The Off-Season Is When You Fix Sleep

On Sleep4Performance Radio, Dr. Meeta Singh made a point that reframes how teams should think about sleep support. Ask most performance staff when sleep becomes a problem and the answer is during the season. Ask when it gets addressed and the answer is the same. That sequencing guarantees the wrong intervention, because by the time an athlete is struggling in week six, the only tool fast enough to reach for is a pill.

Season 3, Episode 9, Sleep4Performance Radio, September 2019.

Why athletes cannot sleep after games

The post-game sleep problem is not mysterious, it is the predictable result of stacking arousals. After a game an athlete has elevated body temperature, circulating cortisol, caffeine still in the system, aching muscles, possible injury and pain, hours of bright light exposure, and either the excitement of winning or the stress of losing. Then post-game socializing and alcohol are added on top.

Pre-competition anxiety produces the same trouble at the other end. Some athletes do not sleep at all after competition, a finding that shows up in research on rugby players among others.

Dr. Singh also notes something teams frequently do not know: athletes prescribed stimulant medication for ADHD sometimes take it immediately before a game because they feel it helps them focus, which reliably prevents sleep six hours later.

The scheduling conflict nobody writes down

The obvious advice is to live the schedule you compete on: train at the time you play, keep the sleep window consistent, treat an evening-game athlete like a night-shift worker. It is correct, and it collides with the rest of an athlete's life.

A player finishing at two in the morning wants to sleep until ten or eleven. He also wants to be up at 6:30 to say goodbye to his children before school, because that is when his family is awake. In the NHL and NBA, with two to five games a week, this conflict is constant.

Dr. Singh is direct about what happens when practitioners ignore it. She calls it an expertise bias, a blind spot: build the recommendation only from the scientific data, hand over a plan that does not fit the athlete's life, and the plan goes in the bin unread. The useful version compromises. Pick a few days a week for the early wake-up rather than all of them.

Why sleeping pills become the default

The recommended first-line treatment for insomnia complaints is cognitive behavioral therapy for insomnia, which retrains a person how to sleep. It works. It also takes time and practice.

Once a season has begun, athletes do not have that time, and digital versions run into the same wall. So the request that arrives in-season is for medication, and the medication is usually being used for sedation to manage pre- and post-game arousal rather than to treat a diagnosed insomnia.

Several things follow, and Dr. Singh lays them out plainly:

• The effect of sleeping pills on next-day performance in athletes who do not have insomnia has not really been studied.
• Combining them with alcohol is genuinely dangerous, and post-game drinking is part of the culture in most sports.
• Occasional use often means the medication did not come from the team physician, who may not know the athlete is taking anything.
• There are side effects of their own, including complex sleep behaviors such as sleepwalking or sleep driving with no memory formed, which is why regulators have asked prescribers and patients to be vigilant.
• The appropriateness of using a sedative to sleep in order to perform better has been questioned in sport, and some national programs have restricted sleep medication for selected athletes.

Her bottom line is not that medication is never appropriate. It is that medication is meant for short-term use, that long-term use carries its own risks, and that it belongs under the guidance of a sleep-trained clinician rather than as an in-season workaround.

So move the work upstream

If an athlete has had sleep problems in their second or third season, they will have them in the next one. That is predictable, which means it is schedulable. The off-season is when cognitive behavioral techniques, relaxation and meditation practice can actually be learned.

Dr. Singh frames it in language athletes already accept: this is skill acquisition. You learn the technique in the off-season so you can use it when the calendar gets hostile. Nobody expects to learn a new movement pattern in week ten.

Why devices do not solve this

Asked about wearables, Dr. Singh is measured. The data is useful. It is not the intervention.

Her illustration is memorable: she has had players hand their tracker to a girlfriend to wear on a night out so the staff would not know what they had been doing. A device measures compliance until an athlete decides to defeat it.

What changes behavior is understanding. Sleep is private, and an athlete has to buy in, has to decide for themselves that eight hours in bed is worth more than the alternative because of what happens the next day. Information can be given. The choice cannot be installed.

The honest limit

None of this is medical advice for an individual athlete, and medication decisions belong with a treating clinician who knows the person. Sleep complaints can also be a symptom of an underlying disorder such as sleep apnea, which a behavior plan will not fix. The point is about sequencing: the intervention with the best evidence needs time, and time is the one thing an in-season roster does not have.

Source

• "Season 3, Episode 9: Athletes and Sleep with Dr. Meeta Singh," Sleep4Performance Radio, September 12, 2019. Watch