Sleep deprivation and Low Testosterone
Sleep deprivation leads to lower testosterone levels, health declines and greater risk of injury and disease.
SLEEP DEPRIVATION is an everybody problem. In 2011, the CDC declared insufficient sleep to be a public health problem.
Over the past 50 years, according to research conducted by Dr. Charles Czeisler, the director of sleep medicine at Boston’s Brigham and Women’s Hospital and Harvard Medical School, the national average sleep duration on work nights has fallen from eight and a half hours to less than seven. That has consequences.
As Matthew Walker, professor of neuroscience and psychology at the University of California at Berkeley and founder and director of its Center for Human Sleep Science, says: “Based upon the weight of about 10,000 empirical scientific studies, the number of people who can survive on six hours of sleep or less without showing any impairment, rounded to a whole number and expressed as a percent of the population, is zero.”
Chronic sleep loss has been associated with higher risk for cancer, diabetes, obesity, heart disease, heart attacks, Alzheimer’s, dementia, depression, stroke, psychosis and suicide.
As Phyllis Zee, chief of sleep medicine in the department of neurology at Northwestern University’s Feinberg School of Medicine, says, “Sleep deprivation … doesn’t only affect the brain — it affects all your other organs. … Think about it as punching your other organs.”
And as for those naps? Sleep scientists suggest they are not all that beneficial.
“We have a circadian rhythm, and there are times when we have been designed to sleep and thus get optimal sleep,” Walker says. “Trying to sleep during the day results in worse sleep quantity and quality and leads to significant poor health outcomes. We know this from hundreds of studies in nighttime shift workers.”
Dr. Czeisler, for his part, recommends adults ages 26 to 64 to get seven to nine hours, according to the National Sleep Foundation.
As one NBA executive notes: If a person slept four or five hours a night over an extended period of time, they’d survive. “But we’re not asking our players to just be alive. We’re asking them to perform at an elite level against others at an elite level. There’s a huge difference between those two things.”
Testosterone is vital for athletes. It’s a foundational hormone that impacts speed, strength, muscle mass, mood. And while studies had already shown that sleeping about five hours a night for one week temporarily lowers testosterone levels in men by an equivalent of 11 years of aging, what Royer saw in NBA players stunned him all the more.
By January, just three months into the 2012-13 NBA season, the testosterone of one player in his 20s had dropped to that of a 50-year-old man. (Those reductions in testosterone, it’s worth noting, are not permanent, but they do require multiple days of recovery to offset.) And as testosterone levels fell for more players, the injuries seemed to correspondingly accumulate.
Initially, Royer and his staff were focused on optimizing performance. But all the red flags began pointing in one direction — toward minimizing the impacts of travel and sleep loss.
For her part, Dr. Eve Van Cauter, director of the Sleep, Metabolism and Health Center at the University of Chicago, notes that sleep loss leads to a decline in physical performance, eye-hand coordination, attention span — almost everything one can measure.
A sleep-deprived person at the top of a staircase is more likely to stumble and fall, she says. An equally exhausted NBA player jumping, landing, cutting and diving on a court? More likely, she says, to take a misstep that leads to an injury.
“Lack of sleep messes up your recovery, messes up how you play, your cognitive function, your mindset, how you’re moving on the court. Sleep is everything.”
Royer also began monitoring one Eastern Conference NBA team’s brain wave activity throughout the season beginning with normal cognitive levels to start the season, but by April, the team’s players had levels collectively on par with some patients in their late 60s or early 70s who were experiencing deficits in processing speed and short-term memory.
Such short-term memory loss is temporary. Dr. Andrew Heyman, lead physician and owner of the Virginia Center for Health & Wellness, notes that mental faculties can return within a couple of weeks with seven to eight hours of nightly sleep, moderate exercise and proper diet.
The next season, Royer and his team broadened their efforts, tracking hormones four times a season, heart-rate variability and breathing patterns not just for players but also for dozens of members of traveling parties for teams in both conferences.
They found that those who simply traveled with the team showed similar declines to those of the players themselves. “That’s when we stopped thinking, ‘Oh, these guys are playing too much,'” Royer says. “It’s not about playing. It’s about traveling and lack of sleep.”
By the 2016-17 season, Royer and his staff had begun gauging players’ sleep overnight with wearable devices throughout the season, and by the end saw that players were obtaining little, if any, restorative REM sleep.
If deep sleep is like cash in a wallet, REM sleep is like a retirement fund. In such a grinding schedule, with so much sleep debt, the players were all but bankrupt.
IN EARLY 2018, Royer and his staff, motivated by the data they’d collected from NBA players, turned to John Leopold, an independent statistics consultant at DePuy Synthes, a provider of orthopedic and neuroscience products and services. (Neurocore — Neuropeak Pro’s parent company — consulted with Leopold to analyze the data and provide results.)
Royer and his team wondered most of all: Did the lower testosterone levels they’d uncovered correlate to an increased risk of injury? They provided Leopold with nearly 400 testosterone samples from more than 100 players across almost six years — players who had cumulatively reported more than five dozen injuries during that span.
Two analyses were performed. A few weeks later, Royer and his staff got the full report. In both, factoring only data gathered from those players during that span, Leopold had found a “statistically significant increase in risk” when testosterone levels for players decreased below the 20th percentile for males their age.
Czeisler, the leading sleep researcher at Harvard, suspects there isn’t another group that has collected the sort of data that Royer has. He says Royer’s observations on the adverse impact of sleep deficiency on testosterone are “consistent” with what he would expect to see “based on the evidence of the adverse physiological impact of recurrent circadian disruption and sleep deficiency. There’s no doubt to me that these things were happening.”
Says Michele Roberts, executive director of the National Basketball Players Association: “It’s not surprising that poor sleep patterns will negatively affect performance and, more importantly, can cause significant long-term health risks. In our last round of bargaining, we addressed some of these concerns through schedule adjustments, including by lengthening the season … and by increasing the mandatory number of days off. We are anxious to see any new data analyzing the effects of sleep loss in professional sports so that we can continue our efforts.”
Royer himself is an imperfect messenger. He isn’t a research scientist. He hasn’t conducted a conclusive double-blind peer-reviewed study. But he is convinced that he’s seeing the next major player health issue.
“We’ve been doing this for six years. We’ve been on the planes. We’ve been at the games. We’ve been on the road. … I am 100 percent certain that what we’re talking about is real.”
To learn more about hormone decline and testosterone deficiency,
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