Healthier Sleep Magazine/ Spring 2024/ Human Performance Issue
Healthier Sleep
A publication of World Sleep Society
Your Trusted Source for Improving Sleep
Publisher
World Sleep Society
Editor
Amy Larson
Copy Editor
Emily Neville
Designer Brook Lanz
Issue Reviewers
Matteo Cesari, PhD
Melissa C. Lipford, MD
Maya Ramagopal, MD
Robert J. Thomas, MD
Contributing Writers
Jonathan Charest, PhD
Sophie Kaplan
Maria Paola Mogavero, MD
Katie Thrasher
Grayson Vidovich
Genevieve Walker, PhD
World Sleep Society Staff
Sales Manager
healthiersleep@worldsleepsociety.org
For advertising or editorial contact information, email healthiersleep@worldsleepsociety.org or visit healthiersleepmag.com for current rates.
Healthier Sleep is published up to four times per year by World Sleep Society, 3270 19th Street NW, Suite 109, Rochester, MN 55901 and distributed to sleep medicine and research professionals as well as the public. No part of this publication may be reprinted or reproduced without written permission.
Healthier Sleep does not necessarily endorse the claims or content of advertising or editorial materials. All advertisements and editorial material included represents the opinions of the respective authors.
World Sleep Society/Healthier Sleep Magazine does not provide or offer medical advice. All content within the magazine, such as text, graphics, information obtained from sleep experts, and other material, is for informational purposes only. The content is not intended to be a substitute for medical diagnosis, advice, or treatment. Relying on information provided by World Sleep Society and/or any of its employees, experts within the material, or other writers is solely at your own risk.
Photo credit: Amber Andrews
Living With Narcolepsy as a Professional Football Player
by World Sleep Society Staff
Whether a professional athlete, or a person with a day-to-day job, sleep disorders can affect you. Learning the signs and symptoms of different conditions can help detect undiagnosed sleep disorders.
Josh Andrews, a professional football player in the National Football League (NFL), talked with Healthier Sleep about his experience with narcolepsy and how he helps educate and raise awareness of this sleep disorder.
You may know Josh Andrews from his professional football career in the NFL, playing with the Philadelphia Eagles, Indianapolis Colts, New York Jets, Atlanta Falcons, or New Orleans Saints. Did you know that Josh Andrews succeeded in his athletic career while living with narcolepsy?
Symptoms of Narcolepsy
People would ask, “why are you so tired all the time?”
Josh thought it was because he was so active.
Josh was always playing sports, baseball, basketball, and football. The philosophy in his house was an active child is a successful child. This proved true for him when after high school he earned a football scholarship to Oregon State University. From there, he went on to the NFL where he played nine years as offensive guard. On the field Josh was giving 100%, but off the field you would often find Josh sleeping. When he would get in a car for a short drive, sit in class, or relax with friends, he would fall asleep. Once he even fell asleep in the middle of a video game with friends, the controller in his hands. Often people would ask, “why are you so tired all the time?” He thought it was because he was so active. What he didn’t realize at the time was that excessive daytime sleepiness is a major symptom of narcolepsy. Other symptoms may include cataplexy, a weakening of muscles with strong emotions like laughter, disrupted nighttime sleep, sleep paralysis, and sleep related hallucinations.
Sleep Testing
His mother, a respiratory therapist, suggested he be tested for sleep apnea, but he shrugged off the suggestion, until he was in college. Falling asleep in class was something he couldn’t ignore. He went in for a sleep test, but it came back negative for sleep apnea. So, he left it at that. A few years later, he almost drove off the road with his girlfriend in the car. She too asked that he get checked out. In 2017 Josh had a second sleep test. This time, it was a multi-latency test which measures how quickly you go into Rapid Eye Movement (REM) sleep. He went into REM sleep immediately, a sign of narcolepsy.
Diagnosis
Narcolepsy? Josh was shocked! His ideas of narcolepsy were all negative, but as he learned about it, and its symptoms, he thought, yes, I definitely have narcolepsy. Following the diagnosis Josh felt very alone and isolated until he found patient organizations where he could connect with others who also have narcolepsy. This provided a community where he could ask questions, bounce ideas off others, and find people who understood. Narcolepsy is a rare disease: fewer than 200,000 people are diagnosed in the United States – that's far less than 1% of the population – so dedicated patient organizations are often the best support communities.
Be Active
In some ways it is easier for athletes to counter the effects of narcolepsy because they are active. The job requires you to move. It may be more difficult for someone who has a desk job and is physically more stationary. For Josh, professional football was very structured: you have a printout of where you need to be and what you need to be doing. The structure proved very helpful in managing narcolepsy. But everyday life is not like that. Now that he has retired from football, he creates his own structure, being sure to schedule workouts and naps daily.
Narcolepsy is a manageable disease. Seek out a sleep professional for answers on the best ways to manage symptoms.
Josh at Oregon State. Winning the Super Bowl while playing in the NFL for the Philadelphia Eagles.
Educate Others
The diagnosis of narcolepsy has changed his life. He now makes sure to take his medication before he drives his kids anywhere and to adhere to a schedule including activity and sleep to give him wakeful hours when he wants them. His need to check out has put more pressure on his wife. There are times when he just has to say "I can't drive" or "I need a nap." Educating those around you about narcolepsy and its limitations is important for your health and safety.
Josh’s Advice for Others With Narcolepsy
Josh recently retired from playing football and spends more of his time advocating on behalf of narcolepsy, specifically how to navigate narcolepsy. Narcolepsy is a manageable disease. Seek out a sleep professional for answers on the best ways to manage symptoms.
• Keep moving! Be active physically and mentally.
• Set a scheduled time to nap and to be active.
• Find a community of people who have narcolepsy that you can connect with.
• Inform those around you about narcolepsy.
Josh speaking about his experience with narcolepsy at an event for Project Sleep.
Josh with his wife and children. Josh and Julie Flygard from Project Sleep.
Clinician as Advocate
Five Questions with Moira Junge
Moira Junge, PhD, a health psychologist, Adjunct Clinical Associate Professor and CEO of the Sleep Health Foundation in Melbourne, Australia, believes collaboration plays a key role in spreading good health messages, increasing reach, and attracting sustainable funding. She is keen to continue collaborating with lived experience experts, clinical experts, sleep researchers, other health organizations, and all levels of government. World Sleep Society had the opportunity to ask her some questions about her invaluable contributions to sleep.
How many years have you been in the field of sleep?
I started as a very junior, naïve but super keen "sleep technologist" in 1994. I was a registered nurse studying psychology when I saw an advertisement for positions at the brand-new Sleep Disorders Centre. This was exactly 30 years ago. I fell in love with the sleep field and haven’t looked back.
What led you to work in sleep medicine?
I noticed during my time as a junior sleep scientist (tech) how debilitating it was for people with sleeping challenges such as insomnia or hypersomnia. There were no clear pathways of treatment.
As a junior psychologist, I was getting a lot of referrals for sleep-related distress, so I embarked on a journey of self-education. I went to every conference, bought every textbook, attended every workshop that was available internationally in CBTi, and sought mentoring options in Australia. Gradually, I became known in Melbourne as a keen young psychologist with some sleep expertise. Looking back, I wouldn’t call it expertise, but at the very least I had passion, concern, and specialized knowledge.
Why is patient advocacy important to you?
I see myself as more than a patient advocate; I am an advocate for everyone in Australia. Seeking better treatments and support for those with sleep disorders and playing a key role in prevention for those without sleep disorders. Inadequate sleep is a risk factor for, and potential consequence of, so many conditions.
I knew I had to take a different approach and lean into education, awareness and advocacy, and the upstream causal factors.
A couple of years ago, I strongly felt that I needed to shift my approach to the bigger picture, focusing on the systems and environments where we live. If we learn more about the where/how/why/what of sleeping and health difficulties, then we will have a better chance of improving the nation’s health.
What is one important thing you want people to know about sleep education?
We need to take a broad approach to sleep health and consider how our environments, nutrition, physical fitness, mental health, and socioeconomic/ health equity contribute to us getting adequate sleep.
What are you most excited about?
I am so excited about the momentum we have in Australia. There has been a recent realization within the government of the role sleep can play in the prevention of chronic disease, chronic mental health issues, and chronic distress. Many chronic disease risk factors are also risk factors for, and potential consequences of, poor sleep health. Improving physical activity, diets, and sleep health of everyone can promote a healthier Australia in the coming years, and I am so excited about that.
Photo credit: Rebecca Taylor Photography
Sleep Like a Professional Athlete
By Sophie Kaplan
There’s sleep, there’s good sleep, and then there’s sleeping like a professional athlete. When it comes to professional athletes, even good sleep isn’t good enough. If you have poor sleep habits, fixing your routine can feel insurmountable. But at the end of the day, mastering healthy sleep can make all the difference.
The effectiveness of our sleep cycle impacts everything from work performance to mental health, and this is especially true for people with hectic professional lives. Regardless of your career, sleep affects us all. So how do athletes in pro sports manage to sleep perfectly every night and wake up to play their best?
The short answer is they don’t. No one does. In fact, if you want to learn how to sleep like a pro, start by abandoning the idea of “perfect sleep.”
The Problem of Perfect Sleep
Even elite athletes from star gymnasts to professional soccer players set multiple alarms, weigh the risks of a late night, and worry until dawn before a game or competition. Overcoming inconsistent sleep is a human problem, not just one that impacts high-achieving people. To elevate your sleep, start by addressing the way you think about sleep.
Looking to achieve “perfect sleep” every night isn’t just a lofty goal, it’s an unrealistic one. It’s impossible to predict every variable that affects a night of sleep. A party next door, a sick child, a bad storm – the possibilities are endless. Not every night can be perfect, so rather than relying on perfection, real pros cultivate a pro-sleep culture.
Healthier Sleep had the opportunity to speak with neurologist and sleep specialist Chris Winter, MD to learn more about the relationship between sleep and athletics. Dr. Winter works closely with professional athletes and helps them develop lifestyles that lead to higher quality sleep and subsequently higher quality sports performance. Much of Dr. Winter’s advice centers around a core idea: effective sleep is a lifestyle.
A holistic approach to sleep that includes diet, activity, and mental health will always be more effective than attempting sleep “tricks.” Counting sheep might feel like an effective strategy for insomnia, but individuals looking for long term sleep improvement find more success by making broad adjustments to their mindset and daily habits.
When asked about improving the sleep of professional athletes, Dr. Winter recommends focusing on three key areas:
• Cultivate a pro-sleep culture at your organization
• Stay informed about sleep via sleep specialists
• Improve sleep whenever possible but understand that it will never be “perfect”
Pro-Sleep Culture
So, what is a pro-sleep culture? According to Dr. Winter, adjusting how you and your support system view and react to sleep makes a big difference. Dismantling a culture that idolizes non-stop doing, and as Dr. Winter says, “setting a tone where sleep is supported” is the first step towards a better relationship with sleep. A prosleep culture doesn’t vilify getting the rest you need while simultaneously encouraging support and sleep education.
Stay Informed
That leads to his second piece of advice: stay informed. Sleep is like any other science in that we are always learning more about how it works and how to make it work for us. Dr. Winter recommends that athletes consult sleep specialists regularly. In fact, sleep specialists should be a core part of any athlete’s support team alongside dieticians and trainers. Beyond the obvious benefit of having an on-site expert, sleep specialists also help sort fact from fiction as new sleep research becomes available.
“Perfect Sleep”
Finally, perhaps the most vital advice of all: abandon the idea of perfect sleep. Dr. Winter explains that even if your sleep can’t be optimal, it can almost certainly be better. Making your sleep as good as possible is the goal. The occasional sleepless night will happen, but if you take steps to maintain a healthy diet, check in with a sleep specialist, and take care of your body, it won’t make or break your relationship with sleep.
Taking Your Sleep to the Next Level
Dr. Winter’s ultimate takeaway is a great lesson for everyone, train your mind to see sleep as something beyond a problem that needs to be solved. Sleep may come easily some nights and not others, but if you teach yourself to treat sleep as part of your overall health instead of a nightly battle, then you can start to cultivate a pro-sleep perspective. That perspective is what allows professional athletes to master sleep as thoroughly as they’ve mastered their sport. With the right mindset and routine, anyone can learn how to sleep like a professional athlete.
Benefits and Drawbacks of Napping
By World Sleep Society Staff
There are as many opinions on napping as there are hours in the day. Is napping good or bad? How long should you nap? When should you nap? Do kids need naps?
These are some of the questions that Dr. Anne Marie Morse commonly hears about napping. She is a neurologist at Geisinger in Pennsylvania, specializing in child neurology and sleep medicine, and has been practicing for seven years. Although it can be complicated, Dr. Morse gives guidance on the best practices for napping.
The Sleep/Wake Cycle
Sleep patterns change with age. Daytime naps are developmentally normal in childhood. For instance, a one-year-old child relies on napping to foster learning and development. But by the time the child is five years old, they don’t need naps. At this stage, longer nocturnal sleep cycles provide a better environment for learning and recovery. For adults, the ideal is seven to nine hours of sleep a night and 16 to 17 hours awake.
Napping: The Good and the Bad
Infants and young children need to nap to optimize, growth, development, mood, and behavior. Ideally, adults with no sleep disorders shouldn’t need to nap. However, not every day is ideal. A good question to ask yourself is, “Why am I napping?” There are good reasons to take a nap, such as an occasional night of poor sleep, travelling across time zones, or being sick with a cold. However, if you are consistently needing
to nap, there may be an unrecognized sleep issue affecting your sleep. Do some digging to determine if you are getting the right duration, timing, and regularity, as well as quality of sleep you need.
If you need a nap, timing and duration is important. Naps should be short, 20 to 30 minutes, and early enough in the day so as not to interfere with nighttime sleep. The danger of napping too long, or too late in the day is the inability to fall or stay asleep at night. This can create a vicious cycle of again needing a nap the following day, creating a pattern of interrupted sleep.
Napping Rooms in Athletic Facilities
The nature of an elite athlete’s schedule including travel, late games, and increased energy demand may require napping for optimal performance. Sleep is a critical tool that any athlete can use to have a competitive edge. Although the goal is to have quality nighttime sleep, a nap can be part of a team’s strategy for optimal performance. Napping is a healthier
alternative to relying on caffeine or other stimulants. Teams may even have a napping room. The best thing about a napping room is that it takes away the stigma of needing a nap. Prioritizing sleep health should be a team’s expectation rather than a sign of weakness.
Napping and Recovery
Recovery happens when growth hormones are active, which usually occurs during longer sleep periods. Naps are good for restorative energy, but muscle recovery happens with longer sleep at night.
Conclusion
Sleep plays a critical role in learning, reaction time, judgement, and recovery. For otherwise healthy adults with no sleep disorders, short naps can help restore energy after insufficient sleep. However, generally it is better to get solid blocks of sleep and wake cycles. If someone takes frequent naps, they should seek advice from a sleep doctor as there may be other sleep issues.
Bedtime Reads
Looking to learn even more? In each issue, we highlight a book about sleep.
Peak Sleep Performance for Athletes: The Cutting-edge Sleep Science That Will Guarantee a Competitive Advantage
by Shane A. Creado, MD
Although written for the elite athlete, everyone can benefit from the sleep tips discussed in Peak Sleep. Sleep is a major factor for athletes maintaining optimal health and performance. This book is divided into “levels,” taking the reader from the most common obstacles of sleep to detailed routines for optimal sleep. Level one discusses barriers to optimal sleep, followed by a discussion of sleep tracking, measurements to determine if there is a sleep disorder, and sleep practices. It also discusses how changes in environment and lifestyle can contribute to healthy sleep. By level four, you will learn advanced sleep techniques specifically designed for athletes to get the most out of their sleep. If you are looking to maximize your sleep, this may be the bedtime read for you!
Uplifting Athletes
by World Sleep Society Staff
From competing as an elite athlete to becoming Executive Director of Uplifting Athletes, Rob Long has had an incredible journey, granting him insight into rare diseases and their treatments. As captain for the Syracuse University football team, it looked like Rob would be drafted into the National Football League (NFL) until he was diagnosed with a rare form of brain cancer just five days after his final collegiate game.
Twelve years ago, when Rob was playing football, people were beginning to understand the importance of sleep for recovery. Rob soon found that sleep is important for recovery in all aspects of health. At age 22, Rob was diagnosed with anaplastic astrocytoma, a rare form of brain cancer. Hopes of joining the NFL were replaced by hopes to live another day. In Rob’s honor, his teammates opened a chapter of Uplifting Athletes at Syracuse University, which introduced him to the organization.
Naturally, elite athletes are in the spotlight. Uplifting Athlete’s uses this spotlight to shine awareness on rare diseases and raise funding for rare disease research. There are over 10,000 rare diseases, 95% of which have no treatment available. Uplifting Athletes aims to change that. By funding young researchers, Uplifting Athletes plants the seeds for future treatment.
Rob was hired as Executive Director of Uplifting Athletes in 2016, and by 2018 he had devised a new and fun way to push research for rare diseases forward: the Young Investigator Draft. Held in the Philadelphia Eagles stadium, crowds gather to cheer on drafted researchers, who receive a jersey with their name on the back, as well as a check to fund rare disease research.
Each researcher partners with a patient advocacy group. This allows researchers to know what is important to rare disease patients and puts a face to the work. The hope is the researcher will use the funding they receive to begin research and then apply for larger grants to continue working towards a treatment.
There is a Chinese proverb that states the best time to plant a tree is 20 years ago. The second-best time to plant a tree is now.
– Rob Long, Executive Director of Uplifting Athletes
Rob’s promotion of research into rare diseases came full circle when he began investigating the chemotherapy drug he took for his brain cancer. The doctor who developed the drug had received a small grant to begin research, like those given through Uplifting Athletes, and went on to develop the first chemotherapy drug to break the brain blood barrier. It was approved for use in the United States just 36 months prior to Rob’s cancer diagnosis. He is a living example of the life-saving work Uplifting Athletes is doing
Uplifting Athletes’
Uplifting Athletes Executive Director, Rob Long, speaking.
World Sleep Day (WSD) is an annual public awareness day that celebrates healthy sleep. World Sleep Society members organize local and regional activities that raise awareness of sleep health.
Since the first World Sleep Day in 2008 there have been 92 participating countries and 2,500+ activities organized.
The next World Sleep Day is Friday, March 14, 2025. Sign up for updates at worldsleepday.org for the latest developments.
worldsleepday.org
facebook.com/wasmf @_worldsleep
Guatemala Brazil Botswana
Romania
China
Italy
India
Ghana
El Salvador
South Korea Nigeria
Singapore
Norway
Slovenia
United
Mexico
Thailand
Cyprus
Sleep’s Role in Recovery
Don’t Skip This Part of Your Workout!
By Genevieve Walker, PhD
You go to the gym every day. The day isn’t complete without a workout or practice, and your cupboard is stocked with everything you need to rebuild and recover – or so you think. Your energy isn’t what it used to be. You’ve tried eating more protein, and you’re drinking plenty of fluids. What’s missing?
You might be overlooking a key part of training and recovery: sleep. Catching some Z’s may feel like downtime to you, but your brain and body kick into high gear during this time. Everything from brain cells to muscle tissue is repaired and even grows while you sleep, helping you meet the next challenge.
How Sleep Affects Your Muscles
While you sleep, your body makes the hormones that help repair damaged muscle fibers. This includes growth hormones and testosterone (yes, even for women). They also help your body make new protein, the building blocks of muscle tissue. This happens up to 30% faster during sleep than while you are awake.
Good sleep is especially important after hard exercise, which causes more minitears in your muscles than a light workout. If you sleep too little or sleep poorly, your body can’t repair the damage. Building new muscle tissue doesn’t happen either. Eventually, tough workouts without enough sleep hurt your health.
Other Ways Sleep Helps
Lack of sleep affects more than your muscles. It can keep your body from completely refueling the stored sugars in your liver and muscle tissue. This normally happens while you sleep. You need this sugar for quick bursts of energy and to keep your blood sugar stable.
Exercise causes inflammation, leading to soreness, pain, and swelling. Sleep time is when your body’s immune system goes to work treating this inflammation.
Finally, when you don’t sleep well, you are less alert, making injury more likely.
Schedule Your Workout for Better Sleep
Exercise also affects sleep. When you exercise, your muscles make substances called myokines that can help you sleep more deeply. It’s a win-win: good sleep boosts exercise and exercise improves your sleep.
Can the time of day you exercise affect your sleep? Experts recommend avoiding vigorous exercise for at least an hour before bedtime. If you typically have trouble sleeping, four hours may be better.
So, when should you exercise to get the best night’s sleep? It depends. Morning exercise may help you get to sleep faster at night. Afternoon or early evening workouts could help you sleep more deeply. If you wake up often, gentle exercise before bed could help you stay asleep.
Genevieve Walker, PhD is a freelance writer and editor specializing in patient education, plain language, and consumer health content. She holds a PhD in English and serves on the board of the American Medical Writers Association.
No matter when you work out, going to sleep and getting up at the same time every day is critical for quality rest. Aim for seven to nine hours of sleep each night.
Sleeping at High Altitudes
By Grayson Vidovich
Many bodily functions can be impacted by high-altitude and low-oxygen environments, especially sleep. High-quality sleep is crucial for mood, memory, and overall health and well-being. When sleep is consistently disrupted, troubles with focus, stress, problem-solving, and energy can arise.
High-altitude environments can cause several health conditions including nausea and confusion as well as acute mountain sickness, characterized by headache, fatigue, weakness, and gastrointestinal symptoms.
How Does High Altitude Impact Sleep?
High altitudes impact both sleep quality and sleep quantity and can negatively affect sleep in two ways: by altering breathing patterns and by disrupting the stages of sleep. Dr. Michael Furian, a senior researcher at the University of Zürich, helped us understand these disruptions and how to mitigate them.
Sleep Quality. At higher altitudes, there is less oxygen in the blood. To compensate, we begin to breathe quickly (or hyperventilate). Hyperventilation leads to decreased carbon dioxide (CO2) levels within our blood. Our bodies need a certain amount of CO2 to function properly, so when CO2 levels drop too low, we stop breathing for 15 to 20 seconds. This allows CO2 to build back up to normal levels, and we can breathe again, causing high-altitude periodic breathing. This is a type of sleep-disordered breathing characterized by repeated central sleep apneas, which is associated with daytime sleepiness, headaches, and poor mood. Anyone who ascends to 4,000 meters (about 13,120 feet) or above will likely experience this condition to a certain degree.
Sleep Quantity. High altitude is associated with less deep sleep, increased superficial sleep, and more disruption throughout the night. Superficial sleep is crucial to ensure the overall length of sleep, but the lack of deep sleep is associated with fatigue, memory problems, and decreased focus.
Who Does High Altitude Affect?
Anyone can be impacted by altitude-related conditions; however, some populations are at greater risk than others.
Men. Men are more likely to have highaltitude periodic breathing since they have a stronger stimulus for hyperventilation at high altitudes. Conversely, men generally have less acute mountain sickness than women.
Individuals with Respiratory Disease.
Individuals with pre-existing conditions, such as chronic obstructive pulmonary disease (COPD), obstructive sleep apnea, or other lung diseases, are at greater risk for experiencing intense altitude-related sleep disturbances. Anyone with sleep disturbances at low altitudes will see them increase at high altitudes.
> Sleeping at High Altitudes continued from page 21
How to Prevent AltitudeRelated Sleep Disturbances
Worried about altitude-related conditions? Fortunately, preventive measures can be taken.
Prescription Medication.
Acetazolamide, a prescription medication, is a preventative treatment against acute mountain sickness and has been shown to stabilize breathing and decrease high altitude periodic breathing. It can also increase a person’s ability to adapt to the elevation more quickly and with less discomfort.
Avoid Alcohol. Avoiding alcohol at greater altitudes can help to prevent sleep disturbances.
Avoid Rigorous Exercise. Perform light exercise rather than moderate or heavy exercise. High-intensity training is a risk factor for developing symptoms of acute mountain sickness and exaggerate disturbed sleep.
Slowly Ascend. Allow your body time to slowly adjust to greater altitudes to decrease the likelihood of suffering from sleep disturbances and altitude-related illnesses. Spending multiple days at a certain altitude before ascending is associated with less sleep disruption.
*Citations available on healthiersleepmag.com
Grayson Vidovich is an occupational therapist who specializes in health promotion and disease prevention.
At higher altitudes, there is less oxygen in the blood. To compensate, we begin to breathe quickly (or hyperventilate). Hyperventilation leads to decreased carbon dioxide (CO2) levels within our blood. Our bodies need a certain amount of CO2 to function properly, so when CO2 levels drop too low, we stop breathing for 15 to 20 seconds.
The BuZZZ About Sleep
Your Latest Buzzword is Hypersomnolence
You had a good night’s sleep, a full eight hours, but when the alarm goes off it is hard to wake up. It feels as if you could sleep for another eight hours, and often you could. As you go through the day, you are very tired, sloth-like, and may doze off doing your everyday activities. You never wake up feeling rested. If this is your story, you may be struggling with hypersomnolence.
Hypersomnolence is a type of imbalance in the sleep-wake cycle: it is easier to transition from wake to sleep but difficult to transition from sleep to wake. This causes a person to fall asleep when they should be awake or feel constant fatigue. It can be difficult to spot. Severity, frequency, and context of occurrence needs to be carefully assessed.
Symptoms can include falling asleep several times during the day, unremitting fatigue, brain fog, taking long naps to help the sleepiness but not waking up refreshed, sleeping more than 9-10 hours but not feeling rested, difficulty waking up from sleep, and feeling confused or combative while trying to wake up.
The good news is that there are treatments for hypersomnolence - with new potential options under development. With some lifestyle changes and medication quality of life with hypersomnolence can be improved. Consult your doctor if you suspect you suffer from hypersomnolence.
Better Sleep Through Better Nutrition
By Katie Thrasher
Waking up rested and ready for the day is a wonderful feeling. Stress, noise, or snacking on spicy chicken wings too close to bedtime can lead to a terrible night of sleep. Reducing stress or noise can be hard, but improving your eating habits is something everyone can do.
Dr. Marie-Pierre St. Onge at Columbia University Irving Medical Center believes we need to break the poor diet, poor sleep cycle. Following a bad night of sleep, we tend to eat foods that are higher in fats and sugars to give us a quick energy boost. But it does not last and can begin a cycle of poor eating and poor sleep that repeats until a change is made.
What is the key to a great night of sleep?
It begins with melatonin, a hormone produced by the brain to regulate sleep. Melatonin is dependent on tryptophan, an amino acid. Without tryptophan, you cannot make melatonin.
Building Blocks for Better Sleep
Tryptophan is an essential amino acid that people must get from food. A balanced diet including foods containing tryptophan aids melatonin production which can lead to more regular sleep. Thankfully, many foods contain tryptophan.
Foods rich in tryptophan:
Turkey Eggs Nuts Cheese
Whole grains Beans Fish
Beyond eating tryptophan containing foods, Dr. St. Onge recommends the Mediterranean diet for good sleep and overall health largely due to the focus on fruits, vegetables, and whole grains.
What is the Mediterranean Diet?
The Mediterranean diet, named for the eating habits of people living near the Mediterranean Sea, focuses on locally grown fruits and vegetables, whole grains, and lean meats.
Meals that are part of the Mediterranean diet are "plant forward". This means most of the food on your plate is plant-based (fruits, vegetables, whole grains, nuts) and the primary fat used for cooking is olive oil. Cheese, yogurt, and lean meats such as fish and chicken are part of the diet but are not the focus of each meal.
Why the Mediterranean Diet?
The Mediterranean diet focuses on healthy eating, not restrictive dieting. It is built around foods you eat every day, so finding recipes and ingredients is easy. Having a simple meal plan is important because it is easier to stick to.
The Mediterranean diet is not a fad. People have been eating it for generations and it has been studied by experts since the 1950s.
The Mediterranean diet has been associated with better sleep including waking up less often during the night, having an easier time falling asleep, and a better sleep overall.
Creating Better Nutrition and a Better Sleep Cycle
Big changes in diet, health, and sleep do not happen overnight. But making simple changes will help you build changes that last.
Eating foods rich in sleep-supporting nutrients such as fruits, vegetables, and whole grains helps to naturally regulate sleep. Combining a healthy diet with other sleep-boosting habits such as moderate movement and eating dinner earlier in the evening (to allow for better digestion) will lead to better quality sleep.
Having better nutrition that leads to a better sleep cycle can take time. But the rewards you feel from a restful night of sleep can change your life for the better
Healthier Sleep is a public awareness magazine that acts as a trusted source for information regarding sleep health, disorders, and research. The magazine is published four times per year and available for free online
Issue Topics
Legs Syndrome (RLS)
Right Now in Sleep Science
Orexins and Their Role in Sleep Disorders
by Maria Paola Mogavero, MD
Orexins are chemical signals produced in the brain. The area where nerve cells make orexins is called the “hypothalamus”, which is at the base of the brain. This area controls many automatic and hormonal functions. They play a critical role in regulating various functions such as sleep-wake cycles, wakefulness and alertness, and appetite.
When you are awake, orexin neurons are highly active, releasing orexin into their target regions. This promotes arousal, enhances alertness, and helps maintain a state of wakefulness. During rapid eye movement (REM) sleep, the activity of orexin neurons decreases, resulting in less orexin release. When the orexin system doesn’t work correctly, it can contribute to sleep disorders like insomnia and narcolepsy, a condition characterized by excessive daytime sleepiness.
Researchers are exploring ways to manipulate the orexin system with medications to develop treatments for sleep disorders. Disruptions in the orexin system may contribute to difficulties
in falling or staying asleep, resulting in insomnia. Research suggests that adjusting orexin receptors could offer a novel approach to promote sleep onset and duration. By blocking orexins effect with medication, researchers hope to help those suffering from insomnia. Conversely, increasing the effect of orexins is likely to benefit conditions with excessive sleepiness such as narcolepsy.
Understanding orexins and how they work is particularly important in sleep disorder research. As researchers unravel the intricate role of orexins in sleep wake regulation, treatments may be developed which better target sleep disorders, specifically insomnia and narcolepsy.
Dr. Mogavero is a neurologist at Vita Salute, San Raffaele University, Milan, Somnologist, Master in Sleep Medicine, and on faculty of the World Sleep Academy.
Sleeping Your Way to Better Performance
By Jonathan Charest, PhD
Sleep is a normal and reversible activity that is essential for recovery. Studies show that sleep is important for health and performance, especially for athletes. Getting enough sleep not only helps athletes perform better but also impacts overall physical and mental wellbeing. One tool to improve sleep is the Athlete Sleep Screening Questionnaire (ASSQ).
The ASSQ was developed by a team of four researchers and sleep practitioners* to identify elite athletes who have sleep issues. Multiple studies have shown that the ASSQ survey successfully identifies elite athletes who are abnormal sleepers.
Athlete Sleep Screening Questionnaire (ASSQ)
It is crucial in an Olympic year for healthcare professionals supporting athletes to efficiently screen for sleep difficulties. The Athlete Sleep Screening Questionnaire was developed specifically to do this.
The ASSQ is a 16-question survey designed to look at six different sleep aspects:
1 2 3 4 5 6
How well you sleep.
Total time you sleep.
Preference for daytime or nighttime activities.
Do you have trouble sleeping?
Do you struggle with sleep while traveling?
Breathing issues during sleep.
Answers are used to calculate a combined score called the ASSQ Sleep Difficulty Score (SDS). Scores range from zero to 17; scores above eight suggest that an individual might need help with their sleep.
Based on an individual’s answers, the ASSQ can also help guide recommendations for improving sleep. For example, if you have a mildly high SDS and your struggles are related to poor habits, the recommendation might be general sleep hygiene information and personalized tips. If your sleep issues are related to breathing issues, you might need more help from a sports physician, or a consultation with a sleep medicine professional.
Sleep Recommendations for Athletes
Athletes can improve their ASSQ score by practicing good sleep hygiene. Use the following recommendations to get the most from your sleep.
Athletes need around 8 to 10 hours of sleep to recover from intense training and prevent injuries.
Do not rely on caffeine to replace sleep.
Sleep in a dark, cool room without any electronic devices.
Short 20- to 30-minute naps on competition days and longer 90-minute naps on rest days can be beneficial.
Sleep is vital to the immune system, so when travelling and under stress, protect your sleep.
Ask yourself, “Am I doing everything I can to get optimal sleep?”
Jonathan Charest, PhD, is an adjunct professor in the School of Psychology at the Université Laval of Canada and holds the office of Member at Large for Media and Advocacy in the Canadian Sleep Society.
* Charles Samuels, Lois James, Doug Lawson, and Willem Meeuwisse
Scan the code to take the Athlete Sleep Screening Questionnaire.
Ask the Sleep Experts
As answered by our issue reviewers
Maya Ramagopal, MD Robert J. Thomas, MD
Does exercise improve sleep?
Dr. Ramagopal:
In general exercise does help people achieve better quality sleep. Exercise increases the core body temperature, and the temperature dropping after exercise mimics what happens before sleep onset, telling the brain it is time for rest. Over time, moderate aerobic exercise increases total sleep time, sleep latency onset, and the amount of slow wave sleep. This supports memory consolidation, mind-body rejuvenation, and growth hormone secretion, which is especially important for children.
Dr. Thomas:
There is some data that a moderate workout two to three hours before bedtime can be beneficial. Exercise too close to bedtime can cause sleep disruption. Other approaches to optimize sleep (e.g., consistent wake up time, strong and regular light/dark cycle, relaxing before bedtime) may be more reliable. There can be trial and error to tailor exercise time and intensity for an individual. Exercise does improve general fitness and quality of life, so there is an indirect benefit to sleep.
Should I work out if I feel tired?
Dr. Thomas:
Gentle working out is fine, but an exhausting program will amplify fatigue. Of course, the cause of tiredness matters. If it is transient, like an overnight shift, do what you can. If chronic or part of a fatigue disorder (e.g. long Covid), or post-exertional malaise – symptoms can worsen. Knowing your limits is important. It is usually difficult to do a strenuous program when sleep deprived.
Dr. Ramagopal
As tempting as it is to skip working out when feeling tired, increasing physical activity has benefits. Exercise releases endorphins which help relieve pain, stress, and can improve the quality of sleep. Additionally, exercise releases serotonin, which is a precursor to melatonin, the main hormone involved in sleep onset. However, if there is a medical condition that is causing chronic fatigue, address this condition first.
Exercise releases endorphins which help relieve pain, stress, and can improve the quality of sleep. –Maya Ramagopal, MD
How does the time of day I work out affect my ability to sleep?
Dr. Ramagopal:
This depends on one’s schedule. There is no “bad time” to exercise, but consistency is key. Physiologically speaking, before 7am is the best time to exercise. The elevated levels of cortisol and growth hormone in the morning stimulate gluconeogenesis, which is a metabolic process by which the body synthesizes glucose from non-carbohydrate precursors like fats and proteins and maintains glucose homeostasis. This process is helpful for weight loss.
This time may not work for shift-workers, so doing some form of cardiovascular activity prior to the start of a shift may be helpful. Strenuous exercise within two hours of bedtime may cause a shift in the circadian rhythm and delay sleep onset. A low intensity activity like stretching or yoga is less likely to affect sleep onset.
Dr. Thomas:
If the workout is part of insomnia/circadian management, then exposure to light should determine the "zone" of the engagement. For example, if there is a need for morning light exposure, then morning is best. Often, your schedule and responsibilities determine the best time to exercise. If you have a long commute, early morning may not be practical. It makes sense to avoid a workout just after a major meal since it can be uncomfortable to have a large meal bouncing in the stomach. Insulin-dependent diabetics will have a complex protocol of what to do when, and not.
Have a question for the sleep experts?
Submit questions to healthiersleep@worldsleepsociety.org Questions are selected based on space and applicability.
