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Reversing the state of arousal and accelerating sleep onset: pharmacological and non-pharmacological manipulation of sleep in athletes
  1. Charles Pedlar1,2,3,
  2. Neil Stanley4,
  3. Shona L Halson5,
  4. Luke Edinborough6,7,
  5. Phoebe Law2,
  6. Michael Harrison8,
  7. Paul Catterson9
  1. 1 School of Sport, Health and Applied Science, St Mary's University Twickenham, Twickenham, UK
  2. 2 Orreco Limited, Galway, Ireland
  3. 3 Division of Surgery and Interventional Sciences, University College London, London, UK
  4. 4 Neil Stanley, Independent Sleep Expert, London, UK
  5. 5 School of Behavioural and Health Sciences, Australian Catholic University, Banyo, Queensland, Australia
  6. 6 Faculty of Sport, Allied Health and Performance Sciences, St Mary's University Twickenham London, Twickenham, UK
  7. 7 Sport Science, Southampton Football Club, Southampton, UK
  8. 8 Medicine, Chelsea Women Football Club, London, UK
  9. 9 Medicine, Newcastle United Football Club, Newcastle upon Tyne, UK
  1. Correspondence to Professor Charles Pedlar, School of Sport, Health and Applied Science, St Mary's University Twickenham, Twickenham, TW1 4SX, UK; pedlarc{at}

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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.

Categories of sleeping medications and mechanism of action

Table 1 provides …

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  • Twitter @pedlarcr, @shonahalson

  • Contributors CP instigated the editorial and all authors contributed to authorship and editing of the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.