"The Importance of Sleep for Optimizing Athletic Performance and Recovery" Christopher E Kline (12.16.2020)

December 21, 2020

ID6032

To CiteDCA Citation Guide

00:19Alright, I think we're going to
00:21get started. Welcome everybody.
00:23My name is Lauren Tobias and I'd
00:25like to welcome you to our Yale
00:28Sleep Seminar this afternoon.
00:30I have a few quick announcements
00:32before I introduce today's speaker.
00:34First off, I can't believe how
00:36quickly time has flown this semester,
00:39but today is actually our
00:41last conference for the fall.
00:43We're going to resume on January 6th
00:45with a talk by Kathy Goldstein from
00:47the University of Michigan Sleep
00:49Disorder Center and her talk is entitled
00:52Consumer Sleep Technologies Potentials.
00:54Set pitfalls in the future
00:56of ambulatory sleep tracking,
00:58so please join us for that
01:00on January 6th next.
01:01Some housekeeping announcements first.
01:03Please take a moment to make
01:06sure that you're muted.
01:07In order to receive CME
01:09credit for attendance,
01:10please see the chat room for instructions.
01:12You can text the unique ID for this
01:15conference until 3:15 PM today,
01:16and if you're not already
01:18registered with Chelsea and me,
01:19you will need to do that first.
01:22If you have questions
01:23during the presentation,
01:24I encourage you to make use of the
01:26chat room throughout the hour,
01:28and we may invite people to ask
01:30questions at the end of the hour
01:32and then recorded versions of these
01:34lectures will be available online
01:36within two weeks at the link provided.
01:38In the chat.
01:39Finally,
01:40please feel free to share the
01:42announcements for this weekly
01:44lecture series to anyone else you
01:46think might be interested and
01:48we're going to be sending out our
01:50full Winter Spring 2021 schedule
01:52in the next week or so.
01:54So now I'm delighted to introduce
01:56Doctor Christopher Klein as our speaker.
01:58This afternoon,
01:59Doctor Klein completed his PhD in
02:01exercise science at the University
02:03of South Carolina,
02:04with the dissertation focused on
02:06the effect of exercise training on
02:08the severity and health consequences
02:10of obstructive sleep apnea.
02:12He then completed a postdoctoral
02:14research fellowship and sleep and
02:16chronobiology at the University
02:18of Pittsburgh.
02:19Currently he's an assistant professor
02:21in the Department of Health and
02:24Physical Activity and Health and
02:26Human Development within the School
02:28of Education at the University of Pittsburgh.
02:31His research interests include the
02:32role of exercise as a behavioral
02:35treatment for sleep disorders
02:37such as insomnia and OSA,
02:39and the bidirectional relationship
02:40between physical activity and sleep.
02:42His numerous publications related to
02:44these topics lectures regularly on
02:47sleep and exercise, and his mentoring.
02:49Numerous students and trainees.
02:51His current NIH funding includes a
02:53project examining the role of physical
02:55activity on cardiovascular risk in
02:57pregnancy and a project looking at
02:59how increasing physical activity
03:01among sedentary individuals may
03:03lead to blood pressure reduction.
03:05I think we all know that physical
03:07activity impacts sleep quality and
03:10daytime functioning in important ways,
03:12and I'm really looking forward to
03:14hearing Doctor Klein educate us all
03:17about this relationship this afternoon,
03:19so.
03:19With that I will turn it over to you,
03:21Chris.
03:22OK, thank you for this invitation. Let me.
03:26I'll go ahead and share my screen here.
03:33OK, can everyone see that OK?
03:36OK, yeah, thank you again Lauren for
03:39the opportunity to present here.
03:42As Lauren mentioned my.
03:45My research focus generally
03:46encompasses the bidirectional
03:48relationship between sleep and
03:50physical activity and with my
03:51background PhD in exercise science,
03:53postdoctoral training and Sleep Medicine,
03:55I sort of have one foot
03:57in both of those fields.
04:02Today though, I will not be talking
04:04about sleep and exercise in general.
04:05I'll be talking a little
04:07bit more specifically about.
04:09The importance of sleep for
04:10optimizing athletic performance.
04:12So this is an area that.
04:15I don't have too much current
04:17research going on on this topic,
04:20but again, with my background with
04:22the disciplines that I interact with,
04:25this is a topic that is constantly
04:28discussed and I've always stayed
04:30relatively on top of the.
04:32The current literature so and I
04:35also find it just a topic that
04:38is to me very fascinating.
04:40So we just to move forward here.
04:47I this is what doctor Tobias mentioned.
04:51And I do not have any conflicts of interest.
04:56So. As everyone knows here,
05:00the topic of sleep in athletic
05:03performance has really gained a lot of
05:06popularity in recent years, so athletics.
05:09Practitioners have long noted the importance
05:12of optimizing training programs for
05:15subsequent optimization of performance,
05:17but only recently have practitioners
05:19really begun to appreciate
05:21the importance of recovery,
05:23or basically the 22 or so hours.
05:27Of the day that you spend not training
05:30and really sleep and nutrition
05:32are the most critical factors.
05:35Facilitating recovery and with
05:37appreciation of the importance of sleep.
05:39The research has tended to follow that.
05:44But as I'll show you here,
05:46that we still,
05:47there's still quite a bit to know
05:49quite a bit to learn about the impact
05:52of sleep on athletic performance.
05:54So here's just a brief outline
05:57of what I will be.
05:59Covering over the next 40 or so minutes
06:02and at the end I will obviously welcome
06:06any questions that you may may have.
06:11So I usually top talk on this topic.
06:15Sorry to interrupt.
06:17You probably want to share screen in.
06:21For I don't know is everybody else,
06:24is anyone else seeing I'm
06:26seeing you as larger than.
06:28The slides themselves.
06:29Oh, maybe that's just me.
06:30I was able to fix it.
06:32Never mind keep continue here.
06:33I was like Oh no.
06:35'cause I don't know how to fix that one, OK?
06:39So I usually talk on this topic
06:41to audiences who don't really have
06:44much expertise in Sleep Medicine,
06:46so I usually begin with a few slides
06:49just priming the audience on on sleep,
06:51and specifically how sleep is.
06:54Is really an active state that prepares
06:56our bodies for optimal functioning.
06:58Now. I obviously don't need
06:59to do that for this audience,
07:02but I did want to emphasize how
07:04sleep is really critical for
07:06both the brain and the body.
07:08So for the brain,
07:09sleep plays an essential role
07:10in both memory consolidation.
07:12More recently,
07:13we've learned the importance of sleep
07:15for clearing out metabolic byproducts
07:17in the brain, but also, it's.
07:19It's critically important for the body.
07:21It's when multiple body systems are restored,
07:23including the.
07:24Nervous system, muscular system.
07:26Immune endocrine skeletal systems.
07:29Anne.
07:30But it also serves as a critical
07:32period for energy conservation.
07:34It's when energy stores are
07:36built up for the subsequent day.
07:38So even though.
07:39You know,
07:40many people still consider sleep
07:42to be this passive state where we
07:44go offline and nothing happens.
07:46We as a Sleep Medicine field,
07:48know that this couldn't be
07:51further from the truth.
07:53Michael Grandner,
07:54researcher who most of you probably
07:56know and who I will be mentioning
07:58it a couple of other stops.
08:00In this presentation.
08:01He's really led.
08:02The charge is getting the NCAA to
08:05recognize the importance of sleep
08:07for their athletes and he just has
08:09a quote that I absolutely love.
08:11Rather than being a passive process of rest.
08:14Sleep is an active state of rebuilding,
08:17repair, reorganization and regeneration,
08:18and I think that just really
08:21emphasizes the relevance of
08:23sleep to athletic performance.
08:25So in general, how well do athletes sleep?
08:28So as Doctor Tobias mentioned,
08:30my primary area of interest is
08:32really in the impact of physical
08:34activity on sleep and in general we
08:37know that exercise improves sleep.
08:39So you would think.
08:42Athletes,
08:43they get more exercise than mostly everyone,
08:45so they should have the best sleep of all.
08:49But it's actually somewhat of a
08:51paradoxical relationship there,
08:52as you'll see athletes do not have
08:54better sleep than non athletes and
08:57in many cases it is quite disturbed.
09:02So anecdotal reports have always
09:04claimed a high prevalence of
09:06sleep disturbance in athletes,
09:08but there's been surprisingly
09:09little characterization.
09:10Obviously, patterns of this population.
09:13And of those available studies,
09:16most involve small sample sizes and
09:20relatively limited measures of sleep.
09:23The best evidence really comes from a
09:26recent systematic review led by Luke Gupta
09:30and Kevin Morgan in at Loughborough an.
09:33They summarize the findings across
09:3537 different studies that focused
09:38on characterizing sleep in elite.
09:40Athletes. In general,
09:42they found that athletes sleep a
09:45similar duration to non athletes but.
09:49Even though they sleep a similar duration,
09:51the sleep that they do obtain seems to
09:53be more fragmented, as evidenced by.
09:56Lower sleep efficiency than expected
09:58and higher sleep onset latency.
10:01And that's I shown just Table 2
10:03at the bottom left of this slide.
10:05That sort of depicts that.
10:08In addition,
10:09they found that nearly half of all
10:11athletes across these 37 studies self
10:13reported having poor sleep quality.
10:15According to the Pittsburgh
10:17Sleep Quality index.
10:19Again, that's on the bottom right
10:21portion of the slide.
10:23An complaints related to Assump
10:25insomnia were especially common,
10:27including as I mentioned before,
10:29long sleep latency,
10:30inefficient fragmented sleep,
10:32and then waking up feeling
10:35relatively unrefreshed.
10:36This review also pointed out,
10:38though that of the studies reviewed,
10:40they generally were of poor quality.
10:42Majority of studies were graded.
10:44Actually is poor quality evidence
10:46and only 5% were deemed high quality.
10:49And, you know,
10:50as I mentioned before,
10:51the biggest flaws in most of these
10:54studies were small sample sizes,
10:56but also the lack of the control
10:59condition control or comparison group.
11:02So overall,
11:02in addition to pointing out
11:04the need for higher quality
11:06characterization of sleep in athletes,
11:08this review really highlighted that the
11:10problem may not be insufficient sleep
11:13due to voluntary sleep curtailment,
11:15but rather disturbed or fragmented
11:17sleep that is the primary issue
11:19with most athletes.
11:24So good is review generally focused just
11:27on elite athletes without regard to age
11:29Group an not too many studies actually
11:32focus on collegiate student athletes, but.
11:35Among specifically collegiate student
11:37athletes, this might be where the highest
11:40prevalence of poor sleep is seen.
11:42If you think about it,
11:44collegiate student athletes need to juggle
11:46the demands of collegiate coursework,
11:48high demands on training, especially at.
11:52The more the higher levels,
11:55such as Division One, power five conferences.
11:58And then there's still college students,
12:01so relatively poor sleep hygiene
12:04habits are relatively common.
12:06So shown here on the left are the average
12:09sleep durations that were self reported by
12:12NCAA athletes from the 2016 goals survey,
12:15and these results are separated by
12:17athletic division of the NCAA and
12:19you can see that the prevalence
12:21of different sleep durations are
12:23pretty similar across Division 1,
12:26two and three.
12:27But approximately half of all
12:30athletes report.
12:32Six or less hours of sleep at night
12:35on average and with the mean being
12:38around 6 1/4 hours of sleep per night.
12:41So this amount of sleep is.
12:43Really similar to what college students
12:46generally report sleeping on average, but.
12:49Within within those who studies
12:52sleep enough like performance,
12:54there is the assumption that athletes
12:57need more sleep than non athletes.
13:01In addition,
13:01the Gold survey did.
13:05They did show that in addition
13:07to sub optimal sleep duration,
13:10college athletes just oftentimes
13:11have poor quality sleep.
13:13Over 50% of athletes reported that
13:15they felt rested upon awakening.
13:18In the morning 3:00 or less days per week.
13:22So overall, just a broadview
13:24of the literature is that at
13:26the elite professional level,
13:28the issue seems to be much more likely
13:31to be insomnia related symptoms,
13:34whereas in contrast among non elite,
13:37collegiate and high school athletes,
13:39short sleep seems to be.
13:42On average, the bigger issue.
13:47It's important to note, though,
13:49that the prior couple of slides
13:51in which the prevalence of poor
13:54sleep there was was presented.
13:56Those represent disruption in an
13:58athlete's normal or typical sleep.
14:00It's even more common, though,
14:02for athletes to experience sleep disturbance
14:04immediately prior to a competition.
14:07So this was I think,
14:09really well demonstrated in in a recent
14:12study of elite Australian athletes.
14:14And in that sample 64% of the athletes
14:17surveyed reported experiencing worse
14:19sleep immediately prior to an important
14:22competition within the past year.
14:23And as you can see from these two graphs,
14:27most of the time the problem
14:30was an inability to fall asleep.
14:33And most often this difficulty sleeping
14:35was attributed to thoughts and nervousness
14:38about the upcoming competition.
14:43So there's a variety of
14:45factors that at play that could
14:47predispose athletes to poor sleep.
14:49Some of these factors are going
14:51to be directly relevant to
14:53the sport they participate in,
14:55while others seem to be seem to be
14:58more related to the individual itself.
15:01So this schematic is from a
15:03recently published consensus
15:04statement on Sleeping Lead athletes,
15:07and I think it characterizes
15:09these risk factors really well.
15:12So first we have non sport or individual
15:16factors on the periphery in blue.
15:20And there's just numerous
15:23external non sport influences.
15:26That impact in athlete Ann may
15:28predispose them to sleep disturbance,
15:30so most athletes aren't well
15:31paid professionals,
15:32so they have to juggle other family
15:35social commitments that often
15:36come at the expense of sleep,
15:38such as school part time or full
15:41time job caretaking duties.
15:43In addition,
15:44individual characteristics may
15:46play a significant role, so.
15:48In fact,
15:49the very attributes that may
15:51predispose one to XLS an athlete,
15:54such as perfectionism,
15:55attention to detail, strong work ethic.
15:58They also may predispose an
16:00athlete to insomnia.
16:02And these could also include factors
16:05like chronotype and sleep need
16:06that are highly individualistic.
16:08Finally,
16:09the athletes lifestyle choices and
16:11attitudes about the importance of
16:13sleep likely play a role in their
16:15predisposition to poor sleep,
16:17even though most athletes.
16:18Now know about the importance of sleep.
16:21For many,
16:22it's still not a high priority until
16:25right before a big competition.
16:27Now, on the other hand,
16:28sport related factors which are
16:30shown here on the inner circle in orange.
16:33Those are easier to identify and
16:35they largely revolve around training,
16:37travel and competition.
16:40Specifically,
16:40high training loads in poorly poorly
16:43timed training training sessions,
16:45so either excessively early
16:47or late in the day.
16:49Those may predispose predispose
16:51athlete to poor sleep well,
16:53while the experience of competition
16:55and with it coming potentially late
16:58competition times travel the unfamiliar
17:01settings in which one is required to sleep.
17:04Those may just add onto this
17:07poor sleep issue.
17:08Now the relevance of these.
17:11Various factors are going to differ according
17:14to the individual and the individual sport.
17:17So for instance,
17:18swimming is notorious for early
17:21morning training sessions,
17:22whereas professional.
17:24Basketball players may be more
17:26likely to engage in evening or
17:29even later night competitions,
17:30and these factors can act in isolation,
17:33or they can interact.
17:35So for instance,
17:36an athlete who may normally be
17:39predisposed to insomnia may be able
17:41to sleep fine during the offseason
17:43when training loads are lower,
17:45travel is minimal, but then.
17:49The insomnia may manifest itself
17:51during the competitive season when
17:53training loads are much higher
17:55in competition and travel is
17:57much more frequent.
17:58So overall,
17:59this schematic really just emphasizes
18:01the numerous factors that could
18:03contribute to poor sleep and athletes.
18:08So we see that poor sleep is
18:10prevalent among athletes,
18:12and the reason that why that's
18:14such a big deal is that poor or
18:17insufficient sleep could impact.
18:19Athletic performance. So in general,
18:23there is the expectation that poor sleep,
18:25which is manifested in a variety
18:27of ways as shown here on the slide,
18:29could impair multiple domains that
18:31are relevant to athletic performance.
18:33However, the existing experimental
18:35literature really is primarily focused
18:38on sleep restriction or even outright
18:41total sleep deprivation an there's
18:43really an across the board need for
18:46quality research that examines athletic
18:48performance outcomes under conditions
18:50of more realistic conditions of
18:52poor sleep that athletes experience.
18:56So what is the actual evidence that links
18:59poor sleep to impaired athletic performance?
19:01Well, as I alluded to on the last slide,
19:05there's there's actually surprisingly
19:07minimal literature that's
19:08focused on realistic sleep loss.
19:10In fact, many of the early studies
19:13focused on complete sleep deprivation
19:16of 24 to 60 hours of duration.
19:19And then they examined how that
19:22impacted different exercise
19:23parameters or performance markers.
19:26So I didn't even really include those
19:29in this talk, just because that's
19:31not realistic for most athletes.
19:33Now, among studies that have examined
19:36more realistic scenarios of sleep loss,
19:38they've shown relatively minimal
19:40changes in performance with a
19:43single night of reduced sleep.
19:45So somewhat consistently,
19:46studies have shown that simple
19:49performance metrics involving large
19:51muscle groups so gross motor function,
19:53such as muscular strength,
19:55power output, and view to Max.
19:57Aren't affected that much by a.
20:00Single night of sleep loss.
20:02Again,
20:03the evidence is is very equivocal there.
20:06So what does seem to be impacted?
20:09Well, for one,
20:11in contrast to large muscle group activities,
20:13performance of the more complex or
20:16fine motor skills may be impacted
20:18by one night of sleep loss.
20:20So small studies have shown that
20:23sport specific skills of tennis,
20:25darts, handball,
20:26they all are significantly affected
20:28by even a single night of sleep loss.
20:31Also,
20:32activities involving a high cognitive
20:34load or the need for precise decision-making.
20:37They may also be impacted as
20:40reaction time is affected,
20:42regulation of mood and emotion is impaired,
20:45but the biggest impact of a single
20:48night of sleep loss may be on repeated,
20:52submaximal efforts.
20:53So studies have shown that one's
20:55perception of effort forgiven.
20:57Submaximal task is going to be
21:00higher with restricted sleep.
21:02And also accompanied by reduced
21:05pain tolerance.
21:06But overall,
21:06when you consider the existing evidence
21:08regarding the effect of one night
21:11of reduced sleep on performance,
21:12and you combine that with the fact
21:14that most athletes do sleep poorly
21:16the night before competition,
21:18one thing I always tell the
21:20efforts I work with is that.
21:23If you sleep poorly the
21:24night before competition,
21:25do not worry about it.
21:29So as I talked about in the last slide,
21:32you know contrast in gross motor
21:34function versus more fine motor skills.
21:36There does seem to be a difference,
21:38so I wanted to just highlight
21:40this study here that focused on.
21:43A simple sample of collegiate tennis
21:46players and tennis serve accuracy.
21:49So they actually conducted two
21:50different studies in this publication.
21:52In the first, they looked the effects
21:54of a single night of sleep restriction.
21:57By restricting the athletes sleep by 33%,
21:59so down from about 7 1/2 hours of
22:03sleep to five hours for one night.
22:06In the second study they keep.
22:08They kept that same sleep manipulation,
22:11but they added in the possibility of
22:13receiving 80 milligrams of caffeine
22:16in that sleep restricted condition.
22:18And for both studies,
22:19the tennis players were tested.
22:21On their ability to place the serve
22:23in a very specifically marked
22:25area in the service box,
22:27so that's actually taken straight from
22:30their publication that graphic there.
22:32In the first study,
22:34they found that tennis serve accuracy
22:36was impaired by approximately
22:3830% under sleep restriction.
22:41So a significant reduction in
22:43performance from only a single
22:45night of sleep restriction.
22:47In the second study,
22:49they found relatively similar results,
22:51but what was most notable here is that
22:53caffeine did not rescue performance
22:55in the sleeper statistic in the sleep
22:58restricted condition did not improve
23:00it back up to normal baseline levels.
23:03So this study provided some pretty
23:06compelling evidence that a single night
23:08of sleep loss may have a significant
23:11impact on fine motor skills that are
23:13relevant for athletic performance.
23:18Now where we see more consistently
23:20pronounced decrements in performance,
23:22this seems to be with more sustained
23:25or chronic sleep loss, but again,
23:27even here there's very little high
23:30quality research in this area,
23:31and these studies of quote unquote
23:34chronic sleep loss are still
23:36relatively short term, which.
23:38Doesn't mimic what may be occurring among
23:42athletes who are chronically sleep deprived.
23:46So I wanted to over the
23:48next couple of slides,
23:49just point out a couple of classic studies
23:51that have demonstrated these effects.
23:54So in this first study on this slide,
23:56this is a study by led by
23:59David Dangerous at Penn,
24:00and they had participants complete a
24:0210 minute sustained reaction time task.
24:04So the Pvt.
24:05At baseline after week of
24:07approximately 8 hours of sleep,
24:09and then they restricted these participants
24:11sleep by 33% to so approximately
24:134 to 5 hours of sleep per night.
24:16And they had to maintain that sleep
24:18schedule for seven nights, again,
24:20measuring reaction time in each
24:22day over that seven day period.
24:24So what they found was a gradual
24:28increase in reaction time overtime.
24:30Again,
24:31a relatively minor increase after
24:33one night of sleep restriction,
24:36but a but more accumulated effect
24:39over those seven nights.
24:42In altogether seven nights of
24:44restricted sleep resulted in a 33%
24:47slowing of sustained reaction time.
24:51Now,
24:51what's interesting is that after those
24:53seven nights of restricted sleep,
24:55the.
24:56The protocol involved two nights
24:59of recovery sleep,
25:00so sleep of eight to 10 hours.
25:04And it took two full nights of that
25:06recovery sleep to recover from the
25:09seven nights of restricted sleep
25:10and subsequent studies have shown a
25:13similar cumulative effect on different
25:15aspects of cognitive performance.
25:18And this obviously has.
25:20Direct relevance to performance and training,
25:22so even this,
25:23even though this study was not
25:25conducted specifically in athletes.
25:27Reaction time decision making.
25:28Those are all highly relevant,
25:30especially at the elite level when.
25:32Really, the physical physical ability.
25:35It's a relatively level playing field.
25:38What differentiates are these
25:40more cognitive factors?
25:43So shown here is another classic study,
25:46this time with the focus of looking at
25:48chronic sleep loss in muscular strength.
25:50So in this study, participants experienced
25:52three nights of sleep that was reduced
25:55from eight to three hours per night,
25:57and this is contrasted against a
26:00control condition that was allowed to
26:02sleep 8 hours each of those nights.
26:05So in this study,
26:07participants performed variety of lifts,
26:09muscular strength lifts,
26:10but I've only shown the leg press here
26:14so you can see that relative to baseline
26:17after one night of restricted sleep,
26:20there wasn't too much of a difference,
26:23but the effects became increasingly
26:26apparent on the second and third nights,
26:29eventually resulting in 19% lower
26:31strength output in the leg press.
26:34In the Sleep Restriction Group after
26:37after three nights now, surprisingly,
26:39there's still very few of these studies
26:42examining athletic performance markers
26:43over these subchronic periods of sleep loss.
26:46So we're currently in the planning
26:49stages for one of the zip it.
26:52There was,
26:53unfortunately interrupted by by Covid.
26:57So what about training in recovery?
26:59So obviously optimizing training and
27:00recovery is essential for performance,
27:02and if you're injured,
27:03sick,
27:04or just simply unable to recover,
27:06you're not going to be able to
27:08put in the training that allows
27:10you to perform your best.
27:14So I wanted to start off this section by
27:17really pointing out and emphasizing how
27:19sleep is critical for the acquisition
27:21and retention of motor skills.
27:23And remember it's during sleep
27:25that we consolidate memories.
27:26We prune synapses that aren't critical,
27:28strengthen those that are important,
27:30and I always go back to this classic
27:32study by Matt Walker and colleagues
27:34when he was in Bob Stickels lab.
27:37So this is going back nearly 20 years now.
27:40But in this study they showed
27:42that learning a new skill.
27:44Is improved with sleep,
27:45so on the far left that graph shows
27:49that participants first learned a
27:52finger tapping task at 10:00 AM.
27:55An when they tested them 12 hours later,
27:58no improvement.
27:58Then they allowed them to
28:00sleep and suddenly performance
28:01was significantly improved.
28:03But this could be due to a delayed
28:05effect or just the passage of time.
28:08So in a separate group of participants they.
28:12Initially taught that same skill at 10:00 PM,
28:14then test it again 12 hours later.
28:17After a night of sleep and again
28:19just confirmed that sleep seemed
28:21to be the critical factor.
28:23Now the role of sleep in motor
28:26skill acquisition is been shown to
28:28be much more complex than this,
28:30but it really to me highlights the
28:32potentially important role for
28:34sleep in learning skills that are
28:36rehearsed in athletic team practices.
28:37And while a number of studies have
28:40now linked sleep to both fine and
28:43gross motor skill acquisition.
28:45To my knowledge,
28:46no studies really looked at the
28:48acquisition of specific sports skills
28:50and how sleep may influence its acquisition.
28:56Now, while athletes may debate which recovery
28:59strategies are most most beneficial,
29:01sleep is often considered to be the best
29:04recovery strategy available to an athlete,
29:06and the schematic on the
29:08left really to meet a pix,
29:10depicts well how training is designed to
29:13lead to a transient dip in performance,
29:16but with proper recovery will
29:18lead to a new and greater baseline
29:21of performance overtime.
29:23But with insufficient recovery,
29:24that new baseline is not reached,
29:27and in contrast,
29:29performance continues to deteriorate
29:31with with subsequent training.
29:35Sergio two fixed group in Brazil,
29:37published nearly ten years ago.
29:39Now a theoretical review that
29:41described how restricted sleep could
29:43impair or could impact the muscle
29:46repair and regeneration process,
29:48basically converting sleep from
29:50a relatively anabolic state.
29:52Into more of a catabolic state.
29:54But just like for athletic performance,
29:56we we still have relatively little
29:58research that's directly examine them.
30:00Words of sleep for the recovery of athletes.
30:05Now we do know that acute bouts of
30:08training not even considering sleep.
30:10Acute bouts of training lead to
30:12transient dips in immune function.
30:14And we also know from the non athlete
30:17literature that there's increased illness.
30:19Rick risk with restricted sleep.
30:21So this infographic is from a study that
30:24was conducted at Carnegie Mellon about
30:26five years ago now and in this study
30:29they inoculated a sample of participants
30:32with the rhinovirus or the common cold.
30:35And then they looked at how participants
30:38slept in the two weeks leading up
30:40to exposure to that rhinovirus.
30:42And they found a relatively dose
30:45dependent likelihood of catching a
30:48cold based upon your sleep history.
30:51So.
30:53This really provided.
30:55Pretty strong evidence that sleep will
30:59adequately protect you against catching
31:01the cold in a dose dependent manner.
31:05An obviously this wasn't conducted
31:07in athletes, but this to me.
31:09Also emphasizes the importance of
31:11sleep at protecting immune function.
31:13Athletes cannot train in an
31:16optimal manner if they're sick.
31:20We also know that inadequate sleep
31:22leads to an increased risk for injury,
31:25so this study, shown here on this slide
31:27is the first of several studies that have
31:31been published on sleep and injury risk,
31:33and ironically, for some reason they are
31:36seemingly all focused on adolescents.
31:38But in this survey,
31:39high school athletes in California
31:41completed a survey about training
31:43habits and health behaviors,
31:44and then these factors were
31:47evaluated against objective injury
31:48records that were kept by the.
31:50Various high school athletic department's.
31:54And you can see here that the injury
31:57rate differs across different amounts of.
32:01Typical sleep duration that
32:03reported by these athletes,
32:04but altogether getting less
32:06than 8 hours of sleep.
32:08Those athletes had 70% greater
32:11odds of experiencing injury
32:12in that competitive season.
32:17Finally, minimal evidence,
32:18but what evidence is there does seem to
32:22does seem to suggest that athletes just
32:24don't seem to bounce back as quickly
32:27when they aren't sleeping enough.
32:29So the study involved a within subjects
32:33design in which they assessed peak
32:36power on a bike or grammar test
32:39prior to high intensity training
32:41session and then 24 hours after.
32:44That high intensity training session.
32:48So assessed twice 24 hours apart and
32:50in between those two assessments,
32:53participants were either allowed to
32:55maintain their normal sleep patterns or
32:58they were told to restrict their sleep.
33:01By 50% and you can see here on the
33:04left under normal sleep conditions,
33:08the athletes were actually able to
33:10bounce back almost completely from
33:13that high intensity training session
33:15and have nearly the same peak power
33:18generation 24 hours after that.
33:20After that training session,
33:22whereas under restricted sleep.
33:25They only were able to recover by 9595% so.
33:31This may seem trivial,
33:33only a 4% difference in the magnitude
33:37of recovery,
33:38but many practitioners emphasize that
33:41it's exactly these small incremental
33:44differences on an individual daily
33:46basis that can accumulate overtime and
33:50lead to significant reductions in the
33:53ability to recover and repair bodies.
33:59So just a few slides here on what we
34:01know about sleep interventions and how
34:04they could impact athletic performance.
34:07So around 10 years ago.
34:10I mean only a few professional teams really
34:13consulted with sleep experts and that
34:16was they were considered cutting edge.
34:19Now among collegiate and
34:21professional athletic teams.
34:22They're considered lagging if they're not
34:25consulting with with sleep experts in.
34:27Several. Commercial companies now
34:29exist solely for the purpose of
34:31sleep consulting to athletic teams.
34:35So the study that really seemed to jumpstart.
34:39Our appreciation on the potential
34:41of sleep to optimize performance
34:43came from this study from Sherry,
34:45MA and colleagues at Stanford.
34:48The study involved a sample of
34:51Stanford basketball players and the
34:53intervention was basically encouraging
34:55the athletes to extend their sleep
34:59with the goal of achieving up to 10
35:01or more hours of sleep per night.
35:05Optimally focused on obtaining
35:07sufficient nighttime sleep,
35:08but when that wasn't possible,
35:10daytime napping was was encouraged.
35:13So overall, over the five to
35:15seven weeks of sleep extension.
35:18They didn't quite get to the 10 hour goal,
35:21but these athletes on average did increase
35:25their sick duration by 1.8 hours on average.
35:28And with what Mon colleagues found
35:30was pretty much across the board
35:33improvements in performance compared
35:35to after sleep extension compared
35:37to prior compared to baseline.
35:39So a 4% improvement in Sprint times.
35:43A 12% improvement in mean
35:45reaction time and then.
35:48Really significant
35:49improvements in basketball.
35:50Specific parameters of related
35:52to performance and then also just
35:55general mood in daytime sleepiness.
35:58So this study really.
35:59Remains the strongest evidence of
36:01the potential impact that increasing
36:03sleep duration or improving sleep
36:06can have on improving performance,
36:08and is rightly considered a very
36:12impactful paper on the field.
36:15But the rigor for this study was
36:18relatively low in terms of sample size.
36:21More importantly, no control condition.
36:25In terms of the more specific
36:28athletic performance parameters.
36:30Shooting Sprint times free
36:32through actual accuracy.
36:33Those would be expected somewhat to
36:36improve over the course of a season.
36:39Now the mood.
36:40Daytime sleepiness would definitely
36:41not be expected to improve.
36:45The intervention was relatively loose
36:47without a lot of structured guidelines,
36:50so from a practical standpoint,
36:52this study really demonstrated the
36:54potential for sleep to improve performance,
36:57but from a scientific standpoint,
36:59it still left a lot of questions unanswered.
37:06Another study that really strongly
37:08demonstrated the impact of sleep extension
37:11on performance involved 12 collegiate
37:13varsity tennis tennis players and
37:15they monitored these athletes for one
37:17week in which they just maintain their
37:20habitual normal sleep habits and that
37:23was followed by a week in which these
37:26tennis players were asked to obtain at
37:29least nine hours of sleep per night.
37:33Now the main outcome here was tennis
37:36serve accuracy similar to that previous
37:38study that I already talked about,
37:40in which participants needed to place the
37:42server into a specific location in the
37:45service box for it to be considered accurate.
37:48So what they found was a significant
37:51improvement in tennis serve accuracy.
37:54After just one week of sleep extension
37:57and alongside the improvements in tennis,
38:00serve accuracy were significant
38:02reductions in self reported sleepiness
38:05so as depicted by the Epworth Sleepiness
38:09Scale and the Stanford Sleepiness Scale.
38:12So as I noted,
38:13you know those two studies over
38:15the last couple slides really have
38:18provided the most notable support.
38:20For the value of improving
38:22sleep to improve performance.
38:24Now more recently,
38:25the concept of banking sleep prior to
38:28anticipated sleep loss has started to
38:30begun to be examined for its effectiveness.
38:33Most of these studies have
38:34focused on cognitive outcomes,
38:36so shown here is a study with the closest
38:38relevance to athletic performance.
38:42This was a randomized study in which
38:44randomized crossover study in which
38:46participants went through two different
38:48conditions that were six nights long.
38:50Prior to a night of total sleep deprivation,
38:53so in one condition,
38:54participants maintain their normal sleep
38:56habits around 8 hours in bed for six nights,
38:59and in the other they increase their time
39:02in bed by approximately 2 hours per night.
39:05Over those six nights.
39:06And after both of those six night conditions,
39:09they were tested before and
39:11after staying up all night.
39:13With the primary outcome being how long these
39:17individuals could sustain a submaximal knee
39:20extension at 10% of their maximal effort.
39:23So, again, not directly relevant to
39:25athletic performance, but does have some.
39:30Some applications here.
39:31Now during the habitual sleep
39:33condition shown here on the slide.
39:34Right now, time to exhaustion.
39:36So the amount of time they could
39:39sustain that that contraction.
39:41Worsened by 7% after sleep deprivation,
39:44so that so D0 is pre sleep deprivation.
39:48D1 is after sleep deprivation.
39:52In the sleep extension condition,
39:54time to exhaustion also worsen
39:57after sleep deprivation.
39:58But it was only three.
40:00Point 7% here.
40:02So the amount of reduction in
40:06performance was attenuated.
40:08But even more importantly,
40:10in the sleep extension condition,
40:13baseline performance was 3.9% better
40:15than the habitual condition and then
40:188% better after sleep deprivation.
40:21So in other words,
40:22banking sleep lead to better performance
40:25prior to sleep loss and also better
40:29performance after sleep loss or a
40:31smaller attenuation or blunting of
40:34performance impairment after sleep loss so.
40:38Subsequent research really needs to be
40:40performed on this concept of banking,
40:43sleep and more relevant outcomes
40:46related to athletic performance.
40:48But if you're not able to extend
40:50sleep at at at night,
40:52can napping improve performance so?
40:55This study involved a within subject design,
40:58both under both conditions.
40:59Athletes slept from 2300 to 3:00 AM,
41:02so four hours of sleep.
41:05In one condition they were allowed a
41:0730 minute nap around an hour before
41:10performance was tested and in the other
41:14condition they were not allowed to nap.
41:17So this is a wide variety of performance.
41:20Markers were assessed,
41:22but I'm only showing 2 here,
41:24they found.
41:25State spring performance was
41:27significantly improved under the
41:29napping condition and then using
41:31the digits pintat digit span task
41:33test that assesses short-term
41:35memory they found a significant
41:37improvement after napping as well.
41:40So again,
41:40showing that the potential for
41:42napping to improve performance
41:43under sleep loss conditions.
41:44But again,
41:45I did want to point out here too,
41:48that this was only a 30 minute nap,
41:50so it doesn't necessarily have
41:52to be an extensive nap also.
41:56So the results from these few
41:58last few slides really suggest
42:00that simply extending sleep,
42:02whether through increasing
42:04nocturnal sleep or adding naps.
42:07Maybe that's the key to improve
42:09performance and some reviews on
42:10this topics even suggests as much,
42:12with the emphasis being,
42:13the athlete should simply get as
42:16much sleep as possible, but I.
42:18I want to express some caution against
42:21this being across the board suggestion.
42:24First off, not all studies have
42:26found notable improvements in
42:28performance with sleep extension,
42:30so I don't have time to really
42:32go into them here.
42:34But multiple studies have found minimal
42:36to no impact of sleep extension or
42:38napping on subsequent performance.
42:40But to me the bigger concern is that
42:43among adults who have difficulties sleeping,
42:45sleep extension may actually
42:47exacerbate these problems.
42:48So instructing athletes who already have
42:50issues falling asleep or maintaining sleep,
42:53asking them to go to bed.
42:55Earlier or stay up or wake up
42:57later that simply may lead to
42:59maladaptive sleep behaviors and
43:01worsen sleep instead of improving it.
43:04So obviously for those people
43:06with severe sleep debt,
43:07sleep extension should.
43:11So of course work and definitely
43:13be encouraged, and in general
43:15we should be, you know.
43:19Asking athletes to optimize or
43:20prioritize sleep as much as possible,
43:23but. In most situations,
43:24it's just not a one size fits all solution
43:28and it shouldn't be the end goal in itself,
43:31and again with differences between
43:33sports between individuals,
43:34it likely is going to require an
43:36individualized approach to improving sleep.
43:39Now I don't have time to present.
43:42Other studies that have looked at
43:44intervening on sleep and performance,
43:46but suffice to say that.
43:48Simple short-term sleep hygiene
43:50interventions haven't really shown
43:51that much in terms of being effective
43:54at improving sleep or significantly
43:56improving performance in athletes samples.
43:58In my opinion,
43:59the Gold Standard approach is to provide
44:02a multi component sleep intervention
44:04that incorporates comprehensive sleep
44:06education and screening for all athletes,
44:09providing personalized feedback
44:10and then also providing tailored
44:13approaches to improving sleep in
44:15those individuals who are identified
44:17to be in need of intervention.
44:19So a good example of this type of
44:22approach comes from some Finnish
44:24authors who studied professional
44:25hockey players in implemented a program
44:28similar to what I just described.
44:30They screened all the athletes provided
44:32sleep education to all of them,
44:34and then they followed up with
44:37individualized treatment programs to
44:38the approximately 20% or so who were
44:41suspected to have a sleep disorder,
44:43and they found significant
44:45improvements in sleep.
44:46Based on this,
44:47more comprehensive sleep intervention.
44:49In a couple other studies have
44:51utilized a similar approach to this,
44:53but.
44:53The problem not really problem,
44:55but it's that they haven't really
44:57included any objective measures of
44:59performance to see if improving sleep
45:01also leads to improve performance.
45:05So one more section to go here.
45:07I did want to review some of
45:10the consensus recommendations
45:11that have been developed for
45:13practitioners who work with athletes.
45:14So I'll start with the first statement.
45:17First consensus statement that
45:18focused on sleep and athletes,
45:20and this was specifically focused
45:22on collegiate athletes.
45:23Now, I was fortunate to be a part
45:25of this as a member of the Inner
45:28Association Task Force on Sleep and
45:30Wellness that the incident NCAA put
45:32put together a couple of years ago,
45:35and it began with an in person
45:37stomach in 2017,
45:38and they continued in smaller
45:40group meetings and eventually a
45:42writing group that focused on
45:44developing consensus recommendations.
45:45That were aimed to improve the sleep in
45:48collegiate athletes but were aimed to
45:51be implemented by collegiate athletic
45:53departments so you can see here already.
45:56The focus was somewhat unique.
45:58The audience wasn't
45:59specifically the athletes,
46:00but rather the larger ecosystem.
46:03They could facilitate better
46:05sleep for those athletes.
46:07And we utilized something called the
46:09Delphi process to identify recommendations
46:11for those athletic department's and when
46:14we were considering recommendations.
46:17We consider two primary factors
46:18that the recommendation had utility
46:20that it was going to be useful for
46:22improving athletes sleep,
46:23but also that was going to
46:26be feasible to implement.
46:27So in the end,
46:29our committee had lots of recommendations,
46:31but really only a few
46:34recommendations made it.
46:36They basically made it to the top
46:38in terms of deeming being deemed to
46:41have sufficient utility an sufficient
46:44feasibility from the expert panel.
46:46So shown here in this box
46:48are those recommendations.
46:50So First off,
46:51completing an athlete Time Demand
46:53survey on an annual basis really
46:55chronicling how these athletes
46:57are spending their time studying,
46:59training,
47:00and sleeping.
47:02Recommendation two was really to
47:04dampen the enthusiasm that at the
47:07time we were perceiving athletic
47:09departments to be moving toward a lot
47:12of commercial devices for monitoring,
47:14sleep and just really pointing
47:16out the potential privacy laws
47:19that could be in question there.
47:21Recommendation three involved
47:23incorporating sleep screening as
47:25a standard part of the athletes.
47:27Preparticipation screening exam.
47:29And then recommendations.
47:31Four and five really providing
47:33comprehensive sleep education to
47:35both the athletes but also the
47:38coaching staff and surrounding
47:39athletic training staff.
47:41So overall,
47:41I'm not sure how much of an F how
47:44much of an impact this is made,
47:46the consensus recommendation.
47:48The recommendations were published
47:50just middle of 2019, and you know,
47:53I've worked with a couple of
47:55institutions because of this
47:57consensus statement.
47:58Pitt and a couple of smaller schools
48:01in Western PA. But it's been.
48:03It's been difficult to convince them
48:05to implement some of these recommendations,
48:08and that that was really our
48:10fear all along regarding the
48:12feasibility of implementations by
48:14these athletic departments.
48:15Now recently it's still impress.
48:18Actually,
48:18consensus recommendations were
48:20provided for managing sleep in
48:22elite athletes and as part of this
48:25this document they provided asleep
48:27toolbox that they recommended for
48:30sleep practitioners to utilized
48:32when working with athletes,
48:33and this toolbox consisted
48:35of four primary tools.
48:37One educate the athletes,
48:39including on their sleep need the use
48:42of daytime napping to supplement,
48:45but not replace.
48:46Nighttime sleep proper sleep hygiene
48:49awareness of their chronotype
48:51and also just a cautionary tale
48:54about using commercial monitors.
48:56And they also recommended
48:58screening for all athletes,
49:00specifically the use of.
49:02Athlete specific sleep.
49:03Screening tools that I'll mention
49:05on the on the next slide and
49:08then third strong emphasis that
49:10they placed on utilizing naps,
49:12including how to properly diploid them.
49:16Uh.
49:17But again,
49:18viewing that naps as supplementing
49:20nighttime sleep instead of
49:21replacing nighttime sleep,
49:22and then finally this concept
49:25of banking or extending sleep.
49:27But the emphasis here was really on
49:30obtaining sufficient sleep in the months,
49:32weeks,
49:32days prior to an important
49:34competition to safeguard the
49:36athlete against the occasional
49:37night of insufficient sleep,
49:39especially right before competition.
49:43So there have been two screening
49:45tools that have been developed
49:46specifically for identifying
49:48sleep problems in athlete samples.
49:50The first was the athlete
49:52Sleep Screening Questionnaire,
49:53much more of a diagnostic measure.
49:58And then the athlete Sleep
50:00Behavior questionnaire.
50:00Really has a greater emphasis on sleep.
50:03Hygiene consists of 18 items.
50:05Not sure if you can see the
50:07individual items on the slide here.
50:10It doesn't really do much to identify
50:12sleep disorders like the athlete
50:14Sleep Screening Questionnaire does,
50:16but it could be useful for identifying
50:18potential areas of improvement for athletes,
50:20so these were developed because
50:22of the perceived need for more
50:24specific tools for athletes.
50:26But I still think you know the
50:28more standard tools of the piski.
50:31The ISI, those still should identify
50:35most athletes sufficiently well.
50:37So overall.
50:40There's really been an explosion
50:42of research of.
50:43Explosion of interest and research and
50:46sleep enough like performance but.
50:48Much of the available evidence,
50:50even though it certainly suggests
50:52a significant relationship
50:54between sleep and performance.
50:55It's generally low quality and generally,
50:58though in general,
50:59though,
51:00we see that sleep disturbances prevalent
51:02among athletes and whether it's voluntary
51:05curtailment or insomnia driven by insomnia,
51:08there's also evidence that sleep loss,
51:10especially over multiple nights,
51:12impacts multiple parameters that are
51:15relevant to both performance and recovery.
51:17And while existing research.
51:19Doesn't point to interventions
51:20that are especially effective
51:22aside from sleep extension,
51:24there's many different ways that natly
51:26can improve their sleep and hopefully
51:29optimize performance and recovery.
51:32So with that I'm sorry and then
51:34consensus recommendations as well.
51:36Again,
51:36pointing out the need for greater research
51:39to better inform our recommendations
51:41that we can make and how to how to
51:45work and manage sleep in athletes.
51:47OK with that,
51:48I'm happy to take any questions.
51:51Great, thank you so much. Doctor Klein.
51:54That was a wonderful overview of a topic
51:57we really don't talk about that much.
52:00An I think warrant more attention.
52:02I'll start off with the question and if
52:05others would like to post them in the chat,
52:08please feel free to do so.
52:11So most of the research that you
52:13reviewed related to competitive
52:14athletes at various levels.
52:16And I was just curious.
52:18The outcomes were often relating
52:20to their sort of performance, but.
52:22Many of us who kind of exercise in non
52:25competitive arenas were not as much
52:27interested in how many miles we can run,
52:30but what's the benefit to our health?
52:32How many calories can we burn?
52:34And and you know,
52:36should we try to go to the gym at least
52:39an ANCOVA times after six hours of sleep?
52:42Or are we going to have a
52:44better workout after 8 hours?
52:46I know you mentioned that in
52:47general after just one night,
52:49at least in competitive athletes that
52:51they are not tremendously impacted.
52:53But it's just much harder to actually.
52:55Do that workout.
52:56But what do we know about kind
52:58of non competitive athletes?
53:02Well, that could be another presentation
53:05on itself, but. In general,
53:09I get that question asked a lot about.
53:11You know there's only 24 hours in a day,
53:14an oftentimes non athletes have to
53:17choose between getting that seven
53:198 hours or getting up a little
53:21bit early and going to the gym.
53:23And I I always weasel out of that answer,
53:26because I don't want to.
53:28I don't want to anger either side,
53:30but in general,
53:31if an athlete is if non athlete.
53:34If a general individual is able to obtain
53:37relatively sufficient amount of sleep.
53:40It to me allocating 45 minutes
53:44to exercise rather than.
53:47Moving from 6 1/2 to a little
53:49over 7 hours of sleep may be
53:52beneficial on a short term basis.
53:54There are some studies coming
53:56out now that suggests that under
53:58conditions of sleep loss exercise
54:00helps sort of rescue metabolic
54:02function into being more normal and.
54:05And not demonstrating the impaired
54:07metabolic function that you would
54:10see with with sleep loss so.
54:12No firm answer there, but I guess.
54:17It does seem to be an emerging area
54:19of research of research that sort of
54:22looks at comparing and contrasting,
54:24allocating time to exercise
54:26versus versus sleep, so it's.
54:29I think I sufficiently weaseled my way
54:32of that out of that.
54:34In fact, I ask a question.
54:36Yeah, please go ahead,
54:38we thank you for the nice review.
54:41Having experience poor
54:42sleep during high altitude mountaineering.
54:44I was kind of wondering what
54:47is the mechanism or what are
54:49the mechanisms by which the
54:51organs start to malfunction.
54:53If they do like such as
54:55cardiac and muscular level.
54:59And you're talking about at
55:01high altitude, high altitude.
55:02I understand that
55:04hypoxia is going to have a
55:06major effect on both the
55:08neurocognitive dysfunction and
55:09obviously oxygen transport, but having
55:11experienced poor sleep.
55:14Without hypoxia, potentially can affect
55:18the peripheral system functions.
55:22Any any feelings about the potential
55:25mechanisms that can poor sleep
55:28affect their peripheral function?
55:32There is some sort of negative
55:34component, right? Yeah, yeah.
55:36So more at the muscular level and
55:39the cardiac, yeah. And their client.
55:44So there seems to be a greater under
55:47sleep loss conditions a greater.
55:52There does seem to be increased
55:55sympathetic tone to the muscles to
55:57the cardiac musculature leading to
56:00increased heart rate under sleep.
56:02Loss conditions for a
56:04given exercise intensity.
56:05Obviously it at maximal effort
56:08you're already at maximal.
56:11Maximum heart rate also at.
56:15No maximal sympathetic outflow,
56:17so that isn't necessarily the issue,
56:20but it sort of gets to the submaximal effort.
56:26It's harder, both physiologically, but also.
56:31In terms of perceived effort,
56:34so sympathetic activity is greater,
56:36there does seem to be.
56:41You know, I didn't allude to it too
56:44much here, but there does seem to be
56:46impaired feedback from the brain to the
56:49musculature under sleep loss conditions.
56:51So the commands coming down
56:53from the brain aren't as strong.
56:55It takes us stronger studies have done
56:58transcranial magnetic stimulation,
56:59and it takes a stronger impulse
57:01under sleep loss conditions to
57:03get the same muscular output.
57:05Um? But overall,
57:06I mean most studies haven't
57:09really looked at those mechanisms,
57:11so those to me are the main ones that have
57:14been relatively decently interrogated,
57:16and both of those have been shown
57:20to be actual.
57:22Prominent mechanisms for
57:23experiencing the decrements that
57:25you can see at submaximal efforts.
57:30Great thank you and I think one
57:32more question from the chat from
57:35someone in sports Medicine who has
57:37asked the following some power,
57:40five collegiate conferences and
57:41professional sports teams are
57:43utilizing sensory deprivation
57:44deprivation tanks to supplement
57:46for individuals with sleep debt.
57:48Are you familiar with any research
57:50to validate their use as it
57:53relates to performance? So I
57:55have heard about this.
57:57I've seen a couple of those tanks.
58:00And I I don't know of
58:03any empirical literature,
58:05especially in athletes,
58:07but even more generally among
58:10non athletes samples that that
58:13does relate to better sleep
58:15and better performance.
58:18But I should say that.
58:21You know, like like a lot of other fields,
58:23but especially in athletic performance.
58:25What's being deployed in athletic
58:28performance circles oftentimes is is well
58:32ahead of what the research can be can
58:35be validating basically so oftentimes.
58:38You know the the researchers are
58:40playing catch up and talking to
58:42practitioners and saying what are
58:44you guys doing to optimize recovery?
58:46Or what are you guys doing
58:48with these athletes?
58:49And that's sometimes what Spurs the
58:51subsequent research that then either
58:53refutes or validates that approach.
58:54So I wouldn't necessarily.
58:57Say it's unfounded.
58:58But the research doesn't
58:59support it right now.
59:02Great, thank you so much and I just
59:04want to thank everybody for attending
59:06the conference this semester and
59:09we will see you all on January 6th
59:11to resume for the next semester.
59:13Thanks again, Doctor Klein.
59:14Take care. Happy Holidays everybody.
59:16Yeah. And if
59:17anyone has any questions feel free
59:19to email me. OK, thank you so much.