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Understanding sleep disturbance in athletes prior to important competitions

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Objectives Anecdotally many athletes report worse sleep in the nights prior to important competitions. Despite sleep being acknowledged as an important factor for optimal athletic performance and overall health, little is understood about athlete sleep around competition. The aims of this study were to identify sleep complaints of athletes prior to competitions and determine whether complaints were confined to competition periods. Design Cross-sectional study. Methods A sample of 283 elite Australian athletes (129 male, 157 female, age 24 ± 5 yr) completed two questionnaires; Competitive Sport and Sleep questionnaire and the Pittsburgh Sleep Quality Index. Results 64.0% of athletes indicated worse sleep on at least one occasion in the nights prior to an important competition over the past 12 months. The main sleep problem specified by athletes was problems falling asleep (82.1%) with the main reasons responsible for poor sleep indicated as thoughts about the competition (83.5%) and nervousness (43.8%). Overall 59.1% of team sport athletes reported having no strategy to overcome poor sleep compared with individual athletes (32.7%, p = 0.002) who utilised relaxation and reading as strategies. Individual sport athletes had increased likelihood of poor sleep as they aged. The poor sleep reported by athletes prior to competition was situational rather than a global sleep problem. Conclusion Poor sleep is common prior to major competitions in Australian athletes, yet most athletes are unaware of strategies to overcome the poor sleep experienced. It is essential coaches and scientists monitor and educate both individual and team sport athletes to facilitate sleep prior to important competitions.
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Please
cite
this
article
in
press
as:
Juliff
LE,
et
al.
Understanding
sleep
disturbance
in
athletes
prior
to
important
competitions.
J
Sci
Med
Sport
(2014),
http://dx.doi.org/10.1016/j.jsams.2014.02.007
ARTICLE IN PRESS
G Model
JSAMS-1000;
No.
of
Pages
6
Journal
of
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Medicine
in
Sport
xxx
(2014)
xxx–xxx
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Sport
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om
epage:
www.elsevier.com/locate/jsams
Original
research
Understanding
sleep
disturbance
in
athletes
prior
to
important
competitions
Laura
E.
Juliffa,b,c,,
Shona
L.
Halsona,
Jeremiah
J.
Peifferb
aPerformance
Recovery,
Australian
Institute
of
Sport,
Australia
bSchool
of
Psychology
and
Exercise
Science,
Murdoch
University,
Australia
cPhysiology,
Australian
Institute
of
Sport,
Australia
a
r
t
i
c
l
e
i
n
f
o
Article
history:
Received
14
October
2013
Received
in
revised
form
22
December
2013
Accepted
5
February
2014
Available
online
xxx
Keywords:
Sleep
complaints
Sleep
strategies
a
b
s
t
r
a
c
t
Objectives:
Anecdotally
many
athletes
report
worse
sleep
in
the
nights
prior
to
important
competitions.
Despite
sleep
being
acknowledged
as
an
important
factor
for
optimal
athletic
performance
and
overall
health,
little
is
understood
about
athlete
sleep
around
competition.
The
aims
of
this
study
were
to
identify
sleep
complaints
of
athletes
prior
to
competitions
and
determine
whether
complaints
were
confined
to
competition
periods.
Design:
Cross-sectional
study.
Methods:
A
sample
of
283
elite
Australian
athletes
(129
male,
157
female,
age
24
±
5
y)
completed
two
questionnaires;
Competitive
Sport
and
Sleep
questionnaire
and
the
Pittsburgh
Sleep
Quality
Index.
Results:
64.0%
of
athletes
indicated
worse
sleep
on
at
least
one
occasion
in
the
nights
prior
to
an
important
competition
over
the
past
12
months.
The
main
sleep
problem
specified
by
athletes
was
problems
falling
asleep
(82.1%)
with
the
main
reasons
responsible
for
poor
sleep
indicated
as
thoughts
about
the
compe-
tition
(83.5%)
and
nervousness
(43.8%).
Overall
59.1%
of
team
sport
athletes
reported
having
no
strategy
to
overcome
poor
sleep
compared
with
individual
athletes
(32.7%,
p
=
0.002)
who
utilised
relaxation
and
reading
as
strategies.
Individual
sport
athletes
had
increased
likelihood
of
poor
sleep
as
they
aged.
The
poor
sleep
reported
by
athletes
prior
to
competition
was
situational
rather
than
a
global
sleep
problem.
Conclusion:
Poor
sleep
is
common
prior
to
major
competitions
in
Australian
athletes,
yet
most
athletes
are
unaware
of
strategies
to
overcome
the
poor
sleep
experienced.
It
is
essential
coaches
and
scien-
tists
monitor
and
educate
both
individual
and
team
sport
athletes
to
facilitate
sleep
prior
to
important
competitions.
©
2014
Sports
Medicine
Australia.
Published
by
Elsevier
Ltd.
All
rights
reserved.
1.
Introduction
Within
elite
sport,
success
is
underpinned
by
optimal
preparation1and,
equally
important,
adequate
recovery
between
training
and
during
competition.2,3 Sleep
has
been
recognised
as
an
essential
component
for
athlete
preparation
and
is
suggested
to
be
the
single
best
recovery
strategy
available
to
an
athlete.4,5
Despite
the
importance
of
sleep
for
athletic
performance,
data
on
elite
athletes
is
limited.5Anecdotal
reports
suggest
athletes
often
sleep
worse
around
competition
periods,
particularly
the
night(s)
prior
to
an
important
competition.6,7 With
reduced
sleep
shown
to
negatively
influence
performance
this
reduction
may
become
problematic.8,9 Sleep
deprivation
studies
in
athletes
has
found
decreased
anaerobic
performances
through
decreased
mean
Corresponding
author.
E-mail
address:
laura.juliff@ausport.gov.au
(L.E.
Juliff).
and
total
sprint
time
in
team
sport
athletes
after
30
h
of
sleep
deprivation10 and
decreased
aerobic
performance
following
24
h
of
reduced
sleep.11 Whilst
it
may
be
seldom
that
athletes
expe-
rience
total
sleep
deprivation
prior
to
competition,
acute
partial
sleep
deprivation
may
exist.
One
night
of
poor
sleep
in
athletes
is
associated
with
reduced
reaction
times,12 reduced
anaerobic
per-
formance
the
following
afternoon
in
football
players13 and
declines
in
cognitive
processes
such
as
visual
tracking,
focus,
determination
and
mood.14,15 As
many
sports
rely
on
fine
motor
movements
and
the
ability
to
make
fast
accurate
decisions,
reduced
sleep
in
athletes
is
a
genuine
concern.16
As
it
is
possible
that
sleep
quantity
and
quality
may
influence
performance,17 there
is
a
growing
need
to
understand
sleep
pat-
terns
in
elite
athletes.
To
date,
relatively
few
studies
exist
that
provide
this
information.3,19,20 In
a
survey
of
632
German
athletes
prior
to
competition,
65.8%
acknowledged
worse
sleep
than
nor-
mal
at
least
once
before
a
competition,
indicating
their
main
issue
to
be
“problems
falling
asleep”
(79.9%),
due
to
“thoughts
about
http://dx.doi.org/10.1016/j.jsams.2014.02.007
1440-2440/©
2014
Sports
Medicine
Australia.
Published
by
Elsevier
Ltd.
All
rights
reserved.
Please
cite
this
article
in
press
as:
Juliff
LE,
et
al.
Understanding
sleep
disturbance
in
athletes
prior
to
important
competitions.
J
Sci
Med
Sport
(2014),
http://dx.doi.org/10.1016/j.jsams.2014.02.007
ARTICLE IN PRESS
G Model
JSAMS-1000;
No.
of
Pages
6
2
L.E.
Juliff
et
al.
/
Journal
of
Science
and
Medicine
in
Sport
xxx
(2014)
xxx–xxx
Table
1
Distribution
of
athletes
by
sport.
Individual
Team
Athletics
n
=
21
Basketball
n
=
14
Canoe/Kayak
n
=
6 Football
(soccer)
n
=
24
Cycling
n
=
17
Hockey
n
=
30
Gymnastics
n
=
3
Netball
n
=
30
Moguls
n
=
1
Rugby
League
n
=
15
Rowing
n
=
4
Rugby
Sevens
n
=
44
Sailing
n
=
2
Softball
n
=
14
Short
Track
Speed
Skating
n
=
1 Volleyball
n
=
10
Ski
Cross
n
=
3 Waterpolo
n
=
4
Surf
Life
Saving
n
=
1
Wheelchair
Basketball
n
=
19
Swimming
n
=
9
Wheelchair
Rugby
n
=
6
Tennis
n
=
3
Triathlon
n
=
1
Power
Lifting
n
=
1
the
competition/game”
(77%)
and
because
of
this
“increased
day-
times
sleepiness”
with
athletes
indicating
“no
special
strategy”
to
enhance
sleep.6These
findings
provide
valuable
information
on
sleep
habits
of
the
elite
athlete
and
provide
a
stimulus
for
further
investigation.
Furthermore,
if
elite
athletes
do
present
as
“poor”
sleepers
it
is
important
to
differentiate
poor
competition
sleep
from
chronic
sleep
issues
if
coaches,
athletes
and
sports
scientists
hope
to
use
this
knowledge
to
enhance
future
performance.
The
purpose
of
this
study
was
to
document
the
occurrence
of
sleep
disturbances
in
athletes
prior
to
important
competitions
and/or
games.
If
sleep
disturbances
were
indicated
by
athletes,
we
aimed
to
examine
the
particular
problems,
reasons
and
perceived
consequences
associated
with
the
sleep
disturbance.
In
addition
from
the
information
obtained
we
sought
to
determine
whether
a
particular
group
of
athletes
had
an
increased
likelihood
of
sleep
disturbance.
This
study
additionally
aimed
to
provide
a
compre-
hensive
analysis
of
whether
individual
versus
team
sport
athlete
sleep
habits
differ.
Finally,
a
novel
aspect
of
the
study
was
to
estab-
lish
whether
sleep
disturbances
are
a
general
complaint
present
on
a
day-to-day
basis
in
athletes
or
whether
it
is
merely
situational.
2.
Methods
A
sample
of
283
elite
Australian
athletes
(mean
±
SD;
age:
24
±
5
y,
age
range:
16–47
y)
volunteered
to
participate
in
the
study
from
a
variety
of
Australian
sports
(Tables
1
and
2).
Athletes
were
recruited
from
the
Australian
Institute
of
Sport,
Australian
Winter
Olympic
team,
Australian
Paralympic
team
and
National
Sport-
ing
Organisations
through
personal
contact
with
researchers
or
through
coaching
and/or
support
staff.
All
athletes
were
at
an
inter-
national
level
or
were
members
of
professional
teams.
The
athletes
sampled
had
competed
in
their
sport
for
a
mean
of
11
±
6
y,
trained
on
average
16:42
±
6:42
h
per
week,
slept
on
average
7:42
±
0:54
h
per
night
and
had
competed
in
14
±
13
important
competitions
or
games
in
the
past
12
months
(Table
2).
Ethical
approval
was
obtained
through
Murdoch
University
and
the
Australian
Institute
of
Sport
ethics
committees
prior
to
data
collection.
In
the
period
prior
to
(1
month)
and
following
(7
months)
the
2012
Olympic
games,
participants
were
asked
to
complete
two
questionnaires
regarding
their
sleep
(Competitive
Sports
and
Sleep
Questionnaire6and
the
Pittsburgh
Sleep
Quality
Index21)
either
online
(Survey
Monkey©)
or
through
hard
copy.
The
Competitive
Sports
and
Sleep
Questionnaire,10 previously
described
by
Erlacher
and
colleagues,6is
a
sport
specific
question-
naire
used
to
assess
sleep
habits
and
dreams
of
athletes
prior
to
important
competitions
and
games.
The
questionnaire
is
divided
into
three
main
sections.
The
first
section
is
used
to
obtain
demo-
graphic
data
and
information
about
the
athlete’s
chosen
sport.
This
information
was
used
to
categorise
athletes
into
male
and
female,
team
sport
or
individual
sport
and
in
season
or
out
of
season
at
the
time
of
answering
the
questionnaire,
for
statistical
purposes.
The
subsequent
section
aimed
to
obtain
information
on
athlete
sleep
habits
prior
to
important
competitions
or
games.
If
an
athlete
answered
“yes”
to
having
poor
sleep
at
least
once
before
an
impor-
tant
competition
or
game
in
the
past
year,
they
were
required
to
complete
a
further
four
closed
response
questions.
The
initial
closed
response
question
assessed
the
types
of
sleep
problems
the
athlete
experienced.
The
response
options
were;
“problems
falling
asleep”,
“waking
up
at
night”,
“waking
up
early
in
the
morning”,
and
“unpleasant
dreams”
with
the
first
three
options
referring
to
typical
sleep
problems
associated
with
insomnia.
The
second
question
addressed
reasons
for
the
sleep
disturbance;
“not
used
to
surroundings”,
“noises
in
the
room
or
from
outside”,
“nervousness
about
competition/game”,
and
“thoughts
about
the
competition/game”.
The
third
question
addressed
the
perceived
consequences
of
poor
sleep
with
options
including;
“no
influence”,
“bad
mood
the
following
day”,
“increased
daytime
sleepiness”,
and
“poorer
performance
in
competition”.
In
the
fourth
question,
ath-
letes
report
on
the
strategies
used
to
deal
with
sleeping
problems
with
responses;
“no
special
strategy”,
“methods
to
relax”,
“sleeping
pills”,
“reading”,
and
“watching
TV”.
In
the
final
section
of
the
questionnaire,
an
additional
series
of
questions
were
used
to
obtain
information
regarding
general
sleep
habits
and
training.
Within
this
section
athletes
answered
questions
such
as;
“If
you
have
a
late
training
session
or
game
do
you
find
it
hard
to
sleep
after?”
and
“Do
you
take
sleeping
medication?”.
The
validated
Pittsburgh
Sleep
Quality
Index
(PSQI)
has
been
used
throughout
numerous
sleep
studies
as
a
standardised
sleep
questionnaire
estimating
general
sleep
quality,21 however
there
has
been
limited
use
in
athletes.16 For
the
current
study
the
ques-
tionnaire
was
used
to
identify
‘good’
or
‘poor’
sleepers.
Prior
to
filling
out
the
PSQI
athletes
were
notified
that
all
answers
were
to
indicate
the
most
accurate
reply
for
the
majority
of
days
and
nights
in
the
past
month
only.
Seven
component
scores
were
gen-
erated
(using
a
0–3
scale):
subjective
sleep
quality,
sleep
latency,
sleep
duration,
habitual
sleep
efficiency,
sleep
disturbances,
use
of
sleeping
medication,
and
daytime
dysfunction.
From
the
sum
of
the
seven
component
scores
a
global
score
(range,
0–21)
was
calculated.22,23 If
an
athlete
scored
between
0
and
5
they
were
classed
as
a
‘good
sleeper’
as
specified
by
the
PSQI
and
a
score
above
5
classed
an
athlete
as
a
‘poor
sleeper’.21
Differences
for
age,
years
in
sport,
practice
hours
per
week
and
sleep
per
night
between
the
groups
for
gender,
sport
and
time
of
season
the
questionnaire
was
answered
were
analysed
using
an
independent
sample
t-test
for
the
continuous
variables.
The
per-
centage
of
athletes
who
responded
“yes”
to
reporting
poor
sleep
the
night
before
an
important
competition
or
game
in
the
past
year
was
calculated.
For
the
“yes”
respondents,
associations
between
categorical
variables
for
sex
(female
versus
male),
sport
groups
(individual
versus
team
sports)
and
time
of
season
the
question-
naire
was
answered
(in
season
versus
out
of
season)
was
calculated
for
each
sleep
disturbance
question
using
a
2
×
2
frequency
table
and
Pearson’s
chi-squared
test
(2).
To
determine
whether
an
asso-
ciation
existed
between
athletes
who
reported
“yes”
or
“no”
to
sleep
disturbance
prior
to
a
competition
and
athletes
who
were
classed
as
generally
‘good’
or
‘poor’
sleepers
through
the
Pittsburgh
Sleep
Quality
Index,
a
chi-squared
test
was
calculated.
A
binary
logis-
tic
generalised
linear
model
was
run
to
ascertain
the
effects
of
the
dichotomised
variables
age,
gender,
sport
and
athletes
in
or
out
of
season
on
the
predicted
likelihood
of
athletes
having
poor
sleep
prior
to
an
important
competition.
All
statistics
were
com-
pleted
using
SPSS©
Statistics
(version
19,
IBM©,
USA)
and
R
(R
Foundation
for
Statistical
Computing,
Vienna)
statistical
software
programs
with
significance
set
to
p
0.05.
Please
cite
this
article
in
press
as:
Juliff
LE,
et
al.
Understanding
sleep
disturbance
in
athletes
prior
to
important
competitions.
J
Sci
Med
Sport
(2014),
http://dx.doi.org/10.1016/j.jsams.2014.02.007
ARTICLE IN PRESS
G Model
JSAMS-1000;
No.
of
Pages
6
L.E.
Juliff
et
al.
/
Journal
of
Science
and
Medicine
in
Sport
xxx
(2014)
xxx–xxx
3
Table
2
Characteristics
of
athletes
by
gender,
sport
and
season
(mean
±
SD).
Overall
(n
=
283)
Gender
Sport
Season
Male
(n
=
126)
Female
(n
=
157)
Individual
(n
=
73)
Team
(n
=
210)
In-Season
(n
=
187)
Out
of
Season
(n
=
96)
Age
24.1
±
5.1
24.0
±
5.5
24.2
±
4.9
24.4
±
5.8
23.9
±
4.9
24.5
±
5.2*23.2
±
4.8
Years
in
sport 11
±
611
±
711
±
611
±
6.0 11
±
7
11
±
6
11
±
6
Practice
hours
per
week
(h:min) 16:42
±
6:42
16:42
±
6:00
16:48
±
7:12
23:00
±
7:30*14:36
±
4:42
16:06
±
6:06*18:00
±
7:30
Sleep
duration
per
night
(h:min)
7:42
±
0:54
7:48
±
0:54
7:36
±
0:54
7:48
±
1:00
7:36
±
0:54
7:42
±
0:54
7:42
±
1:00
*Difference
(p
<
0.05)
between
groups
within
category.
3.
Results
From
the
283
Australian
athletes
sampled,
181
(64.0%)
indicated
they
had
slept
worse
than
usual
in
the
night(s)
prior
to
an
important
competition
or
game
over
the
past
12
months.
There
were
no
sig-
nificant
differences
between
gender
(62.4%
male
vs.
65.9%
female),
sport
(71.23%
individual
vs.
61.4%
team)
or
athletes
currently
in
or
out
of
season
(61.3%
in-season
vs.
69.1%
out
of
season)
(Table
3).
The
181
Australian
athletes
who
reported
worse
sleep
at
least
once
prior
to
a
competition
or
game
answered
further
questions
in
relation
to
their
sleep
disturbances
(Table
3).
Overall,
the
majority
of
athletes
indicated
they
had
“problems
falling
asleep”
(82.1%)
due
to
“thoughts
about
the
competition/game”
(83.5%)
however
(46.6%)
believed
this
had
“no
influence”
on
their
performance.
There
was
an
association
between
genders
for
unpleasant
dreams,
with
dreams
affecting
sleep
in
females
(10%)
more
fre-
quently
than
males
(0%);
(x2
(1) =
9.16,
p
=
0.002).
In
addition,
females
reported
reading
more
frequently
(32.6%)
as
a
strategy
to
obtain
improved
sleep
on
the
night
prior
to
a
competition
than
males
(18.5%);
(x2
(1) =
4.51,
p
=
0.034).
No
further
differences
were
found
between
gender.
There
were
no
differences
observed
between
individual
versus
team
sport
athletes
for
problems
and
reasons
for
sleep
disturb-
ance
with
both
indicating
internal
factors
“nervousness
about
the
competition/game”
and
“thoughts
about
the
competition/game”
as
the
main
reasons
for
their
sleep
disturbance
(Table
3).
An
asso-
ciation
(x2
(1) =
8.36,
p
=
0.005)
was
found
for
individual
athletes
reporting
worse
sleep
to
have
no
influence
on
performance
(63.5%)
when
compared
with
team
sport
athletes
(39.7%).
Increased
day-
time
sleepiness
was
stated
more
frequently
in
team
sport
athletes
(48.4%)
compared
with
individual
athletes
(26.9%);
(x2
(1) =
6.97,
p
=
0.012).
Additionally,
a
higher
percentage
of
team
sport
athletes
(59.1%)
reported
having
no
special
strategy
to
obtain
better
sleep
on
the
night
before
an
important
competition
or
game
compared
with
individual
athletes
(32.7%);
(x2
(1) =
9.87,
p
=
0.002).
Individual
athletes
reported
using
methods
to
relax
(x2
(1) =
5.53,
p
=
0.024)
and
reading
(x2
(1) =
12.4,
p
=
0.001)
as
strategies
to
enhance
sleep
more
often
than
team
sport
athletes
(Table
3).
There
was
an
association
between
poor
sleep
responses
prior
to
competition
and
the
PSQI
(x2
(1) =
5.195,
p
=
0.002)
indicating
the
two
variables
are
statistically
independent
of
one
another.
The
logistic
regression
model
that
predicted
the
likelihood
par-
ticipants
had
poor
sleep
was
statistically
significant
(x2
(3) =
15.819,
p
=
0.001).
Of
the
four
predictor
variables,
age,
gender,
sports
and
season,
only
two
were
statistically
significant;
age
(p
=
0.019)
and
sport
(p
=
0.004).
Increasing
age
was
associated
with
an
increased
probability
of
exhibiting
poor
sleep
in
individual
sport
athletes
whereas
team
sport
athletes’
probability
of
poor
sleep
decreased
with
age
(Fig.
1).
General
sleep
disturbance
percentages
indicate
52.5%
of
ath-
letes
experience
poor
sleep
post
late
game
whilst
47.5%
show
no
sleep
disturbance.
Following
a
rest
day
28.4%
of
athletes
indi-
cate
having
sleep
disturbance
whilst
71.6%
did
not.
Finally
27.7%
of
athletes
experience
sleep
disturbance
during
heavy
training
periods.
4.
Discussion
The
purpose
of
this
study
was
to
understand
the
sleep
com-
plaints
of
elite
Australian
athletes
prior
to
important
competitions
and
games.
The
main
findings
were
(1)
64%
of
Australian
athletes
surveyed
experienced
sleep
problems
prior
to
a
major
competition
at
least
once
in
the
previous
12
months.
The
key
sleep
complaint
reported
was
difficulty
initiating
sleep
due
to
nervousness
and
thoughts
prior
to
competition.
(2)
The
perceived
influence
of
poor
sleep
on
performance
varied
between
individual
and
team
sport
athletes.
(3)
When
further
examining
individual
and
team
sport
variances,
the
percentage
use
of
strategies
was
statistically
differ-
ent.
(4)
The
predicted
likelihood
of
sleep
disturbance
due
to
an
athlete’s
age
differed
with
individual
and
team
sport
athletes.
(5)
A
novel
finding
was
the
sleep
problems
reported
by
athletes
in
this
study
were
confined
to
competition
periods
only.
In
the
present
study,
we
observed
64%
of
the
athletes
sur-
veyed
indicated
sleep
disturbance
prior
to
important
competition
which
supports
previous
anecdotal
evidence.
This
finding
is
com-
parable
to
the
occurrence
of
sleep
complaints
found
in
German
athletes
(65.8%)
prior
to
major
competitions.6The
majority
of
Aus-
tralian
athletes
who
indicated
experiencing
worse
sleep
prior
to
competition
reported
internal
factors
as
the
main
reason
respon-
sible
(Table
3).
Specifically,
nervousness
and
thoughts
about
the
15 20 25 30 35 40 45
0.0 0.2 0.4 0.6 0.8 1.0
Age (years)
probability of having sleep difficulties
Individual Sport
Team Sport
Fig.
1.
The
predicted
probability
of
sleep
difficulties
prior
to
an
important
compe-
tition
for
individual
and
team
sport
athletes’
based
on
age.
Predicted
probabilities
and
95%
confidence
intervals
are
displayed.
Please
cite
this
article
in
press
as:
Juliff
LE,
et
al.
Understanding
sleep
disturbance
in
athletes
prior
to
important
competitions.
J
Sci
Med
Sport
(2014),
http://dx.doi.org/10.1016/j.jsams.2014.02.007
ARTICLE IN PRESS
G Model
JSAMS-1000;
No.
of
Pages
6
4
L.E.
Juliff
et
al.
/
Journal
of
Science
and
Medicine
in
Sport
xxx
(2014)
xxx–xxx
Table
3
Absolute
and
relative
number
of
responses
for
each
person
who
states,
“Yes”
they
have
had
disrupted
or
fragmented
sleep
prior
to
an
important
competition
or
game
in
the
last
12
months.
All
Participants Gender
Sport
Season
Absolute
Frequency
(%)
Male
(%)
Female
(%)
Chi
square
p-Value
Individual
(%)
Team
(%)
Chi
square
p-Value
Out
of
season
(%)
In
season
(%)
Chi
square
p-Value
Overall
181
64.0
65.9
62.4
0.55
0.619
71.2
61.4
0.13
0.158
69.1
61.3
0.20
0.240
What
kinds
of
problems
did
you
experience
with
your
sleep
prior
to
an
important
competition
or
game?
n
=
179
Problems
falling
asleep 147
82.1 80.7 83.3 0.21
0.698
80.7
82.7
0.09
0.831
86.2
79.8
1.13
0.318
Waking
up
early
in
the
morning
48
26.8
24.1
29.2
0.58
0.501
32.7
24.4
1.29
0.269
24.6
28.1
0.25
0.726
Waking
up
at
night 68
38.0 32.5 42.7 1.96 0.169 44.2 35.4
1.21
0.310
43.1
35.1
1.12
0.337
Unpleasant
dreams
10
5.6
0
10
9.16
0.002*
4
6
0.42
0.726
6
5
0.06
1.000
Not
feeling
refreshed
in
morning
65
36.3
34.9
37.5
0.13
0.757
32.7
37.8
0.42
0.608
30.8
39.5
1.36
0.262
What
reasons
were
responsible
for
your
sleeping
problems
prior
to
an
important
competition
or
game?
n
=
176
Thoughts
about
competition 147
83.5
82.9
84.0
0.16
0.837
76.5
86.4
2.59
0.120
83.1
83.8
0.01
1.000
Nervousness
about
competition
77
43.8
42.7
44.7
0.07
0.877
49.0
41.6
0.81
0.405
44.6
43.2
0.03
0.876
Not
used
to
surroundings
39
22.2
23.3
22.3
0.02
1.000
21.6
23.3
0.05
1.000
26.2
20.7
0.69
0.458
Noises
in
room
or
outside 31
17.6
15.0
19.0
0.75
0.428
26.0
14.0
3.62
0.076
15.0
18.0
0.31
0.666
In
what
manner
did
the
sleeping
problems
influence
your
performance
during
the
competition
or
game?
n
=
178
No
influence
83
46.6
48.2
45.3
0.15
0.764
63.5
39.7
8.36
0.005*
56.9
40.7
4.36
0.043*
Increased
daytime
sleepiness 75
42.1 36.1
47.4
2.29
0.171
26.9
48.4
6.97
0.012*
35.4
46.0
1.91
0.207
Bad
mood
the
following
day
24
13.4
13.3
13.7
0.01
1.000
11.5
14.3
0.24
0.810
4.6
18.6
6.90
0.011*
Worse
performance
in
competition
25
14.0
17.0
12.0
1.03
0.388
17.0
13.0
0.65
0.478
11.0
16.0
0.91
0.380
Which
strategies
did
you
use
to
sleep
well
in
the
nights
preceding
a
competition?
n
=
176
No
Strategy
91
51.7
54.3
49.5
0.41
0.548
32.7
59.1
9.87
0.002*
48.4
53.6
0.43
0.534
Methods
to
relax
37
21.0
22.2
20.0
0.13
0.853
32.3
16.5
5.53
0.024*
20.3
21.6
0.03
1.000
Sleeping
pills
23
13.1
12.3
13.7
0.07
0.826
12.2
13.4
0.04
1.000
15.6
11.6
0.58
0.490
Reading
46
26.1
18.5
32.6
4.51
0.034*
44.9
18.9
12.4
0.001*
29.7
24.1
0.66
0.477
Watching
TV
34
19.3
22.2
16.8
0.81
0.445
25.5
16.5
2.27
0.141
20.3
18.8
0.06
0.844
*
Association
(p
<
0.05)
between
groups
within
a
category.
Please
cite
this
article
in
press
as:
Juliff
LE,
et
al.
Understanding
sleep
disturbance
in
athletes
prior
to
important
competitions.
J
Sci
Med
Sport
(2014),
http://dx.doi.org/10.1016/j.jsams.2014.02.007
ARTICLE IN PRESS
G Model
JSAMS-1000;
No.
of
Pages
6
L.E.
Juliff
et
al.
/
Journal
of
Science
and
Medicine
in
Sport
xxx
(2014)
xxx–xxx
5
competition
were
the
most
common
reasons
for
sleep
problems
regardless
of
an
athlete’s
gender
or
sport.
This
finding
is
con-
sistent
with
previous
research
in
both
marathon
runners7and
German
athletes6who
reported
experiencing
anxiety
and
exces-
sive
thoughts
prior
to
competition.
Whilst
external
factors
such
as
noise
may
impact
sleep,
our
results
confirm
internal
factors
strongly
influence
sleep
disturbance
in
the
current
athlete
popu-
lation.
Consequences
of
fragmented
sleep
on
performance
are
of
importance
to
athletes
and
coaches,
as
sleep
restriction
whether
chronic
or
acute
may
have
detrimental
effects
on
health
and
performance.24 In
our
study,
the
two
most
commonly
reported
consequences
of
sleep
disruption
were
(1)
no
perceived
influence
on
performance
(46.6%)
and/or
(2)
increased
daytime
sleepiness
(42.1%).
The
later
finding
is
consistent
with
previous
studies
in
athletes6and
the
general
population24 where
daytime
sleepiness
was
recognised
as
the
most
frequently
described
consequence
of
insufficient
sleep.
Interestingly,
only
14%
of
all
surveyed
athletes
believed
reduced
sleep
directly
resulted
in
worse
performance
dur-
ing
competition.
Performance
was
not
assessed
during
the
study
therefore
there
is
little
information
to
determine
whether
an
ath-
lete
had
an
accurate
perception
of
performance
impacts.
Results
indicate
individual
sport
athletes
are
similar
to
team
sport
athletes
in
the
reported
occurrence
of
sleep
complaints
prior
to
major
competitions.
These
findings
contrast
those
by
Erlacher
et
al.6who
observed
greater
reporting
of
poor
sleep
in
individual
sport
athletes
compared
with
team
sport
athletes.
This
difference
was
explained
by
the
lower
pressure
and
anxiety
experienced
in
team
sports
as
these
athletes,
unlike
individual
sport
athletes,
are
not
solely
responsible
and
accountable
for
their
own
results.6
Although
this
explanation
is
feasible
our
data
does
not
support
this
hypothesis
as
we
observed
team
sport
athletes
to
report
nervous-
ness
and
thoughts
prior
to
competition
as
reasons
responsible
for
the
poor
sleep
similar
to
the
individual
athletes.
While
additional
research
is
needed
to
examine
differences
in
sleep
habits
of
indi-
vidual
versus
team
sport
athletes
to
fully
appreciate
the
diversity,
our
current
data
indicates
sleep
education
through
methods
such
as
sleep
hygiene
(behaviours
that
are
believed
to
promote
improved
quantity
and
quality
of
sleep25)
could
provide
benefits
of
sleep
enhancement
in
both
individual
and
team
sport
athletes.
Despite
team
and
individual
sport
athletes
reporting
similar
sleep
problems
and
reasons
responsible
for
sleep
disturbance,
team
sport
athletes
reported
a
greater
incidence
of
daytime
sleepiness
compared
with
individual
sport
athletes
(Table
3).
It
is
possible
the
greater
daytime
sleepiness
in
team
sport
athletes
is
due
to
a
lack
of
sleep
strategies
utilised
to
overcome
sleep
complaints
compared
with
individual
sport
athletes
(Table
3).
For
instance,
individual
sport
athletes
reported
more
frequently
the
reliance
on
reading
and/or
methods
to
relax
to
combat
sleep
complaints
in
comparison
with
team
sports
athletes
who
were
more
likely
to
have
no
strate-
gies
in
place
(Table
3).
Furthermore,
as
individual
athletes
indicated
having
a
greater
number
of
strategies
to
overcome
sleep
disturb-
ance
this
possibly
explains
why
these
athletes
reported
sleeping
problems
to
have
little
influence
on
their
performance
more
fre-
quently
than
their
team
sport
counterparts.
Increasing
age
in
individual
sport
athletes
was
associated
with
an
increased
likelihood
of
sleep
disturbance
prior
to
competi-
tion.
Intuitively
it
could
be
hypothesised
that
sleep
quality
before
competition
would
improve
as
an
athlete
aged
due
to
being
accus-
tomed
to
the
experience
of
competition
however
this
does
not
seem
to
be
the
case.
Defining
normal
sleep
in
athletes
and
dif-
fering
age
categories
remains
a
challenge
due
to
multiple
factors
contributing
to
poor
sleep.26 Indeed,
age
related
differences
in
sleep
have
been
documented;
however,
these
changes
are
most
prominent
in
individuals
beyond
40
years
of
age
thus,
limiting
the
usefulness
of
this
data
in
our
athlete
population.27 The
exact
reason
for
the
increased
likelihood
of
sleep
disturbance
in
indi-
vidual
sport
athletes
as
they
age
remains
unknown
and
warrants
further
investigation.
Interestingly,
a
lack
of
association
was
observed
between
ath-
letes
who
reported
poor
sleep
prior
to
competition,
from
the
Competitive
Sports
and
Sleep
Questionnaire
and
whether
the
ath-
lete
was
classed
as
a
“poor”
sleeper
in
general,
as
determined
by
the
Pittsburgh
Sleep
Quality
Index.
This
finding
implies
that
although
an
athlete
may
not
be
classed
as
a
problematic
sleeper
on
a
day-to-
day
basis,
sleep
complaints
may
arise
around
competition
periods
that
otherwise
are
not
present.
Indeed,
in
our
athletes
more
than
half
reported
sleep
disturbance
following
a
late
game
or
training
session.
In
addition,
a
smaller
number
indicated
fragmented
sleep
following
heavy
training
periods
and
days
of
rest.
These
findings
highlight
the
need
for
caution
when
using
a
single
subjective
sleep
quality
questionnaire
to
assess
an
athletic
population,
as
global
sleep
quality
assessments
may
not
display
the
same
efficacy
as
with
the
general
population,
due
to
situational
stressors
and
events
athletes’
encounter.
5.
Conclusion
Our
findings
highlight
the
majority
of
Australian
athletes’
surveyed
subjectively
indicated
sub-optimal
sleep
surrounding
important
competitions
mainly
due
to
nervousness
and
thoughts
prior
to
competition.
With
evidence
suggesting
athletes
sleep
poorly
pre-competition
more
research
is
needed
to
investigate
the
effects
of
acute
sleep
loss
on
athletic
performance.
The
current
sleep
strategy
results
were
concerning
with
few
athletes
aware
of
sleep
strategies
to
utilise
during
these
critical
competition
periods.
Whilst
no
gender
differences
were
exhibited,
there
were
age
and
team
sport
versus
individual
sport
differences
that
should
be
con-
sidered.
The
poor
sleep
reported
during
competition
appears
to
be
situational
and
not
associated
with
poor
sleep
in
general.
The
cur-
rent
study
highlights
the
need
for
individual
monitoring
of
athlete
sleep
habits
and
the
need
for
increased
sleep
hygiene
education
within
both
individual
and
team
sports.
Practical
implications
Both
team
sport
and
individual
sport
athletes
would
benefit
from
sleep
education.
Athletes
should
be
made
aware
and
educated
on
strategies
such
as
sleep
hygiene
to
assist
them
to
sleep
around
important
com-
petitions.
Sleep
strategies
should
specifically
focus
on
combatting
nervous-
ness
and
thoughts
prior
to
competition
in
athletes.
Conflict
of
interest
No
competing
agreements,
professional
relationships
and
finan-
cial
interests
existed
where
a
third
party
may
benefit
from
the
presented
results.
Acknowledgements
The
authors
would
like
to
thank
all
athletes
involved
in
the
study.
The
authors
also
would
like
to
express
gratitude
to
Dr.
Emma
Knight
and
Ian
Rayson
for
their
statistical
assistance.
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