Eating Disorders and Sleep: Implications for Athlete Health and Performance

Eating disorders (ED) have a devastating impact on the health of athletes. EDs are often accompanied by medical complications including, but not limited to, disruption of cardiorespiratory, endocrine, neuropsychiatric, and gastrointestinal functioning. Collectively, the medical complications associated with low energy availability encompass a syndrome known as “Relative Energy Deficiency in Sport (RED-S)”. In addition to capturing the multitude of adverse health impacts, RED-S also highlights the ways in which sport performance may be impacted. For example, athletes with low energy availability may experience decreased muscle strength, endurance, coordination, and concentration, as well as increased risk for injury.

Sleep is another area of health that is commonly impacted, but overlooked, in athletes experiencing EDs. Athletes with EDs often have difficulties falling asleep, experience frequent nighttime awakenings, and short (insufficient) sleep. Research demonstrates that the relationship between EDs and poor sleep is bi-directional, meaning short sleep is a risk factor for the development of an ED and EDs are associated with greater vulnerability to sleep problems. In fact, research has indicated that insomnia is two times more likely to occur in women with an eating disorder diagnosis than the general population.

Short sleep alone is associated with detrimental consequences to some of the same bodily systems as EDs (e.g., neuropsychiatric, endocrine), and can have a profound adverse impact on sport performance. For example, athletes experiencing poor sleep are 1.7 times more likely to sustain an orthopedic injury. Similarly, tennis players experiencing sleep restriction have demonstrated reduced serving accuracy of approximately 15%. Moreover, athletes experiencing EDs exhibit tendencies to over-train, engage in compulsive exercise, and underutilize rest/recovery, further increasing risk for the compounded health impact associated with EDs and insufficient sleep. Including brief evidence-based behavioral sleep interventions (e.g., cognitive behavioral therapy for insomnia) to target disrupted sleep as an adjunct to ED treatment is likely to yield promising results for both ED recovery and long-term sleep health.

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