It’s the night before an important race, or your first century, or that group ride that’s dropped you every time. You’re tossing and turning in your bed, telling yourself that you have to sleep. Or maybe you don’t have a problem getting to sleep, but day after day you wake up sluggishly, unrefreshed. The mentally fit cyclist gets sufficient sleep, and has the skills to manage internal sleep disrupters when they arise.
By Marv Zauderer
When I woke up this morning my girlfriend asked me, “Did you sleep good?” I said, “No, I made a few mistakes.”
– Steven Wright
Sleep. For some, it’s easy. For others, not so much. How much does it affect performance on the bike, and what can you do about it?
In the last installment of this Sport Psychology column, we talked with Roei “Jinji” Sadan about the mental side of riding around the world. This month, we talk with Dr. David Claman, Masters cyclist, Professor, and Director of the Sleep Disorders Center at the UC San Francisco Medical Center, about improving your sleep.
PEZ: For athletes who find themselves having difficulty going to sleep or staying asleep the night before an event, what’s actually going on?
Dr. David Claman: My colloquial explanation for what’s going on [with pre-event anxiety] is that it’s like worrying about an early-morning plane flight and getting to the airport. You’re on edge even before you go to bed, worried about the alarm, getting to the airport, and getting through security…because you’re so on edge, you sleep fitfully, and often feel that you hardly rest at all….The more scientific description of that is that you’re hyperaroused – not sexually aroused, although some people use that to relax – if you’re anxious, worried, on edge, your body has a physiologic response. You’re more tense, and the muscle tension tends to make your mind feel more anxious, and so you get a physical activation from the hyperarousal.
PEZ: What can athletes do to prevent that from happening, and deal with it if it does?
Dr. Claman: In general, what you really want [in order] to feel not only rested but also able to train effectively is what I’d call an adequate and consistent duration of sleeping. “Adequate and consistent” doesn’t have to be perfect all the time, but through thick and thin, if you’re fairly consistent about your sleep schedule, that’s one general recommendation for keeping the ability to sleep the way you want to. Then your circadian rhythms are lined up. [For example] If you always go to bed around 11, then your mind is going to know that as it gets close to 11, it’s time to be tired, and it’s easier to fall asleep. If you’re going to get up at 7 and make [your sleep] around eight hours, then your mind kind of knows to wait for that hour. Especially if you’re training, the average person probably needs eight, maybe even eight and a half hours to be optimally rested. Some people get by with seven, seven and a half, and they’re only mildly sleep-deprived. If you’re generally well-rested, one night of not sleeping very well doesn’t have a major impact. My personal impression is that the day after I don’t sleep as well, I’m OK; it’s 24 hours after that when I feel more of the lingering effects.
PEZ: So if an athlete is having difficulty with sleep the night before an event, something that could help the athlete with the pre-event anxiety is to remind themselves to relax about whether and how much they’ll end up sleeping – if they don’t sleep, or don’t sleep much, it’s not going to have that big of an effect?
Dr. Claman: I think that’s a good statement. You’re generally going to sleep enough to be able to perform the next day, so let yourself relax about it, because the more worried and anxious you are, the less you’ll sleep. The more relaxed you are, the better rest you’ll get.
PEZ: So how your sleep rhythms are organized in the days and weeks leading up to that night is going to have a far bigger effect than how the night before goes.
Dr. Claman: That’s generally true.
PEZ: So, as I understand it, it’s very important to practice good “sleep hygiene” to have your sleep be as restorative as possible leading up to the event. What’s good sleep hygiene?
Dr. Claman: The key approach is finding some effective means to reassure yourself….To be cycling-specific, if you find yourself imagining the bike race, you’re going to be tense the whole time, because to ride a bike, you have to be kind of tense and steering and watching out for other cyclists, obstacles, etc. You need a very soothing and relaxing imagery that would let your muscles relax, and so that your mind can be peaceful. It’s very individual for each person what would be relaxing, but finding a form of mental relaxation is part of good sleep hygiene.
PEZ: What are the other basic building blocks of good sleep hygiene?
Dr. Claman: The number one building block is keeping an adequate and consistent schedule. So staying up late on weekends might be fun, but it’s not conducive to the best sleep. The second thing is that caffeine and alcohol are far and away the two most common substances that can affect sleep. Caffeine changes your body rhythms and can stay in your system for six to eight hours, or longer, and make it harder to fall asleep. I often recommend to people to not have any caffeine after the lunch hour, so that when they go to bed, the caffeine is out of their system. Alcohol, similarly, can cause some minor changes in the sleep stages, and although it might help you get to sleep, it’s more likely that you’ll wake up after a few hours when the alcohol wears off, and you’ll have to pee because you drank extra fluid, and then if you’re on edge, the alcohol can interrupt the sleeping and make it harder to get back to sleep. Generally, if you can avoid caffeine and alcohol, especially the few nights before an event, it’s probably a good thing – you’re balancing how important those [substances] are to your quality of life, versus how big or little of an impact they have on your sleeping.
PEZ: What about napping?
Dr. Claman: That can be tricky. When you’re training and you’re tired, napping, especially when it’s 30 to 60 minutes and in the early afternoon, can be very helpful to recovery and rest. If you take a nap in the early afternoon and it’s less than an hour, it’s usually not going to affect your sleep that night. The night before a race, it’s better not to nap in the afternoon – it could make it harder to fall asleep. A purist in sleep hygiene would say you should never nap, but I think you have to balance it [in the case of] a competitive athlete.
PEZ: What about the role of an athlete’s baseline [ie. ongoing, consistent] stress/anxiety and the effect that can have on sleep?
Dr. Claman: There are different personality types vis-à-vis coping mechanisms [for stress/anxiety]. All of us have to deal with stress and anxiety. But if you tend to get caught up in so much worrying that it feels like anxiety is a problem, then the anxiety will generally make it harder to get to sleep and stay asleep. The number one treatment to help with that is some kind of relaxation technique at bedtime to lessen the anxiety and muscle tension….The time to practice the relaxation techniques is not [just] when you’re totally stressed the night before a race, it’s something to work on as a comfortable approach to going to bed on a more consistent basis – enough so that you know it’s soothing and helpful [when you need it].
PEZ: So if an athlete notices that they’re constitutionally prone to stress and anxiety, or they’re going through a period of time when their stress and anxiety is higher than usual, it would be wise to look at how to reduce the stress and anxiety on a consistent basis.
Dr. Claman: That’s exactly right.
PEZ: For the athlete who doesn’t have a problem going to sleep, and isn’t up a lot during the night, but day after day doesn’t awaken refreshed, what might be going on?
Dr. Claman: Probably the most common reason for an athlete to wake up unrefreshed is that the number of hours that they slept is not enough. In general, if you look at some of the research in this [area], a typical sleep duration if you really have the ability to sleep as long as you want, and you’re not stressed by things, is eight to eight and a half hours. I think many of us probably only sleep seven hours or a little less, and say, “Oh, but I can get by with seven hours and a cup or two of coffee, or more, or sodas.” You compensate for the sleep deprivation with the caffeinated drinks. Sleep deprivation is surprisingly common, and it may be mild if you’re only sleeping seven hours a night, but if you’re only sleeping six or six and a half, then of course it’s that much worse. The cut-off for severe sleep deprivation, if it’s a consistent sleep schedule, is about six hours.
PEZ: In addition to stress, anxiety, worry, tension – and caffeine and alcohol – what are some common causes of consistent sleep problems?
Dr. Claman: The quantity issue is a zero-sum game: many people who do a lot of exercise training are struggling to balance their training schedule, their work, and their family and friends. It’s easy to decide that you can do without sleep often, or at least occasionally. The more you train, the less time you have for other things, which is a common struggle for many of us. Plus I think many people underestimate what their true sleep needs are. [Regarding the quality of sleep,] most trained and fit athletes don’t have other sleep disorders. It would be the rare [athletic] patient who had snoring, sleep apnea, or narcolepsy problems.
PEZ: Snoring, sleep apnea, allergies – breathing difficulties can clearly have a significant impact on sleep.
Dr. Claman: That’s true. If you’re prone to allergies, nasal congestion, or asthma, then those are physical issues that can decrease sleep quality.
PEZ: What are the potential benefits and disadvantages of using over-the-counter and prescription sleep medications?
Dr. Claman: There’s good research literature that shows that the best long-term treatment for insomnia and sleep difficulties is making behavioral changes that help you sleep better, because then when you go through these periods of higher stress or anxiety, you have the coping mechanisms to get through those times and realize that you an do it on your own. There’s been consistent research that shows that behavioral treatments really are the most effective approach. It’s a little bit like the “going fishing” analogy – if I’m hungry and you give me a fish, I get one meal, but if you give me a pole and teach me how to fish, I can eat forever. For better or for worse, the pharmaceutical companies want us to use their products, and there are medicines that are short-acting with minimal side effects that do get used from time to time. If it’s something that you just used a handful of times during the year, and it didn’t cause side effects for you, then that’s probably a reasonable thing to consider. But the night before a race, you’d rather not try a pill that you’ve never used before. The problem with using the pharmaceutical solution to the stress and anxiety is that you’re not learning better skills. Potentially it can become a slippery slope: you start to think, “Oh, I can do this more often.”
PEZ: Plus, for medications that are not short-acting, the effects of the medication could linger into the period of time when you’re competing, and detract from your performance.
Dr. Claman: That’s exactly right. Although I’m open to the idea of medications, I really think it’s better to try to avoid them if you’ve never tried the behavioral treatments – that’s the way to start.
PEZ: If athletes want help with improving their sleep, what do you recommend?
Dr. Claman: If you work on the basics of good sleeping habits and good sleep hygiene, and your sleep symptoms don’t improve, then the most appropriate next step would be either to talk with your primary care physician or contact a sleep specialist in your area.
PEZ: How does one find a sleep specialist?
Your primary care physician can evaluate the issues and refer you to a specialist if necessary. The vast majority of patients who are seen in our program and in other programs across the country are referred by their regular doctor. If you’re still concerned that you have a sleep disorder above and beyond stress and anxiety, often you’d need the referral. Some sleep centers, like ours, do allow any patient to call and make an appointment. The American Academy of Sleep Medicine has a website with referrals to sleep centers [and other helpful information].
Improving sleep difficulties on your own may require using – and perhaps building – a variety of mental skills, including:
• Self-awareness, a crucial element in mental fitness;
• Assessing your mental fitness, including any signs of depression or the cyclist’s winter blues, both of which can cause sleep difficulties;
• Managing stress/anxiety and handling pressure, usually essential for sleep improvement;
• Using effective self-talk, visualization, and breathing techniques, all of which can be central to immediate and long-term relaxation.
Said Thomas Dekker, a 16th century English dramatist (and the namesake of a Dutch pro cyclist?), “Sleep is the golden chain that ties health and our bodies together.” May your golden chain shift smoothly!