographics

Age 18.72 (3.02)

Female 56

Habitual Sleep

PSQI total (0-21) 4.61 (2.04) 40 [5]

HSDQ total (0-5) 1.64 (0.35) 12 [2.02]

Insomnia 2.11 (0.67) 3 [3.7]

Parasomnia 1.29 (0.37) 2 [2.4]

CRSD 1.81 (0.65) 3 [3.4]

Hypersomnia 1.49 (0.47) 1 [2.9]

RLS/ PLMD 1.63 (0.61) 6 [2.7]

SBD 1.47 (0.41) 1 [2.9]

• Habitual sleep qualitygenerally ok

• But not for all athletes

Knufinke et al (2017) Journal of Sleep Research

RESULTS | WEEK AVERAGES

M (SD) Healthy

Ranges

Training load (1-10) 5.41 (2.56)

Time in Bed (h:min) 8:33 (1:10)

Total Sleep Time (h:min) 7:51 (1:08) > 7 hrs

Sleep Onset Latency (min) 14 (15) 0-30 min

Wake After Sleep Onset (min) 33 (16) < 30 min

Frequency Awakenings (#) 33 (11) < 30

Sleep Efficiency (%) 88 (5) ~ 92%

REM (%) 27 (7) 20-25%

Light (%) 51 (9) 45-60%

Deep (%) 21 (8) 10-20%

Sleep Quality (1-10) 6.84 (1.48)

Refreshed (1-10) 6.14 (1.70)

Vigor (0-100) 53.81 (18.77)

Affect (0-100) 68.43 (15.64) Knufinke et al. (2017a) JSRKnufinke et al. (2017b) JSMS

insufficiently

recovered

1. CHARACTERIZING SLEEP OF ELITE ATHLETES

▪ 41% poor sleep quality

▪ 12% potential sleep disorder

RESEARCH AIMS - AGENDA

°C

1 2 3 4

CHARACTERIZE SLEEP ‘SLEEP THIEVES’ SLEEP &PERFORMANCE

OPTIMIZE SLEEP

2. IDENTIFYING SLEEP JEOPARDIZING FACTORS

SLEEP HYGIENE

TRAINING LOAD

“the conditions and practices that promote

continuous and effective sleep”(American Academy of Sleep Medicine, 2001)

SLEEP HYGIENE

All

M (SD)

# Athletes

≥ [cutoff]

SHI total (13-65) 30.94 (5.21) 0 [ 4]

Regularity 2.59 (0.67) 3 [ 4]

Environment 1.71 (0.79) 1 [ 4]

Psychological

Strain2.75 (0.78) 6

[ 4]

Active Behavior 2.67 (0.60) 0 [ 4]

Naps 1.77 (0.78) 1 [ 4]

Substances 1.91 (1.00) 9 [ 4]

Knufinke et al. (2017a) JSR

RESULTS - SLEEP HYGIENE

All

M (SD)

# Athletes

≥ [cutoff]

Sleep Hygiene

Heavy Meal (%) 26 (33) 10 [80]

Caffeine After 6 PM (%) 22 (28) 7 [80]

Alcohol After 8 PM (%) 2 (6) 0 [80]

Sleep Medication (%) 3 (1.3) 1 [80]

Bed partner/ Roommate

(%)49 (46) 40 [80]

Bedtime Routine (%) 25 (38) 16 [80]

Nap (%) 18 (20) 1 [80]

Intense Activity (%) 2 (11) 1 [80]

Blue Light (%) 70 (29) 51 [80]Knufinke et al. (2017a) JSR

RESULTS - SLEEP HYGIENE

Sleep hygiene associated with better sleep quality and fewer sleep complaints

0

0,5

1

1,5

2

2,5

3

13 18 23 28 33 38 43 48Ho

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(0

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Sleep Hygiene Index (13-65)

0

2

4

6

8

10

12

14

13 18 23 28 33 38 43 48

Pit

tsb

urg

h S

lee

pQ

ual

ity

Scal

e (

0-2

1)

Sleep Hygiene Index (13-65)

PSQI HSDQ

SHI .45** .50**

RESULTS - SLEEP HYGIENE

• (Habitual) sleep hygiene matters for

sleep quantity and quality

• Sleep hygiene deserves attention

−Regularity of bed- and rise times

−Psychological strain

−Active pre-sleep behavior

RESULTS - SLEEP HYGIENE

SLEEP AND EXERCISE: A RECIPROCAL ISSUE?

Regular exercise benefits sleep

→ But, impaired sleep during periods

of intense training

May cause:

• Overreaching

• Performance decrease

• Increase in injuries

• Mood disturbances

Chennaoui et al., (2015).Sleep Medicine

ReviewsFietze et al., (2009). Chronobiology

International Killer et al., (2015). Journal of Sport Science

SLEEP AND EXERCISE: A RECIPROCAL ISSUE?

How does habitual training load impact

sleep in elite athletes?

RESULTS - TRAININGLOAD

▪ Self-reported training load did not significantly

affect sleep quantity or sleep stage distributions

(REM, Light, Deep), all p’s > .05

With sleep remaining

irresponsive to changes in

training load, future studies

should investigate whether

the current sleep quantity

and sleep stage distribution

provide sufficient recovery

after strenuous exercise.

Knufinke et al. (2017). J. Sci & Med. in Sport

RESEARCH AIMS - AGENDA

°C

1 2 3 4

CHARACTERIZE SLEEP ‘SLEEP THIEVES’ SLEEP &PERFORMANCE

OPTIMIZE SLEEP

3. EFFECTS OF SLEEP ON PERFORMANCE

3 2 1 1 2 3 4 5 6 7

COGNITIVE GROSS MOTORFINE MOTOR

• Reaction Speed

• Error Rate

• Technical skills • Power / endurance

Sport-specific | normalized outcomes converted to arbitrary units

n M SDSleep Quantity

Total Sleep Time (h:min) 282 7:30 1:05Sleep Onset Latency (min) 282 0:14 0:17Wake After Sleep Onset (min) 282 0:31 0:16Sleep Efficiency (%) 282 88.73 5.55

Sleep StagesDeep (h:min) 206 1:37 0:31REM (h:min) 206 1:59 0:42Light (h:min) 206 3:54 0:50

Note. Episodes of sleep / wakefulness were identified using a high sleep-wake threshold (i.e., AW>80; epochs are scored as wake if activity counts were above 80).

3 2 1 1 2 3 4 5 6 7RESULTS

Note. The model in Figure 1 refers to response speed. Translated to response time, the model predicts that for each additional hour of sleep, response time is approximately 5ms faster.

Knufinke et al. (2018). JSSM

RESULTS

COGNITIVE: Increase total sleep time – faster reaction time

FINE MOTOR: No significant effects

GROSS MOTOR: Shorter sleep onset latency – better gross motor performance & shortertotal sleep time – beter gross motor performance

CONCLUSION

Small, naturally occurring changes in sleep quantity and

sleep stages

• are unlikely to result in large

performance effects.

• impact cognitive

performance to a greater extent than athletic

performance.

• highlight a dose-response relationship.

→ more extreme sleep loss or

accumulated sleep debt may

prove to be detrimental for

performance and recovery.

RESEARCH AIMS - AGENDA

°C

1 2 3 4

CHARACTERIZE SLEEP ‘SLEEP THIEVES’ SLEEP &PERFORMANCE

OPTIMIZE SLEEP

HOW IS SLEEP REGULATED?

TARGET MECHANISMSSLEEP

MAINTENANCE

1. SLEEP HYGIENE

2. TEMPERATURE

3. LIGHT

DESIGN CRITERIA

a) theoretically plausible

b) practically usable

SLEEP ONSET

INTERVENTION PILOTS

1. SLEEP HYGIENE 2. TEMPERATURE 3. LIGHT

19 field hockey players 15 recreational athletes

>> NO SIGNIFICANT EFFECTS >> FASTER SLEEP ONSET

OPTIMIZING SLEEP IN ATHLETES – LIGHT REGUALTION

OPTIMIZING SLEEP BY MEANS OF LIGHT

Current situation

Optimal situation

RQ: Can coordinating fixed sleep schedules with light-dark regulation lead to more consolidated sleep in the habitual bedroom environment?

• Delayed melatonin

synthesis

• Increased alertness

• Habitual

melatonin

syntheses

• Increased SOL

• More frequent and

longer WASO

• Reduced sleep duration

• Facilitated sleep onset

• Reduced frequency and

duration of WASO

• Increased sleep duration

DESIGN - AMBULATORY

• 26 recreational athletes

• 19-32 years old

• 14 female

• Trained 8.90 ± 4.56 h/week

• Team and individual sports

PARTICIPANTS

LIGHT REGULATION

faster sleep onset

faster sleep onset

• Most athletes were in need for a sleep optimization strategy (6.8 ± 2.4)

• Comfort

• Ease of use

• Appearance

PROCESS EVALUATION

PROCESS EVALUATION

Light symptoms: 38 15 11

• Carefully timed exposure to bright-light in the morning combined with restriction of short-wavelength light in the evening is effective in shortening self-reported sleep onset latencies and improving sleep quality in athletes, with larger effects in case of a fixed sleep-wake schedule.

• Feasibility of the current intervention is questionable (in a top-sport context) due to:• duration of goggle-use, especially in the

evening• appearance of the goggles• regular sleep-wake pattern

CONCLUSION

• Explore less obtrusive options of light-regulation that are feasible indoors, outdoors and without attracting much attention in public

FUTURE DIRECTIONS

CONCLUSION& PRACTICAL IMPLICATIONS

SLEEP HYGIENE

SLAAPHYGIENE

APP

SLAAP HYGIENE APP

Kies:• een periode

• start- en end datum

• een locatie

• je sport

SLAAP HYGIENE APP - MONITORING

Gevalideerde:• slaap hygiëne vragenlijst

• slaap kwaliteit vragenlijst

SLAAP HYGIENE APP - ADVIES

Advies• persoonlijk feedback

• passend op je slaap behoefde

• passend bij de periode

• makkelijk toepasbaar / praktisch

• op wetenschap gebaseerd

SLAAP HYGIENE APP – VERGELIJK EN VERBETER

• Slaapadvies en tips• tussen verschillende periodes

• seizoenen

• Verbeter• kijk terug

• leer

• zie je progressie

SLAAPHYGIENE

APPVRAGEN?

…from theory to evidence-based intervention