Who Needs Sleep?

My hands are locked up tight in fists. My mind is racing filled with lists.
Of things to do and things I’ve done another sleepless night’s begun.
-Barenaked Ladies, Who needs sleep

Fatigue makes cowards of us all.
-Vince Lombardi

On the wall in my office are all the certificates and degrees I have earned. I decided to put them up because they have followed me from house to house in the same box for years. My wife loaded them up and said, “Take them to your office. They don’t need to live here.” So being an orthopedic surgeon, I grabbed some finishing nails, and the first thing that looked like a hammer (my stapler) and started hanging up all that represents my post high school education and a ton of student debt. Right in the middle of the wall is a small, nondescript certificate that recognizes the completion of my first year in residency as an Intern in General Surgery. This is one of my proudest accomplishments because it was the hardest working year of my life. Before the implementation of the 80-hour work week for residents, the intern year operated on a natural selection model – the successful interns were the ones who worked for 24-36 hours straight then got to go home (at 10 p.m.), fall asleep and wake up at 4 a.m. to do it again, and again, for an entire year. I always knew if I awoke in my own bed that I was on call that day. There are 168 hours in a week, and during that year, I worked about 120 hours of them, meaning I was getting about four to five hours of sleep a night. Surprisingly, I was quite functional with such little sleep. My body adjusted to the schedule, and I spent five years sleeping less than I did after any of my four children were born.

Success without sleep

Lady laying downMany successful people subsist on the same sleep schedule. Our new president, Donald Trump, claims he averages four hours of sleep a day. The CEO of Apple, Tim Cook, gets up every morning at 4:30 and is the first to arrive at the office. The most extreme examples of the lack of sleep are by Nikola Tesla (father of electricity) who said he only slept for two hours a night and by Leonardo daVinci , who would nap for twenty minutes every four hours. So the questions are, “Who really needs sleep?” and “Why is sleep so important?” These are successful guys. Could you be equally as accomplished under the same circumstances?

The people listed above represent only one percent of the population and are called, “short sleepers.” They regularly feel alert and refreshed after sleeping less than six hours per night. Then there are the rest of us who need on average over seven hours of good sleep per night. For the elite athlete, sleep is paramount to achieve optimal performance.

“If you told an athlete you had a treatment that would reduce the chemicals associated with stress, that would naturally increase human growth hormones, that enhances recovery rates, that improves performance, they would all do it. Sleep does all of those things,” says Casey Smith, Head Athletic Trainer for the Dallas Mavericks.

So according to the NBA, sleep is vital for performance.

Sleep studies

What does science say? One study tracked the Stanford University basketball team for several months. Players added an average of almost two hours of sleep a night. The results? Players increased their speed by five percent. Their free throws were nine percent more accurate. They had faster reflexes and felt happier. Other studies have shown similar benefits for football players and other athletes.* Serena Williams says that, given the opportunity, she likes to go to bed at 7 p.m. and get at least nine hours of sleep. Sleep is shown to improve the body’s production of cortisol, an anti-stress hormone. Less sleep has also been linked to poor recovery after injury or exertion.

When thinking about how to get an athlete ready to perform, I often use the analogy of the athlete as a sports car. Proper conditioning is the turbo-charged six-cylinder purring under the hood. The focus on a good diet leading up to an event and during recovery after an event is the high-octane gas fueling the engine. Daily hydration and maintaining proper fluid balance is the oil lubricating all the parts, preventing breakdown in a high intensity environment. Mental preparation can be thought of as all the luxury items, like the leather seats and A/C that allow the driver to feel relaxed. And finally, sleep can be considered the high performance tires that allow everything else to work in unison, from the first burst of acceleration to the last hairpin turn. Without sleep, an athlete will perform like a car without tires.

silver sports car

Improve reaction times

There are multiple areas of an athlete’s performance that can be directly affected by lack of sleep. Elite athletes must react to a play that is unfolding in front of them. Sleep deprivation can severely impair reaction times by up to 300 percent. That is as much as being legally drunk. Clearly not getting sleep is different than throwing back a few beers, but an elite athlete would never expect to be at the top of their game after a couple of beers nor can they expect to perform well on less than a full night’s sleep.

Reduce injury and improve overall health

Proper sleep habits can also reduce injury rates and improve overall health. A University of California study concluded that injury rates increased in athletes that got less than six hours of sleep prior to competition. This ties in with my previous point about how fatigue affects reaction time. In my own experience while standing on the sidelines, I have seen athletes get injured late in the game because they are tired and slow to react to a hit. Sufficient sleep also allows the body to regenerate cells and recover from the abuse of workouts, scrimmages and games. Without adequate sleep, the cumulative effects of training and competition may lead to a persistent state of injury, prevent an athlete from fully recovering and thereby spending more time on the sidelines with me.

Fewer mental errors

Finally, good sleep habits can lead to fewer mental errors. We all know that sleep loss impairs judgment. Lack of sleep can also impair focus, memory, motivation and learning. I learned this the hard way during my college career by pulling a few all-nighters before a test and then bombing the exam. Without sleep, the brain struggles to absorb new knowledge that can affect good decision-making ability on the field, resulting in the poor first touch, bad pass or wayward throw.

Children playing Football

Forming good sleep habits

Now with all I’ve said about why an athlete should get good sleep, are there any recommendations on how to get good sleep, you ask? Below are a few recommendations for how an athlete can incorporate good sleep habits into their routine to maximize sleep:
  • The bedroom should be cool, dark and quiet. Eye masks and earplugs can be useful, especially with travel.
  • Create a good sleep routine by going to bed at the same time and waking at the same time each day.
  • Avoid watching television or surfing the web in bed.
  • Avoid caffeine approximately four to five hours prior to sleep.
  • Napping can be useful; however they should be less than an hour and in the early afternoon.
  • Mental preparation is important, but do not dwell on the next day’s competition because anxiety can be detrimental to sleep patterns.

In today’s world of social media, it is easy to fritter away an hour or two before going to bed. It’s amazing how many times I have made an honest decision to go to bed at a decent time, but I “quickly” check my phone. What I think is only a few short minutes going through my Instagram, scanning Twitter, erasing trash e-mails, checking the weather for tomorrow and perusing the stories on ESPN turns into an hour, and suddenly it’s way past my bedtime. So don’t be me. In order to be the best you can be the next day, whether you are an athlete or an average Joe, make sleep a priority.

Good night.

*Sleep Magazine July, 2011