How Paralympians Combat Common Sleep Disorders
5 min read
Last Modified 20 December 2022 First Added 30 June 2021
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According to research, sleep disorders such as insomnia, sleep apnoea and restless leg syndrome are more likely to be experienced by people with a disability. To understand how athletes competing at the top-level deal with sleep disorders, we spoke with ParalympicsGB’s Dr Tom Paulson and specialist Michael Hutchinson. We also spoke to the Paralympic powerlifter, Ali Jawad, who shared his own experience of chronic nightmares.
Dr Tom says:
Paralympic sport involves a lot of different impairment groups. Some impairments may influence sleep, either directly or indirectly. Part of our role in providing support is to understand the influence that sleep has on them and whether they need to do anything differently.
According to Michael, there are different impairments and health conditions that the athletes have which might increase issues around sleep. The first is visual impairment. As we know, our body has natural rhythms that fluctuate throughout the day, and the one thing that largely drives it is light. Our body perceives light through our eyes to normalise the difference between day and night. So, those who are visually impaired or fully blind may have no perception of light whatsoever, which impacts their body clock.
One thing that we do know is that light perception is really important for melatonin, the hormone that regulates sleep. Melatonin usually increases across an evening, leading to a kind of sleepiness, and ultimately sleep, too. With someone without that light perception, we don’t see the same kind of increase in melatonin as we would in other people. That can mean that the hormone variations are kind of able to run free, as it’s not being regulated by light perception.
That translates to the athletes having what is known as a Circadian Rhythm Sleep Wake Disorder, and it’s very common in people that are blind. Blind athletes do report that they can struggle with their sleep, especially when travelling to unfamiliar environments. When adjusting to a new time zone, like Tokyo, light exposure is key to helping the athlete’s body clock adjust to the new setting.
Michael says that the second group of people with similar sleep considerations is those with a spinal cord injury. He says they may see an association between their health condition and sleep issues. Sleep issues particularly affect athletes with tetraplegia, a high-level spinal cord injury. He adds:
With tetraplegia, it again affects the link between melatonin and sleep nursing. Melatonin is released from a gland within the base of the brain, but the gland is stimulated for nerves that come out in the cervical region of the spine. If someone has one of these high-level spinal cord injuries in that cervical region, the stimulation is impaired. With this group of athletes, we don’t see an increase in melatonin across the evening, so they’re not getting the hormonal cue to initiate sleepiness.
Another factor for tetraplegia is body temperature. For someone who doesn’t have a spinal injury, across the evening as you begin to feel sleepy, your core body temperature will decrease as you fall asleep, then slowly increase as you wake up. What we see with people who have spinal injuries is that they reach their trough of the core body temperature much earlier, and their body temperature steadily increases throughout the night. This means their body is potentially giving them signals to wake up earlier.
My medication for my Crohn’s Disease gives you violent nightmares. Unfortunately, when I get a flare up, I must take the medication, so it’s unavoidable, even when training. The medication makes you sweat and keeps you awake, and at first, I was only getting 2-3 hours of sleep a night. I also get very violent nightmares – I would describe it as a horror film every night. Luckily, I do like horror films! But I have always said I could probably write the scariest horror film ever, just from going through these gory nightmares.
Nowadays, I know that I’m going to have nightmares, and I just get through it. I make sure my sleep environment is the best it can be, and for the last eight months, I’ve managed to get through the night without waking up, even though I do have these nightmares.