“When I sleep poorly, it impacts everything”: An exploratory qualitative investigation of stress and sleep in junior endurance athletes

On their journeys toward senior athletic status, junior endurance athletes are faced with a multitude of stressors. How athletes react to stressors plays a vital part in effective adaptation to the demanding, ever-changing athletic environment. Sleep, the most valued recovery strategy available to athletes, has the potential to influence and balance athletic stress, and enable optimal functioning. However, sleep is sensitive to disturbances by stress, which is described by the concept of sleep reactivity. Among athletes, poor sleep quality is frequently reported, but our understanding of the associations between stress and sleep in junior athletes is currently incomplete. The present study therefore investigated the themes of stress and sleep, and the associations between these variables with the use of in-depth semi-structured interviews in six junior endurance athletes (three men and three women, mean age 17.7 ± 0.5 years). Data was analyzed qualitatively based on the Grounded Theory. The qualitative material was supplemented with quantitative data on subjective sleep quality (Pittsburg Sleep Quality Index), sleep reactivity (Ford Insomnia Response to Stress Test), and mental strain (visual analog scale). The main results showed that stress could be differentiated into relevant stressors (encompassing poor performance, uncertainty in relation to training, school, daily hassles, and sleep) and reactions to stress (with sub-categories facilitative and maladaptive). Sleep could be differentiated into sleep benefits (encompassing energy levels and athletic functioning) and sleep quality (with sub-categories satisfactory and inadequate). All athletes identified relevant stressors, and all athletes were aware of the benefits of sleep for athletic functioning. However, athletes formed two distinctive categories based on the interactions between stress and sleep: three exhibited facilitative reactions to stress and good sleep quality, as well as low sleep reactivity, and low mental strain. The remaining participants exhibited maladaptive reactions to stress and poor sleep quality, as well as high sleep reactivity and high mental strain. Conceptualizing sleep quality based on the evaluation of stressors, reactions to stress, degree of mental strain, and the propensity to stress-related sleep disturbance may offer a plausible explanation for why the occurrence of stressors leads to poor sleep quality in some athletes, but not others

Viktigheten av søvn og utfordringer med stress hos idrettsutøvere

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An observational study of sleep characteristics in elite endurance athletes during an altitude training camp at 1800 m

Objectives - To observe changes in sleep from baseline and during an altitude training camp in elite endurance athletes. Design - Prospective, observational. Setting - Baseline monitoring at Participants - Thirty-three senior national-team endurance athletes (mean age 25.8 ± S.D. 2.8 years, 16 women). Measurements - Daily measurements of sleep (using a microwave Doppler radar at baseline and altitude), oxygen saturation (SpO2), training load and subjective recovery (at altitude). Results - At altitude vs. baseline, sleep duration (P = .036) and light sleep (P Conclusion - This is the first study to document changes in sleep from near-sea-level baseline and during a training camp at 1800 m in elite endurance athletes. Ascending to altitude reduced total sleep time and light sleep, while deep sleep and respiration rate increased. SpO2 and training load at altitude were associated with these responses. This research informs our understanding of the changes in sleep occurring in elite endurance athletes attending training camps at competition altitudes

Unique Predictors of Sleep Quality in Junior Athletes: The Protective Function of Mental Resilience, and the Detrimental Impact of Sex, Worry and Perceived Stress

Since athletic development and functioning are heavily dependent on sufficient recuperation, sleep in athletes is becoming a topic of increasing interest. Still, existing scientific evidence points to inadequate sleep in athletes, especially in females. This may be due to the fact that sleep is vulnerable to disturbances caused by stress and cognitive and emotional reactions to stress, such as worry and negative affect, which may exacerbate and prolong the stress response. Such disturbing factors are frequently experienced by junior athletes aiming for performance development and rise in the rankings, but may be damaging to athletic progression. Based on limited research in non-athletic samples, mental resilience may protect individuals against the detrimental effects of stress on sleep. Therefore, the present study aimed to investigate the extent to which sex, mental resilience, emotional (negative affect) and cognitive (worry) reactions to stress, and perceived stress, uniquely contributed to sleep quality in a cross-sectional study including 632 junior athletes. A multiple hierarchical linear regression showed that females had poorer sleep quality than males, while the mental resilience sub-components Social Resources and Structured Style were positively associated with sleep quality, providing a protective function and thus preventing sleep quality from deteriorating. Simultaneously, worry, as well as perceived stress, were negatively associated with sleep quality. Together, the independent variables explained 28% of the variance in sleep quality. A dominance analysis showed that perceived stress had the largest relative relationship with sleep quality. Based on these results, close attention should be paid to athletes’ abilities to manage worry and perceived stress, and the potential of mental resilience as a protective factor that could prevent sleep from deteriorating. The latter might be especially relevant for female athletes. Since performance margins are progressively becoming smaller and smaller, every improvement that adequate sleep can provide will be beneficial in terms of improved functioning and athletic performance

Sex differences in sleep and influence of the menstrual cycle on women’s sleep in junior endurance athletes

Previous research shows that female athletes sleep better according to objective parameters but report worse subjective sleep quality than male athletes. However, existing sleep studies did not investigate variations in sleep and sleep stages over longer periods and have, so far, not elucidated the role of the menstrual cycle in female athletes’ sleep. To address these methodological shortcomings, we investigated sex differences in sleep and sleep stages over 61 continuous days in 37 men and 19 women and examined the role of the menstrual cycle and its phases in 15 women. Sleep was measured by a non-contact radar, and menstrual bleeding was self-reported. Associations were investigated with multilevel modeling. Overall, women tended to report poorer subjective sleep quality (p = .057), but objective measurements showed that women obtained longer sleep duration (p < .001), more light (p = .013) and rapid eye movement sleep (REM; hours (h): p < .001, %: p = .007), shorter REM latency (p < .001), and higher sleep efficiency (p = .003) than men. R2 values showed that sleep duration, REM and REM latency were especially affected by sex. Among women, we found longer time in bed (p = .027) and deep sleep (h: p = .036), and shorter light sleep (%: p = .021) during menstrual bleeding vs. non-bleeding days; less light sleep (h: p = .040), deep sleep (%: p = .013) and shorter REM latency (p = .011) during the menstrual than pre-menstrual phase; and lower sleep efficiency (p = .042) and more deep sleep (%: p = .026) during the follicular than luteal phase. These findings indicate that the menstrual cycle may impact the need for physiological recovery, as evidenced by the sleep stage variations. Altogether, the observed sex differences in subjective and objective sleep parameters may be related to the female athletes’ menstrual cycle. The paper provides unique data of sex differences in sleep stages and novel insights into the role of the menstrual cycle in sleep among female athletes.publishedVersio

Group‑delivered cognitive behavioural therapy versus waiting list in the treatment of insomnia in primary care: study protocol for a pragmatic, multicentre randomized controlled trial

Background Insomnia is common in the general population and is a risk factor for ill-health, which highlights the importance of treating insomnia effectively and cost-efficiently. Cognitive-behavioural therapy for insomnia (CBT-I) is recommended as first-line treatment due to its long-term effectiveness and few side-effects, but its availability is limited. The aim of this pragmatic, multicentre randomized controlled trial is to investigate the effectiveness of group-delivered CBT-I in primary care compared to a waiting-list control group. Methods A pragmatic multicentre randomized controlled trial will be conducted with about 300 participants recruited across 26 Healthy Life Centres in Norway. Participants will complete online screening and provide consent before enrolment. Those who meet the eligibility criteria will be randomized to a group-delivered CBT-I or to a waiting list according to a 2:1 ratio. The intervention consists of four two-hour sessions. Assessments will be performed at baseline, 4 weeks, 3- and 6 months post-intervention, respectively. The primary outcome is self-reported insomnia severity at 3 months post-intervention. Secondary outcomes include health-related quality of life, fatigue, mental distress, dysfunctional beliefs and attitudes about sleep, sleep reactivity, 7-day sleep diaries, and data obtained from national health registries (sick leave, use of relevant prescribed medications, healthcare utilization). Exploratory analyses will identify factors influencing treatment effectiveness, and we will conduct a mixed-method process evaluation to identify facilitators and barriers of participants’ treatment adherence. The study protocol was approved by the Regional Committee for Medical and Health Research ethics in Mid-Norway (ID 465241). Discussion This large-scale pragmatic trial will investigate the effectiveness of group-delivered cognitive behavioural therapy versus waiting list in the treatment of insomnia, generating findings that are generalizable to day-to-day treatment of insomnia in interdisciplinary primary care services. The trial will identify those who would benefit from the group-delivered therapy, and will investigate the rates of sick leave, medication use, and healthcare utilization among adults who undergo the group-delivered therapy.publishedVersio

NREM Sleep Parasomnias Commencing in Childhood:Trauma and Atopy as Perpetuating Factors

Objective/Background: Phenotyping of non-rapid-eye-movement (NREM) parasomnias is currently poorly undertaken. This study aimed to determine whether there are differences phenotypically among childhood-, adolescent-, and adult-onset NREM parasomnias continuing into and presenting in adulthood. Patients/Methods: A retrospective, cohort study of patients presenting with NREM parasomnia between 2008 and 2019 (n = 307) was conducted. Disorders included sleepwalking (n = 231), night terrors (n = 150), sexualised behaviour in sleep (n = 50), and sleep-related eating disorder (n = 28). Results: Compared to the adult-onset NREM behaviours group, the childhood- and adolescent-onset groups were more likely to have a family history of NREM behaviours (p < 0.001), experience a greater spectrum of NREM disorders (p = 0.001), and report a history of sleep-talking significantly more frequently (p = 0.014). Atopy was most prevalent in the childhood-onset group (p = 0.001). Those with childhood-onset NREM parasomnias were significantly more likely to arouse from N3 sleep on video polysomnography (p = 0.0003). Psychiatric disorders were more likely to be comorbid in the adult-onset group (p = 0.012). A history of trauma coinciding with onset of NREM behaviours was significantly more common in the childhood- and adolescent-onset groups (p < 0.001). Conclusions: Significant differences exist across childhood-, adolescent-, and adult-onset NREM parasomnia presenting in adulthood. This study suggests that adult-onset slow-wave sleep disorders may be confounded by psychiatric disorders resulting in nocturnal sleep disruption and that unresolved traumatic life experiences perpetuate NREM disorders arising in childhood and comprise one of the strongest external risk factors for triggering and perpetuating these disorders in adolescence

Unique predictors of sleep quality in junior athletes: The protective function of mental resilience, and the detrimental impact of sex, worry and perceived stress

Since athletic development and functioning are heavily dependent on sufficient recuperation, sleep in athletes is becoming a topic of increasing interest. Still, existing scientific evidence points to inadequate sleep in athletes, especially in females. This may be due to the fact that sleep is vulnerable to disturbances caused by stress and cognitive and emotional reactions to stress, such as worry and negative affect, which may exacerbate and prolong the stress response. Such disturbing factors are frequently experienced by junior athletes aiming for performance development and rise in the rankings, but may be damaging to athletic progression. Based on limited research in non-athletic samples, mental resilience may protect individuals against the detrimental effects of stress on sleep. Therefore, the present study aimed to investigate the extent to which sex, mental resilience, emotional (negative affect) and cognitive (worry) reactions to stress, and perceived stress, uniquely contributed to sleep quality in a cross-sectional study including 632 junior athletes. A multiple hierarchical linear regression showed that females had poorer sleep quality than males, while the mental resilience sub-components Social Resources and Structured Style were positively associated with sleep quality, providing a protective function and thus preventing sleep quality from deteriorating. Simultaneously, worry, as well as perceived stress, were negatively associated with sleep quality. Together, the independent variables explained 28% of the variance in sleep quality. A dominance analysis showed that perceived stress had the largest relative relationship with sleep quality. Based on these results, close attention should be paid to athletes’ abilities to manage worry and perceived stress, and the potential of mental resilience as a protective factor that could prevent sleep from deteriorating. The latter might be especially relevant for female athletes. Since performance margins are progressively becoming smaller and smaller, every improvement that adequate sleep can provide will be beneficial in terms of improved functioning and athletic performance

Unique predictors of sleep quality in junior athletes: The protective function of mental resilience, and the detrimental impact of sex, worry and perceived stress

Since athletic development and functioning are heavily dependent on sufficient recuperation, sleep in athletes is becoming a topic of increasing interest. Still, existing scientific evidence points to inadequate sleep in athletes, especially in females. This may be due to the fact that sleep is vulnerable to disturbances caused by stress and cognitive and emotional reactions to stress, such as worry and negative affect, which may exacerbate and prolong the stress response. Such disturbing factors are frequently experienced by junior athletes aiming for performance development and rise in the rankings, but may be damaging to athletic progression. Based on limited research in non-athletic samples, mental resilience may protect individuals against the detrimental effects of stress on sleep. Therefore, the present study aimed to investigate the extent to which sex, mental resilience, emotional (negative affect) and cognitive (worry) reactions to stress, and perceived stress, uniquely contributed to sleep quality in a cross-sectional study including 632 junior athletes. A multiple hierarchical linear regression showed that females had poorer sleep quality than males, while the mental resilience sub-components Social Resources and Structured Style were positively associated with sleep quality, providing a protective function and thus preventing sleep quality from deteriorating. Simultaneously, worry, as well as perceived stress, were negatively associated with sleep quality. Together, the independent variables explained 28% of the variance in sleep quality. A dominance analysis showed that perceived stress had the largest relative relationship with sleep quality. Based on these results, close attention should be paid to athletes’ abilities to manage worry and perceived stress, and the potential of mental resilience as a protective factor that could prevent sleep from deteriorating. The latter might be especially relevant for female athletes. Since performance margins are progressively becoming smaller and smaller, every improvement that adequate sleep can provide will be beneficial in terms of improved functioning and athletic performance

Validating the Working Alliance Inventory as a tool for measuring the Effectiveness of Coach-Athlete relationships in Sport

The current study investigates whether the Working Alliance Inventory (Blascovich, Mendes, Hunter, Lickel, & Kowai-Bell) and its factors bond, goal, and task are a suitable measurement for documenting the coach–athlete relationship in the sport setting among a sample of 670 Norwegian junior athletes. The results in the current study showed moderate positive associations between WAI and perceived performance and perception of self, and strong negative associations between WAI and athlete burnout. The proposed model in the current study had good fit with the data and explained 13% of the variance in perceived performance, 12% of the variance in perception of self, and 25% of the variance in athlete burnout. The results are discussed in regard to applied implications and possible future research