Sleep Disturbance in Athletes

Several features of athletic life disturb sleep. Training and competition timing is a major one: very early starts, heavy evening sessions, and the arousal and stimulation that follow an evening or night fixture all shorten or delay sleep. Travel across time zones disrupts the body clock and brings jet lag, and long or awkward travel schedules add to the problem. Pre-competition anxiety and rumination are common causes of a poor night before an event. Lifestyle factors play a large part too, including caffeine and other stimulants taken late in the day, screen use and bright light at night, alcohol, and irregular schedules. The training load itself, and overtraining, can disturb sleep, as can an unfamiliar bed, a noisy environment, altitude and heat. On top of these, athletes develop the same primary sleep disorders as anyone else, such as insomnia disorder, obstructive sleep apnoea (OSA), restless legs syndrome and circadian rhythm disorders, and these should not be overlooked simply because someone is fit and young.

A useful history covers the timing and pattern of sleep, difficulty falling or staying asleep, non-restorative sleep, daytime sleepiness and its effect on training, mood and performance, and the contributing factors above. A sleep diary over a week or two is simple and revealing. Generic sleep questionnaires may miss factors specific to athletes, so a sport-specific tool, the Athlete Sleep Screening Questionnaire (ASSQ), validated mainly in elite athletes, is used to flag those who need further assessment and to guide simple interventions. The clinician also screens for primary sleep disorders and, importantly, for mental health contributors, since sleep and mood are entwined. Asking about snoring and witnessed pauses in breathing helps identify obstructive sleep apnoea, which is easy to miss. Screening supports, but does not replace, a proper clinical assessment, and the aim is to separate a lifestyle or behavioural sleep problem from a disorder that needs specific treatment.

Most sleep problems in athletes improve with behavioural change and better sleep habits, and simple sleep hygiene advice is a sensible first step: a regular sleep and wake schedule, a wind-down routine, a cool, dark and quiet room, limiting screens and bright light before bed, sensible caffeine timing, and using naps strategically rather than late in the day. Sleep hygiene alone does not treat chronic insomnia, for which cognitive behavioural therapy for insomnia (CBT-I) is the evidence-based first-line treatment and outperforms medication in the long run. Travel and jet lag are managed by adjusting sleep timing and light exposure around the destination; melatonin can help shift the body clock, but it is a prescription-only medicine in the UK and its timing is critical, since poorly timed melatonin or light can actually worsen circadian adaptation. Contributing factors are treated directly, whether pain, anxiety, low mood or a suspected primary sleep disorder, and a suspected obstructive sleep apnoea is referred to a sleep service for assessment and appropriate testing. Medication has a limited, short-term role and is used cautiously: any sedating sleep medicine should be trialled away from competition, must not be taken before driving or a safety-critical sport if it impairs alertness, and, like any medicine including over-the-counter products, is checked against anti-doping rules before use, since the athlete remains responsible for what they take. Referral to sleep services is appropriate for a suspected sleep disorder, diagnostic uncertainty, or a problem that does not respond to first-line measures.

• •The 2021 expert consensus on sleep and the athlete, in the British Journal of Sports Medicine, sets out assessment and evidence-based interventions for athlete sleep.
• •The Athlete Sleep Screening Questionnaire is a sport-specific screening tool, validated mainly in elite athletes, that flags those needing further assessment.
• •Current NICE guidance on insomnia supports sleep hygiene and cognitive behavioural therapy for insomnia, with hypnotic medication reserved for short-term use, and separate guidance covers obstructive sleep apnoea.
• •National Health Service and UK sleep charity resources provide practical self-help advice for patients.

• •Poor sleep impairs performance and recovery, is associated with higher injury and illness risk, and is closely tied to mental health.
• •Common sporting causes include training and competition timing, travel and jet lag, pre-competition anxiety, caffeine and screens.
• •Generic sleep questionnaires may miss athlete-specific factors; the Athlete Sleep Screening Questionnaire is the sport-specific tool.
• •Snoring with witnessed pauses in breathing and daytime sleepiness suggests obstructive sleep apnoea and needs referral.
• •Sleep hygiene is the first step, but cognitive behavioural therapy for insomnia is first-line for persistent or chronic insomnia.
• •Use sleep medication cautiously and short-term, trial it away from competition, and always check it against anti-doping rules.