Sleep – The Other Half of That Training Equation

If you sleep well you most likely take it for granted, as many athletes out there would do anything to fall asleep in a short matter of time and stay asleep until morning. Not only do many runners, cyclists, and triathletes not sleep well, but they think their common sleep problems are normal, though they most likely are not. A restful night in the sack will do wonders for your health and physical performance. Sleep, health, and fitness are all related to one another – the better your sleep, the healthier you will be, and the healthier you are the more fit you will become.

Remember: Training = (Working Out + Daily Stress)/Rest & Recovery

Is it normal for me to take a long while to fall asleep, even if I exercised earlier in the day?

You should fall asleep in a relative short period of time (typically less than 15 minutes). Often an athlete can’t fall asleep because their major stress hormone, cortisol, is too high. Cortisol is a hormone made by your adrenal glands and is normally highest in the morning (6-8am) and then slowly lowers itself throughout the day until it is at its lowest around midnight, ensuring a restful sleep. Fluctuations in this cycle can wreak havoc on sleep cycles, particularly if cortisol levels are high in the late evening. Individuals under high stress and athletes training too hard have a tendency to output high cortisol levels throughout the entire day. Anaerobic workouts where your heart rate is too high, even for a short period of time such as during interval training, will elevate cortisol levels. These can stay elevated for a long time, (Mark Allen says up to 9 hours after a workout), and affect sleep, especially if the workout was later in the day. Even going long periods throughout the day without eating will increase cortisol levels because your body will naturally increase cortisol to balance blood sugar, often at the expense of stored glucose (sugar) and valuable amino acids needed to repair tissue. Many athletes are what I call “tired and wired.” This means they need coffee to get them going in the morning (tired) and then they are more productive in the evening (wired – night owls). Many then resort to alcohol to calm them down at night. You can say it winds you down if that makes you sleep better; yes the pun is intended.

Is it normal to wake up during the night to use the bathroom?

This is perhaps the most common sleep problem and rarely is this normal. Athletes think that this is normal because they’ve been carrying a water bottle around with them all day and think they’re well hydrated. But this is rarely the case. Something is up, (other than yourself in the middle of the night), and it is most often due to some physical, chemical/nutritional, or emotional stress stirring up your adrenal glands. However this time more often from another adrenal hormone other than cortisol.

Aldosterone, another one of the adrenal hormones, is responsible for mineral balance in the body (sodium-potassium). It is higher at night, opposite that of cortisol. High aldosterone means that sodium is retained, which also means that fluid is retained. This means that you sleep better since the dreaded walk to the bathroom isn’t needed. A low aldosterone at night means you are going to have to get up and go, literally.

Another reason for frequent nighttime urination common in athletes is from lactic acid, usually from a hard (anaerobic) workout, irritating the wall of the bladder. This irritation will cause you to wake up and urinate, but often results in low urine volume. That is when you think to yourself, “I got up for this?” – only to return with a similar outcome a couple hours later. For you men out there it is important to note that frequent urination and especially that of low volume can be due to a prostate problem. That is not something you want to ignore.

Is it normal to wake up during the night at all?

Ideally, you should not wake up during your sleep, until you are finally up in the morning. Waking up even once, even for a few minutes, is very common, especially in athletes doing too much anaerobic activity, working long hours, or eating poorly throughout the day (going more than 5-6 hours without eating and/or too many refined foods). The most common reason for this is due to a spike in cortisol and sometimes epinephrine (adrenalin), which occurs in response to a drop in blood sugar. Your body increases these hormones when your blood sugar drops too low so it can make glucose (sugar) from glycogen (stored sugar), as well as valuable amino acid stores, in your liver. That surge in stress hormones will wake you up, and you sometimes may wake up hungry, or not. At night you’re trying to play catch-up because you depleted yourself all day long. Instead of being anabolic (rebuilding tissue and healing organs), during sleep, you’re catabolic (breaking down sugars and muscle to give you energy). Next thing you know you’re up buying a ShamWow at 4am. (I heard they’re actually pretty good though.)

Is it normal to have trouble sleeping the night before a race?

This one is not necessarily normal or abnormal. I’d call it more of a hindrance. I often sleep well the night before a race because I’m used to racing over the past 20+ years. I remember the first year I did Ironman Hawaii in 1996 (which was my first IM race ever). I was 4^th in line at body marking. Pre-race jitters might keep you up, and I tend to think they will not cause any negative effect on your race as long as everything else is going well, including sleep the previous nights. Relaxing more during the day before your race, and staying away from all the race hype (away from the expos), might help you sleep better that night too.

Is it normal to wake up at the same time every night?

Another common sleep problem that athletes have is waking up at the exact same time every night. They will say, “I wake up at 2:55am every night,” or “I can’t get to sleep before 1:00am.” When specific times are involved this has to do with the acupuncture meridian system and its relationship to certain organs during those times. 11pm to 1am is the time when the gallbladder is at its highest energy. So if a person has a problem with their gallbladder, (too many bad fats in their diet and too much caffeine are very common), then they often can’t get to sleep between those times – or if they are asleep before 11pm then they may wake up during that 2-hour cycle. Between 1am and 3am is the liver meridian. This is the most common time a person wakes up and is due to many reasons, but most often from a hormonal influence. As noted above, when cortisol and epinephrine levels elevate to pull sugar from the liver, this will wake you up, as it taxes the liver as well. Also the liver has to deal with detoxification of hormones, such as cortisol and estrogen, leading to more work for the organ at that time. Medications will result in a similar problem, maybe even the same medication you’re taking to get you to sleep! NSAIDs, that many runners and other athletes take often to help with inflammation, can result in this sleep problem too from the effect on the liver. 3am to 5am is the lung meridian – so think any breathing difficulty, and sometimes sinus problems (allergies) can show up here too. 5-7am is large intestine. Though many athletes wake for the day to train during this time I’ve often heard someone say, “I can’t sleep past 5am no matter what”, or “It’s like I’m just wide awake at 6am even though I don’t need to get up until 7″. Their large intestine (colon) is irritated – most likely from a food sensitivity/allergy or some dysbiosis (bad gut bacteria), or gut fungus/yeast. Digestive issues are very common in athletes from eating too many refined carbohydrates especially those found in sports drinks.

Is it normal for me to need any medication/drug to fall asleep?

Definitely not. A healthy athlete should not need to take any medication, herb, or hormone (such as melatonin), to fall asleep. The sleep medications such as Ambien, Lunesta, Sonata, and many others work off a powerful inhibitory neurotransmitter (NT) called GABA, to help you relax and get to sleep. A healthy athlete does this without the drug, but many athletes suppress the inhibitory NTs because they have too many excitatory NTs – from hard training/racing. The drugs do not allow you to go through the normal sleep cycles, so you may feel like you’re getting great sleep, but it’s not as good as if you were sleeping without the drug. Likewise, you should be making your own amount of melatonin, from your pineal gland. This hormone is often suppressed by cortisol, the same hormone that is high in stressed-out, hard-working, over-exercised athletes.

Check your environment. Make sure it is dark. The pineal gland which secretes melatonin allowing  you to sleep is turned off by light sources. So the darker the room the better. I  recommend removing major electronic sources from your room – particularly the TV. (I have a small battery clock by my bed – that’s it.) Many people have resolved their sleep problems by removing their TV or their giant LED clock on their nightstand. Even consider using your heart rate monitor watch as your one and only clock. And you should try to get to be around 10pm, 11pm at the latest. A person’s natural circadian rhythm is based off the rising and setting of the sun. Sleeping eight hours from 10pm to 6am is much healthier than 12am to 8am.

Is it normal to have a limb jerk when I fall asleep?

This is not normal, but a sign that your sympathetic nervous system is too revved-up. As you’re falling asleep, your arm, leg, or hand may twitch abruptly, or even in extreme cases your whole body my jolt off the mattress. Don’t worry, you’re not possessed, but you are overtrained and too stressed out. This is a clear sign that you need more rest and aerobic, rather than anaerobic activity.

Is it normal to get leg cramps when I sleep?

Leg cramps at night, especially the excruciating “Charley Horse” cramps that occur in the calves, are most commonly due to poor tissue calcium utilization. Calcium, as most know, is important for bone and joint health, but it is also extremely important for the muscles of athletes. Calcium aids in muscle contraction and if low, can lead to muscle cramping. Most athletes get enough calcium in their daily diet, but they do not use it efficiently. Essential fatty acid metabolism is of utmost importance for calcium to be driven into the soft tissues (muscles) to prevent cramping. This means not eating any trans fats and getting the proper amount of Omega 3s (fish and flax oil), Omega 6s (vegetables, nuts, seeds), and especially healthy saturated fats (egg yolks, butter, cream, coconut oil/milk), fats in your diet. Without them, the calcium won’t be able to get into your muscles. Calcium also needs an acidic environment to work well for you. That is why supplemental forms of calcium carbonate, also known as oyster shell calcium, found in many popular brands of supplements, (TUMS), is poorly absorbed and many times can cause problems. I’ve seen many athletes chew up TUMS all day long. Calcium citrate and calcium lactate supplements are best absorbed into the tissues. However, this does not mean if you have leg cramps as described you should take lots of calcium. Although the deficiency may be the issue, more commonly it is the problem of absorption. If the fats in the diet are off, as well as other health problems such as poor digestion, these issues must be addressed for calcium to work for you. Other signs of calcium tissue “starvation” are cold sores/fever blisters, canker sores, achy muscles especially in Spring/Summer during the first few days of yard work, itchy skin, and bursitis, to name a few. I remember one year Jan Ullrich starting the prologue TT of The Tour de France and Phil Liggett was commenting on his fever blister on his lip. He knew his body was fatigued and overtrained.

Is it normal to snore?

Snoring – definitely not normal, but very common – and if you’re to the point of sleep apnea and need a CPAP machine, well, you’ve got some work to do. Snoring can result from many problems – hormonal issues (as mentioned above), inflammation (from an injury or even from a poor diet), irritation to the digestive tract (from a food sensitivity/allergy, medication, or gut fungus/yeast living in your belly) – to name a few. I tend to look at snoring as a sign that something is not right and needs to be corrected. When someone’s health improves, so does the snoring. I catch myself (or my wife does) snoring if I’m working too hard or training too hard. It’s my “tell” to let me know I better back off and assess how much I’m pushing my body. You should do the same if you snore, either a little, or a lot.

Is it normal to wake up with stiff or achy joints, whether I worked out hard or not?

The most common reason for stiff joints in the morning is improper calcium utilization. First, calcium must be available. Despite what you might think or have been told to think by the dairy association or most medical physicians, eating or drinking more cow milk is not going to solve your calcium issue. Calcium needs an acidic environment to be properly absorbed, which is why supplements such as calcium carbonate or oyster shell calcium are such poor choices. The acidity primarily comes from proper stomach acid (HCL), which along with proper fatty acid metabolism pushes the calcium into the soft tissues. Lack of stomach acid, which commonly manifests itself as heartburn and indigestion (yes, I said lack of, not too much of) from a poor diet,  and excessive training. Poor sources of calcium will contribute to calcium deposits and kidney stones.

It is normal for me to wake up tired – Hey, I train a lot, so isn’t that normal?

You should wake up feeling well rested. If you wake up tired there could be some hormonal imbalance, or a dietary problem. Many people with low thyroid hormone levels wake up tired as do individuals who eat foods high in refined carbohydrates. You will run your thyroid down from even too much aerobic activity – say if you logging in hours on the bike or run each week, even at a low heart rate. Make sure you’re always changing your routine every month or so, and assessing activity duration and intensity.

Is it normal to wake up with a headache?

That is a often a sign that you’re either dehydrated or hypoglycemic, (low blood sugar), or both. Consider drinking more water throughout the day, perhaps back-off on some of the caffeine, and eat more protein and healthy fats to help balance blood sugar levels. Ideally an athlete should be eating at least 1.5grams of protein per kg of body-weight. If you’re training more anaerobically or racing, you may need even more. Check out the Sock Doc Training Principles to learn more!

Dr. Stephen Gangemi "Sock Doc"

I'm a board-certified chiropractic physician and clinical nutritionist with a passion for true natural health care. I implement dietary & nutritional therapies, exercise & movement practices, and lifestyle changes along with manual therapy techniques to help the body heal and prevent illness and injuries.