Reversing the state of arousal and accelerating sleep onset: pharmacological and non-pharmacological manipulation of sleep in athletes

The necessity of sufficient sleep for health and sustained high performance in athletes is increasingly recognised. There are frequently scenarios where an athlete’s opportunity for sleep (eg, travelling East across several time zones, sports fixture congestion) and propensity for sleep (eg, overarousal, anxiety, insomnia, circadian rhythm shifts) may compromise sleep quality and/or quantity.1 For example, transitioning from a highly stimulating night game (often purposefully accentuated with caffeine) to entering a full night of good quality sleep can be highly problematic for athletes, resulting in insomnia. The demand for quick, effective recovery including restful sleep prior to the next training session or game, is top-of-mind for athletes and leads their desire to optimise the time available for recovery. At these times, using a pharmacological intervention can provide a potential solution, however, the risks should also be considered against the benefits. For example, the potential impact on performance, and the risk of an athlete forming a habit. Guidance on sleep medications in sports medicine is limited,2 and the use of sleep agents was not covered by a recent sleep consensus paper.1 The purpose of this commentary is to highlight key considerations in the use of pharmacological and non-pharmacological strategies to optimise sleep in athletes.