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Introduction:

The role of sleep is recognized as an important component for success in athletic performance, and sleep is proposed to be one of the most effective recovery strategies available. Insufficient sleep is commonly reported among athletes while several factors have been put forward to explain why elite athletes might experience poor sleep.

However, Paralympic athletes may be predisposed to a greater risk of poor sleep due to the associated complexities of some impairment types. Clinical research has previously shown that individuals with disabilities have a higher prevalence of sleep disturbances when compared to their able-bodied counterparts. However, research and evidence-based practices regarding the sleep of elite Paralympic athletes are limited.

Study aim:

1) To identify challenges associated with the Paralympic games to obtain optimal sleep,.

2) To identify specific risk factors to sleep associated with particular impairment groups within the Paralympic population.

3) To propose potential sleep-enhancing strategies that might be of relevance for Paralympic athletes.

Methods:

The international literature on Paralympic sleep behaviours and relevant clinical literature of sleep behaviours of various impairment types was summarized in a collaborative team effort. Given the available literature, no explicit exclusion criteria were used for this narrative review.

Available studies were critically assessed at any instance. For the purpose of this review, risk factors to sleep were defined as any process that may negatively impact the characteristics of sleep, which were broadly divided into three primary components: sleep duration, sleep quality, and/or sleep time.

Main findings:

• Thermal environment is a key determinant of sleep – thermally demanding environments might alter an athlete’s natural fluctuations in temperature, which in turn may result in impaired sleep/wake cycles.
• Events that are at the greatest risk of heat illness are scheduled to take place during the lowest thermally demanding times of day (early morning/late evening) - early competition and night-time competition have previously been demonstrated to impair the sleep of elite athletes.
• Quantity and quality of sleep should be included as one of the primary foundations for reaching optimal levels of performance.
• Impairment type may evoke different responses to the environment and thus impact sleep – further research is needed within Paralympic populations to develop an accurate understanding of the prevalence and contributing factors towards poor sleep.
• Melatonin secretion can be disrupted in some Paralympic population groups, which can significantly impair sleep.
• There has been some development of sleep-optimizing techniques - sleep extension, napping, and sleep hygiene practices.

Reference:

Roberts IE, Murphy CJ, Goosey-Tolfrey VL. Sleep disruption considerations for Paralympic athletes competing at Tokyo 2020. J Sports Med Phys Fitness. 2021 Aug;61(8):1159-1172. DOI: . Epub 2021 Jun 29. PMID: 34184496.

Image credit: © Paralympics GB