The relationship between exercise and sleep is quite robust, and it is one of those things that people tend to ignore, despite just how important exercise is to good quality sleep. I have seen multiple people who have had terrible sleep for years, completely cure their sleep issues by just getting into a good exercise routine. You see, exercise improves sleep through multiple mechanisms simultaneously, but the pathway does also go the other way too, and better sleep improves exercise performance and recovery. The two create a positive feedback loop where each enhances the other, compounding benefits over time in ways that extend far beyond either sleep or exercise alone.

Now, this isn’t just about “wearing yourself out” so you’re tired at bedtime, though physical fatigue is part of it. Exercise affects your circadian rhythm, your stress hormones, your mood, your metabolic health, your temperature regulation, and even the architecture of your sleep itself. It’s one of the most powerful non-pharmaceutical interventions available for sleep quality, and it works for nearly everyone regardless of age, fitness level, or current sleep problems.

However, exercise timing matters. Exercise type might matter. Exercise intensity can matter. Some people can exercise vigorously at 8pm and sleep beautifully. Others find that evening exercise leaves them wired and unable to sleep for hours. The individual variation is substantial, which means you need to understand the principles while also experimenting to find what works for your specific physiology.

This article will give you a comprehensive understanding of the relationship between exercise and sleep, and we will cover why it works, what the research actually shows, how to optimise timing and type and intensity for your goals, and how to troubleshoot when exercise doesn’t seem to help or actually makes sleep worse. We’ll also address some special considerations: overtraining, exercising when sleep-deprived, exercise for different life stages, and the underrated power of simply moving more throughout your day for improving sleep.

Why Exercise Improves Sleep: The Mechanisms

The relationship between exercise and sleep operates through multiple pathways, each contributing to the overall benefit. Understanding these mechanisms helps you appreciate why exercise is so powerful and guides decisions about implementation.

Increased sleep pressure: Remember adenosine, the molecule that accumulates during waking hours and creates sleepiness? Well, exercise accelerates adenosine accumulation. When you’re physically active, your neurons fire more, consume more energy, and produce more adenosine as a metabolic byproduct. By evening, you have stronger sleep pressure (e.g. a more powerful drive to sleep), which makes falling asleep easier and sleep itself deeper.

This is one reason why sedentary days often lead to difficulty falling asleep despite feeling mentally tired. Your brain might be fatigued from cognitive work, but you haven’t built sufficient physiological sleep pressure because your body hasn’t been active. Exercise solves this by creating the physical fatigue that complements mental fatigue.

Circadian rhythm strengthening: Exercise, particularly outdoor exercise during daylight hours, reinforces your circadian rhythm. Physical activity during the biological daytime is one of the zeitgebers (time-givers) your body uses to calibrate its internal clock. Morning exercise combined with light exposure provides an exceptionally strong “this is daytime, be alert” signal. Consistent daily activity helps maintain a robust circadian rhythm that produces clear sleep-wake signals.

Additionally, exercise affects core body temperature in ways that support circadian timing. We’ve discussed how core temperature needs to drop for sleep initiation. Exercise raises core temperature acutely, but in the hours afterwards, there’s a compensatory drop below baseline. When timed appropriately, this temperature drop can coincide with your natural evening temperature decline, enhancing sleep onset.

Stress and anxiety reduction: Exercise is one of the most powerful anxiolytic (anxiety-reducing) interventions available, with effects comparable to medication for mild to moderate anxiety. The mechanisms are multiple: reduced cortisol over time, increased endorphins, enhanced GABA signalling, improved stress resilience, and psychological benefits from mastery and accomplishment.

Since anxiety and racing thoughts are among the most common causes of sleep-onset insomnia, anything that reduces anxiety improves sleep. Many people find that regular exercise substantially reduces the nighttime rumination and worry that previously kept them awake.

Mood improvement: Exercise has robust antidepressant effects, again comparable to medication for mild to moderate depression. The relationship between exercise and sleep operates partially through mood improvement; depression disrupts sleep architecture and creates both insomnia and hypersomnia, and treating depression improves sleep. Exercise helps with depression, therefore exercise improves sleep.

The effect is bidirectional: exercise improves mood which improves sleep, and better sleep improves mood, which makes exercise feel less effortful, creating a positive spiral.

Physical fatigue: This is the most intuitive mechanism. When your body is physically tired, you sleep more easily and deeply. Humans evolved to be physically active throughout the day, and our sleep systems expect this. When you’re sedentary all day, your body isn’t particularly tired by evening, even if your mind is exhausted. Exercise creates the physical tiredness that makes sleep feel restorative rather than just a mental break.

Metabolic health: Exercise improves insulin sensitivity, glucose regulation, and overall metabolic function. Poor metabolic health is associated with worse sleep quality and higher rates of sleep disorders. Exercise improves metabolic health, which improves sleep. This is particularly relevant for type 2 diabetes and metabolic syndrome, both of which are strongly associated with sleep problems.

Reduced sleep apnea severity: For people with obstructive sleep apnea, exercise (particularly when combined with weight loss) can reduce apnea severity substantially. Even without weight loss, exercise improves upper airway muscle tone and reduces inflammation, both of which reduce apnea frequency. Since sleep apnea severely degrades sleep quality, anything that reduces it improves sleep.

Acute versus chronic effects: It’s worth distinguishing between the immediate effects of exercise (you sleep better tonight after exercising today) and the cumulative effects of regular exercise (your baseline sleep quality improves over weeks and months of consistent training). Both exist. You get immediate benefits from a single exercise session, and you get compounding benefits from making exercise a regular practice.

Research shows that both matter. People who exercise regularly have better sleep on average than sedentary people, and even within regular exercisers, days with exercise produce better sleep than rest days (though rest days are also necessary and shouldn’t be avoided out of sleep concerns).

The relationship between exercise and sleep is one of the most well-researched areas in sleep science, with hundreds of studies across different populations, exercise types, and outcome measures. The findings are remarkably consistent: exercise improves sleep for most people most of the time.

The effect sizes are meaningful, and not just statistically significant but practically significant. Regular exercisers fall asleep 10-15 minutes faster on average, experience 10-20 minutes more deep sleep, report better subjective sleep quality, and wake feeling more rested. These improvements might not sound dramatic, but 15 minutes faster sleep onset every night accumulates to substantial differences in lived experience over weeks and months.

Who benefits most: The sleep improvements from exercise are most pronounced in people who start with poor sleep. If you’re already sleeping well, exercise provides smaller absolute improvements (though it helps maintain good sleep). If you have insomnia, sleep-onset difficulties, or generally poor sleep quality, exercise produces larger improvements. This makes sense as there’s more room for improvement.

Older adults benefit substantially from exercise for sleep, which is super relevant because sleep quality typically declines with age. Sedentary older adults who begin regular exercise programs often report dramatic sleep improvements.

People with depression or anxiety disorders show larger sleep improvements from exercise than people without these conditions, likely because exercise helps with the treatment of the underlying condition that’s disrupting sleep.

Timeline of benefits: You get acute sleep benefits with exercise, as you tend to have better sleep the same day you exercise. But you also see cumulative benefits that develop over weeks. Many studies show peak sleep benefits appearing after 4-8 weeks of consistent exercise, suggesting that both immediate and adaptive responses contribute to the overall effect.

This means don’t expect miraculous sleep after your first workout (although you may see some benefits). But do expect noticeable improvement within 2-3 weeks if you’re consistent, with further improvement over subsequent months.

Exercise Type: Does It Matter?

The good news is that virtually all types of exercise improve sleep. The even better news is that you don’t need to optimise exercise type for sleep, and you should instead choose activities you actually enjoy and will therefore sustain, because consistency matters more than perfection.

Aerobic exercise is the most studied type, and the evidence is robust. Walking, jogging, cycling, swimming, rowing, etc., all improve sleep quality when done consistently. The benefits appear with moderate-intensity continuous training (the traditional “low intensity steady state (LISS) cardio” approach) and with more varied approaches. You don’t need to run marathons. Even relatively brisk walking for 30-45 minutes most days produces substantial sleep benefits.

Resistance training is also highly effective for sleep, sometimes showing equal or greater benefits compared to aerobic training. Weight lifting, bodyweight exercises, and resistance bands all produce meaningful sleep improvements. The mechanisms overlap with aerobic exercise (adenosine accumulation, stress reduction, mood improvement), but resistance training might have additional benefits through its effects on pain reduction, functional capacity, and body composition.

The research suggests that combining aerobic and resistance training might produce slightly better sleep outcomes than either alone, but the difference is modest. If you only enjoy one type, doing that type consistently beats alternating between types you hate and therefore skip frequently.

High-intensity interval training (HIIT) appears to be as effective as moderate-intensity continuous exercise for sleep, provided it’s not done too close to bedtime. Some people find HIIT more stimulating and need longer recovery time before sleep, but others tolerate evening HIIT well. Individual variation is quite substantial in my experience coaching lots of people.

Yoga and stretching show modest positive effects on sleep, particularly for stress reduction and anxiety management. The physical intensity is lower than traditional exercise, so adenosine accumulation is minimal, but the stress reduction and relaxation components provide sleep benefits through different pathways. Yoga before bed can be part of an effective wind-down routine.

Sports and recreational activity also count as exercise. Playing football, tennis, basketball, hiking, dancing, or whatever gets you moving and raises your heart rate, is likely benefiting your sleep. The social and enjoyment components of recreational activity provide additional psychological benefits that pure exercise might not.

Walking deserves special emphasis because it’s accessible, free, requires no equipment or facility, carries minimal injury risk, and can be done by virtually everyone regardless of fitness level. Don’t underestimate walking. A 30-45 minute daily walk produces meaningful sleep benefits and substantial health benefits beyond sleep. For sedentary people, walking is often the best starting point.

All exercise is better than none: The perfect is the enemy of the good here. Don’t avoid exercise because you can’t do the “optimal” type or duration. Twenty minutes of activity you enjoy beats zero minutes of activity you theoretically should do but avoid.

Exercise Intensity: Finding Your Sweet Spot

Exercise intensity affects both the magnitude of sleep benefits and the practical considerations around timing. Generally, sleep benefits increase with intensity up to a point, but very high intensity requires more recovery and more careful timing.

Light activity still provides sleep benefits, though smaller than moderate or vigorous exercise. A leisurely walk, gentle stretching, and casual recreational activity, all contribute to sleep pressure and are infinitely better than complete inactivity. For people with physical limitations, chronic pain, or severe deconditioning, light activity might be the only feasible starting point, and that’s fine. Some benefit is better than none.

Moderate intensity activity, where you can talk but not sing, where you’re breathing harder but not gasping, appears to be the sweet spot for most people. This intensity provides substantial sleep benefits while being sustainable for longer durations and not requiring extensive recovery. Most research studies showing sleep benefits use moderate intensity exercise. This is where you’re breathing harder, sweating somewhat, and elevating heart rate to 60-75% of maximum, but you’re not destroying yourself.

Vigorous exercise, where conversation is difficult, breathing is hard, and heart rate is 75-90% of maximum, provides robust sleep benefits but requires more attention to timing. Some people find that vigorous evening exercise leaves them too stimulated to sleep well. Others sleep exceptionally well after hard training. The high degree of individual variation means you will need to experiment.

Very high intensity training (sprints, near-maximal lifts, competitive efforts) creates substantial physiological stress and arousal that can take several hours to resolve. This is excellent for fitness adaptations but often problematic for sleep if done within 3-4 hours of bedtime. If you train at this intensity, morning or early afternoon is generally better for sleep than evening.

Ultimately, listening to your body is essential. Exercise should leave you feeling energised during the day and comfortably tired by evening, not utterly depleted and unable to function. If you’re consistently exhausted, if your sleep is worsening despite regular exercise, or if you’re getting injured frequently, you’re likely training too hard or too frequently for your current recovery capacity.

The relationship between exercise and sleep involves finding the intensity that challenges you sufficiently to produce adaptations and sleep benefits, while not overwhelming your recovery capacity. This sweet spot is highly individual and changes with your fitness level, life stress, age, and other factors, so you will have to do a bit of playing around here.

Exercise Duration: How Much Is Enough?

Now, how long do you need to exercise to get sleep benefits? The research provides us with some guidance while acknowledging that there is a lot of individual variation. So, again, you will need to play around with things here. 

Minimum effective dose: Studies show sleep benefits from as little as 20-30 minutes of moderate-intensity exercise. You don’t need to spend hours in the gym. A brisk 30-minute walk produces measurable sleep improvements for most people. This is encouraging because it’s achievable for virtually everyone, regardless of schedule constraints.

Optimal for sleep: Most research suggests 30-60 minutes of moderate to vigorous activity produces the most robust sleep benefits. Longer sessions don’t appear to provide substantially greater sleep benefits, though they might provide other health and fitness benefits.

More isn’t always better: Beyond 60-90 minutes of vigorous activity, the relationship between exercise duration and sleep can become negative for some people. Very long training sessions (90+ minutes of vigorous activity) can create excessive fatigue, elevate cortisol for extended periods, and require substantial recovery. Endurance athletes training 10-15+ hours per week sometimes experience disrupted sleep from overtraining.

This doesn’t mean long exercise sessions are bad, and they’re often necessary for specific athletic goals. But if your primary goal is sleep quality rather than competitive performance, moderate duration (30-60 minutes) is likely optimal.

Consistency over individual session length: One 60-minute session per week provides minimal sleep benefit compared to six 30-minute sessions. Consistent daily or near-daily activity is far more effective than sporadic long sessions. Your sleep system responds to regular patterns of activity, not occasional heroic efforts.

If you can only manage 20 minutes most days, that’s vastly better for sleep than trying to do 90-minute sessions twice a week and skipping the rest. Build consistency first, extend duration second.

Exercise Frequency: How Often Should You Exercise?

Encouragingly, the research on frequency reinforces the importance of consistency while acknowledging that life isn’t perfect and missed days don’t destroy your progress.

Daily activity ideal: From a sleep perspective, daily physical activity provides the most consistent sleep benefits. You’re building adenosine pressure daily, reinforcing circadian rhythms daily, and managing stress daily. You’re creating a predictable pattern that your sleep system can entrain to.

This doesn’t mean structured exercise every single day, and rest days are important for recovery and injury prevention. But it does mean moving substantially every day. Active recovery days (walking, gentle stretching) count.

3-5 times per week: If daily exercise isn’t feasible, 3-5 sessions per week still produces meaningful sleep improvements. This is realistic for most people balancing work, family, and other obligations. You’re getting most of the sleep benefits while maintaining sustainability.

2 times per week: Studies show measurable sleep improvements from just two exercise sessions per week, though effects are smaller than with higher frequency. If you’re currently sedentary and can commit to two sessions weekly, start there. It’s vastly better than zero, and you can build frequency over time.

Rest days are okay: You don’t need to feel guilty about rest days. Recovery is essential for adaptation, injury prevention, and long-term sustainability. Many people find that their best sleep often occurs on rest days because their body is recovering from training stress. The cumulative effect of consistent training still provides sleep benefits on rest days.

Movement throughout the day matters: Beyond structured exercise, non-exercise physical activity throughout your day contributes to sleep quality. We’ll explore this more in the NEAT section, but the principle is that 30 minutes of exercise doesn’t fully compensate for 15.5 hours of complete inactivity. Movement scattered throughout your day, like walking, taking stairs, standing, and physical hobbies, all add to sleep pressure in ways that support your structured exercise.

Exercise Timing: The Complicated Part

Exercise timing affects sleep differently for different people, and you’ll need to do a lot fo experiment to find what works for your physiology.

Morning Exercise

Advantages: Morning exercise provides multiple sleep benefits beyond the exercise itself. You’re getting light exposure during your workout if it’s outdoors, which strengthens your circadian rhythm. The combination of exercise plus morning light is one of the most powerful circadian entraining signals available. Morning exercise energises you for the day, which also often replaces or reduces the need for caffeine. There’s zero risk of evening exercise interfering with sleep. Morning cortisol is naturally elevated, making this a physiologically appropriate time for challenging activity.

Disadvantages: You might need to wake earlier than preferred to fit exercise in, potentially cutting sleep duration if you’re not willing to go to bed earlier. Many people find morning exercise harder because they’re not warmed up, potentially increasing injury risk. Athletic performance is often suboptimal in early morning compared to the afternoon or early evening.

Best for: People who struggle with consistency (getting it done early removes the risk of skipping it later), people who are morning chronotypes naturally, people with evening commitments that preclude later exercise, and people who find evening exercise disrupts sleep.

Afternoon Exercise

Advantages: Body temperature is elevated, muscles are warmer, and athletic performance is often at its peak. Many people find that afternoon exercise feels better physically than morning. It’s far enough before bed that there’s no sleep interference concern. It provides a stress break in the middle of the day for many people. For sleep specifically, afternoon exercise hits a sweet spot, and you get the full benefits without timing concerns.

Disadvantages: Schedule disruption; work meetings, family demands, and other obligations often make consistent afternoon exercise difficult to actually do and sustain. For people working traditional jobs, afternoon exercise might mean going to a gym mid-workday, which often isn’t feasible.

Best for: People with schedule flexibility, people working from home or with flexible work arrangements, people whose natural performance peak is afternoon, people who want to optimise athletic performance while maintaining good sleep.

Evening Exercise (Early Evening, 5-8pm)

Advantages: Practical for many people, and just means exercising after work but before evening commitments. Athletic performance is still good (body temperature elevated, muscles warm). It can serve as a transition between work and home life, providing stress relief and mental separation.

Concerns: Some people find evening exercise too stimulating and struggle to sleep afterwards. The elevation in core body temperature, heart rate, and cortisol can persist for 1-3 hours, potentially interfering with the wind-down process. The mental stimulation of competition or intense training can also make it difficult to shift to relaxation mode.

Individual variation: This is where people diverge dramatically. Some individuals exercise vigorously at 7pm and sleep beautifully at 10:30pm. Others find that any exercise past 5pm makes sleep difficult. You need to experiment and pay attention to your actual response rather than assuming you’ll react a certain way.

Strategies for success: If early evening is your only option, finish exercise at least 2-3 hours before bed when possible. Include a proper cool-down, and don’t just stop abruptly. Implement your wind-down routine after exercise. Consider exercise type too, as yoga or moderate walking might be better tolerated in the evening than HIIT or heavy lifting.

Late Evening (8pm-Bedtime)

Generally not recommended: Exercising in the 1-2 hours before bedtime elevates heart rate, body temperature, and cortisol, all of which work against the physiological changes needed for sleep. The mental stimulation and arousal from exercise, particularly competitive or intense exercise, can make the transition to sleep difficult.

But individual variation persists: Some people genuinely sleep well after late evening exercise. If you’re one of them, and you’ve actually tested this (not just assumed it), then exercise when you can. The sleep disruption from missing exercise consistently is likely worse than the potential timing issue.

Better than nothing: If your only option is late evening exercise or no exercise, choose exercise. Regular exercise with suboptimal timing beats no exercise. You can mitigate some of the sleep interference through proper cool-down, wind-down routines, and attention to post-exercise recovery strategies.

Mitigation strategies: If late evening is unavoidable, include an extended cool-down (10-15 minutes of progressively easier activity), shower or bath after (which can aid the temperature drop), avoid very high intensity when possible, and be meticulous about your wind-down routine afterwards.

Exercise and Sleep for Different Goals

The relationship between exercise and sleep varies somewhat based on your primary goals, and understanding this helps you make intelligent trade-offs.

General Health and Sleep Quality

If your goal is general health and good sleep, the recommendations are straightforward: moderate activity most days of the week, a mix of aerobic and resistance training when possible, timing flexible (just not right before bed). You don’t need to optimise every variable, just move consistently.

The sweet spot for most people: 30-45 minutes of moderate intensity exercise (brisk walking, easy jogging, cycling, swimming, recreational sports) 4-6 days per week, combined with 2-3 resistance training sessions weekly. This provides robust sleep benefits, substantial health benefits, and is sustainable for most people long-term.

Athletic Performance

If you’re training for competitive athletic performance, the relationship between exercise and sleep becomes more complex. Higher training volumes and intensities are necessary for adaptation, but they also create greater sleep disruption potential and higher sleep requirements.

Athletes often need 8-10 hours of sleep rather than the 7-9 hours sufficient for most adults, because recovery demands are higher. Training load affects sleep need; a week with 15 hours of training requires more sleep than a week with 5 hours. While a lot of athletes don’t respect this, sleep is a critical component of training adaptation, and the more you train, the more you need to work on sleep.

The challenge is that high training loads can disrupt sleep whilst simultaneously increasing sleep need. Overtraining (discussed shortly) includes sleep disruption as a primary symptom. Athletes need to monitor sleep carefully and adjust training when sleep deteriorates, even when the instinct is to train through fatigue.

Weight Loss

The relationship between exercise and sleep is particularly important for weight loss because both affect each other and the outcome. Exercise supports fat loss through energy expenditure, muscle preservation during caloric deficit, metabolic adaptations, and adherence support. Better sleep supports fat loss through improved appetite regulation (sleep deprivation increases ghrelin and decreases leptin), better insulin sensitivity, reduced stress eating, and improved training quality.

The relationship is bidirectional: exercise improves sleep, which supports fat loss, which improves sleep further (particularly for people with sleep apnea that improves with weight loss). This creates a positive feedback loop when properly implemented.

So, if you’re trying to lose weight, prioritise both sleep and exercise. Don’t sacrifice sleep to exercise early if you’re not sleeping enough, as the sleep deprivation will undermine fat loss. Don’t skip exercise to sleep more if you’re sleeping adequately, as the exercise supports fat loss and improves sleep quality. Find the balance that allows both.

Stress and Mental Health

For people whose primary concern is stress management, anxiety, or depression, the exercise-sleep relationship operates primarily through mood improvement. Exercise helps in the treatment of underlying mood disorders, which improves sleep, which improves mood further.

Any exercise helps, but activities with mind-body components (yoga, tai chi, walking in nature) might provide additional benefits through mindfulness, stress reduction, and connection with the environment. The social component of group exercise or team sports provides additional mental health benefits through connection and belonging.

The key is sustainability and consistency rather than intensity. A daily 30-minute walk you actually do is far more valuable for mental health and sleep than an ambitious training program you abandon after two weeks.

Special Considerations: When Exercise Gets Complicated

Overtraining and Sleep Disruption

Exercise improves sleep, but too much exercise can make sleep worse. Overtraining syndrome includes sleep disturbance as a hallmark symptom; difficulty falling asleep, frequent waking, unrefreshing sleep, and waking unrefreshed despite adequate time in bed.

The mechanism is persistent elevation of cortisol and other stress hormones, chronic inflammation, nervous system dysregulation, and accumulated fatigue that paradoxically makes sleep difficult rather than easy. You’re simultaneously exhausted and unable to sleep well.

Signs of overtraining:

  • Sleep disturbance (difficulty falling asleep, frequent waking, waking unrefreshed)
  • Persistent fatigue that doesn’t improve with rest
  • Declining performance despite continued training
  • Increased resting heart rate
  • Mood disturbance (irritability, anxiety, depression)
  • Increased illness susceptibility
  • Loss of motivation for training
  • Appetite changes

If multiple signs are present and persisting, you’re likely overtrained and need to reduce training load. The solution is rest and recovery, possibly for several weeks, not pushing through.

Prevention: Include rest days, periodise your training with easier weeks every 3-4 weeks (deload weeks), listen to your body’s signals, prioritise sleep as a training component, not an afterthought, and understand that more training isn’t always better.

Exercising When Sleep Deprived

What should you do when you’ve slept poorly but have a scheduled workout? The answer depends on severity and context.

Generally still beneficial: Most research suggests that exercising when somewhat sleep-deprived is still better than skipping exercise. Moderate-intensity activity can actually improve mood and function after a poor night’s sleep. You might need to reduce intensity or duration, but doing something is usually better than nothing.

Auto-regulation: Adjust based on how you feel. If you’re moderately tired but functional, proceed with exercise but perhaps at 70-80% of your usual intensity or duration. If you’re severely sleep-deprived and barely functional, consider reducing intensity significantly (walking instead of running) or resting entirely.

Injury risk: Sleep deprivation impairs motor control, reaction time, and decision-making, increasing injury risk. Be cautious with heavy weights, complex movements, or activities requiring coordination when significantly sleep-deprived.

Sleep still takes priority: If you’re chronically sleep-deprived and regularly sacrificing sleep to exercise, you’re undermining both. Better to skip or shorten workouts and sleep more until you’re consistently sleeping 7-9 hours, then resume full training.

Exercise and Sleep Disorders

Exercise can improve certain sleep disorders, but it isn’t a cure-all.

Sleep apnea: Exercise, particularly when combined with weight loss, can significantly reduce apnea severity. Even without weight loss, exercise improves upper airway muscle tone and reduces inflammation. For people with obstructive sleep apnea, exercise is part of comprehensive treatment but doesn’t replace CPAP or other medical interventions when those are needed.

Chronic insomnia: Exercise improves insomnia for many people, with effects sometimes comparable to CBT-I (cognitive behavioural therapy for insomnia). Regular exercise increases sleep efficiency, reduces sleep onset latency, and improves subjective sleep quality. However, exercise alone may not resolve severe insomnia, and professional treatment might still be necessary.

Restless legs syndrome: Some evidence suggests moderate exercise may reduce RLS symptoms, though vigorous evening exercise can worsen symptoms. The relationship is complex and individual.

For serious sleep disorders, you should just consult a sleep specialist. Exercise is complementary to professional treatment, not a replacement for it, and you shouldn’t just blindly follow an article online for this stuff.

Chronic Pain and Exercise

Pain severely disrupts sleep, and sleep deprivation worsens pain perception, creating a vicious cycle. Exercise can help to break this cycle by improving pain management, but the wrong exercise or excessive intensity can worsen pain.

The principle is finding activities that provide exercise benefits without exacerbating pain. This might mean swimming or water-based exercise (reduced joint loading), walking, stationary cycling, or specific therapeutic exercises prescribed by physiotherapists. Movement almost always helps chronic pain more than complete rest, but movement needs to be appropriate.

Professional guidance from physiotherapists or exercise professionals experienced with chronic pain populations is super valuable for finding the right approach here.

Age and Exercise

The relationship between exercise and sleep applies across all ages, though optimal approaches vary.

Children and adolescents: Exercise improves sleep quality and duration. Given that many children and teens are insufficiently active, increasing activity often produces substantial sleep improvements. Morning or afternoon exercise is preferable to late evening, and screen time should be limited after dinner.

Adults: The research on exercise and sleep is most robust for adults, and the benefits are clear. All forms of exercise help, consistency is key, and timing matters, but is flexible for most people.

Older adults: Exercise becomes increasingly important for sleep quality as we age because sleep naturally becomes lighter, more fragmented, and less restorative. Regular exercise substantially improves sleep quality in older adults, with effect sizes sometimes larger than in younger adults because baseline sleep is worse.

Additional benefits for older adults include fall prevention, bone health maintenance, and preservation of functional independence, all of which indirectly support sleep by reducing pain and maintaining mobility.

The key is choosing appropriate activities and intensities. A 70-year-old shouldn’t necessarily exercise the same way as a 30-year-old, but they should exercise consistently within their capabilities. Walking, resistance training with appropriate loads, balance exercises, tai chi, and swimming are all excellent options for older adults.

It’s never too late to start. Sedentary older adults who begin exercise programs show meaningful sleep improvements regardless of when they start.

Non-Exercise Physical Activity (NEAT)

NEAT (Non-Exercise Activity Thermogenesis) refers to all the movement you do throughout the day that isn’t structured exercise. This includes walking throughout your day, taking stairs, active hobbies like gardening, housework, standing rather than sitting, fidgeting, and generally accumulating movement. And from a sleep perspective, NEAT is underrated. You see, thirty minutes of structured exercise in the morning doesn’t fully compensate for 15.5 hours of sitting. People who accumulate substantial movement throughout their day, like walking during phone calls, taking stairs, doing housework actively, and pursuing physical hobbies, sleep better than people who exercise for thirty minutes and then remain sedentary the rest of the day.

The mechanism is sustained adenosine accumulation throughout the day rather than a single spike during your workout. You’re also avoiding the metabolic consequences of prolonged sitting, which include insulin resistance and inflammation that can disrupt sleep.

Practical implementation strategies:

  • Walk during phone calls
  • Take stairs instead of lifts when feasible
  • Park farther from destinations and walk
  • Stand during some work tasks if possible
  • Take brief walking breaks every 60-90 minutes
  • Do housework actively rather than minimising movement
  • Pursue active hobbies (gardening, DIY projects, playing with children)
  • Walk or cycle for short errands instead of driving

These individually contribute small amounts, but accumulated over a day, they add up to substantial activity. A person who walks 10,000-12,000 steps per day through NEAT plus structured exercise sleeps better on average than someone who does 30 minutes of structured exercise but remains sedentary otherwise.

This doesn’t mean NEAT replaces structured exercise, and both are valuable. But it does mean that optimising the relationship between exercise and sleep includes thinking about total daily movement, not just formal workouts.

Troubleshooting: When Exercise Doesn’t Help Sleep

“I don’t have time to exercise”: This is usually a priorities issue rather than a time availability issue. You have time for whatever you prioritise. Consider whether you could exercise for 20 minutes three times per week if your sleep depended on it? Because it does. Start with short sessions, and even 10-15 minutes provides some benefit. Increasing NEAT and doing more movement throughout the day doesn’t require dedicated time blocks. Walk during calls, take stairs, and do active chores. This “counts” for sleep.

“Evening is my only option, and it disrupts my sleep”: First, actually test this properly. Many people assume evening exercise will disrupt sleep without trying it. Try 4-6 weeks of evening exercise and track sleep carefully. You might be fine. If you genuinely don’t sleep well after evening exercise, try these modifications: exercise earlier in the evening (5-6pm rather than 8-9pm), reduce intensity (moderate instead of vigorous), extend the cool-down, and implement a meticulous wind-down routine afterwards. Some people find certain activities work better (e.g. yoga or walking rather than HIIT or heavy lifting). Experiment systematically.

If evening exercise consistently makes sleep worse despite modifications, you have a choice: prioritise sleep and find a way to exercise at different times (morning before work, lunch break, quick sessions when possible), or accept somewhat disrupted sleep as the trade-off for consistent exercise, recognising that no exercise might be worse for health overall than somewhat disrupted sleep.

“I’m too tired to exercise”: This is often the doom loop; poor sleep makes you exhausted, exhaustion makes you skip exercise, lack of exercise makes sleep worse, worse sleep makes you more exhausted. Breaking the loop requires temporary discomfort. Start very small, with something like 10 minutes of walking. Just move. Even when exhausted, even when you don’t feel like it. You’ll almost always feel better after, and as sleep improves over 2-3 weeks from consistent movement, the exhaustion eases, and exercise becomes less effortful.

“Exercise wires me up, and I can’t sleep afterwards”: This is individual variation in the exercise-sleep relationship. There are solutions though. You can move exercise earlier in the day when possible, reduce intensity (you might be training too hard), extend the cool-down period substantially (15-20 minutes of progressively easier activity), include relaxation practices immediately after (stretching, breathing exercises), take a shower or bath after exercise (aids temperature drop), and implement a wind-down routine consistently.

If none of these help and evening exercise consistently disrupts sleep, you’re one of the people who genuinely needs earlier exercise timing. This is real, not laziness or weakness. Adjust accordingly.

Exercise and Sleep Conclusion

The relationship between exercise and sleep isn’t just about optimising two separate domains of health. It’s about recognising that humans are designed for movement, and when we’re sedentary, multiple systems, including sleep, function suboptimally. We’re not evolved to sit for 15 hours a day and then expect to sleep well. Our bodies expect physical activity as part of normal existence, and when we don’t provide it, sleep suffers along with everything else. Exercise is part of your foundational sleep hygiene, even if you don’t consider it to be. It is one of the best interventions we have for improving sleep, and I would be remiss to not include it in this series of foundational sleep hygiene.

Exercise transforms sleep through multiple simultaneous mechanisms: increasing sleep pressure, strengthening circadian rhythms, reducing stress and anxiety, improving mood, creating physical fatigue, and enhancing metabolic health. These aren’t separate effects; they’re interconnected, each reinforcing the others, creating a web of benefits that extends far beyond just feeling tired at bedtime.

And the relationship is bidirectional. Better sleep improves exercise performance, recovery, motivation, and adherence. Worse sleep makes exercise feel harder, increases injury risk, and makes skipping workouts more likely. The two create either a positive feedback loop (exercise → better sleep → better exercise performance → more consistent exercise → even better sleep) or a negative one (no exercise → poor sleep → too tired to exercise → worse sleep).

You’re choosing which loop you’re in. Every day you move your body substantially, you’re voting for better sleep tonight and sustained health over time. Every day you remain sedentary, you’re voting for worse sleep, lower energy, and a gradual decline in the physical capacity that makes life feel worth living.

This isn’t about becoming an athlete or achieving some fitness ideal. It’s about honouring the basic biological reality that humans need movement to function well. Thirty minutes of walking most days isn’t extreme. It’s barely adequate. Forty-five to sixty minutes of moderate activity most days is what we’re actually designed for, and when you provide it, sleep transforms from something you struggle with into something that reliably restores you.

The modern world makes sedentary living the default; jobs that require sitting for eight hours, entertainment that requires no movement, transportation that eliminates walking, and environments designed for cars rather than pedestrians. You have to actively resist these defaults through deliberate choice. And if you want to sleep well, this isn’t optional. It’s foundational.

Here’s your implementation plan:

Week 1: Establish baseline movement. Go for a 20-minute walk every morning this week, regardless of the weather or how you feel. Notice how you sleep. This is your baseline intervention. It’s simple, accessible, and low-risk.

Week 2: Extend duration or frequency. Increase to 30-minute walks, or add afternoon walks, or try a different activity if walking isn’t suitable. Continue tracking sleep quality.

Week 3: Add intensity or variety. If walking is your activity, walk briskly enough that you’re breathing harder. Or add resistance training like bodyweight exercises, dumbbells, and gym sessions. Notice if sleep improves further.

Week 4: Optimise timing. If you’ve been exercising at various times, experiment with consistency in timing. Morning, afternoon, or early evening; find what works with your schedule and notice if any timing particularly improves sleep.

After four weeks, you’ll have established exercise as a consistent practice, experienced the sleep benefits firsthand, and identified what works for your body and schedule. From there, maintain consistency whilst progressing gradually. Try doing slightly more duration, slightly more intensity, slightly more variety, but always prioritising consistency over perfection.

As with everything, there is always more to learn, and we haven’t even begun to scratch the surface with all this stuff. However, if you are interested in staying up to date with all our content, we recommend subscribing to our newsletter and bookmarking our free content page. We do have a lot of content on sleep in our sleep hub.

If you would like more help with your training (or nutrition), we do also have online coaching spaces available.

We also recommend reading our foundational nutrition articles, along with our foundational articles on exercise and stress management, if you really want to learn more about how to optimise your lifestyle. If you want even more free information on sleep, you can follow us on Instagram, YouTube or listen to the podcast, where we discuss all the little intricacies of exercise.

Finally, if you want to learn how to coach nutrition, then consider our Nutrition Coach Certification course. We do also have an exercise program design course, if you are a coach who wants to learn more about effective program design and how to coach it. We do have other courses available too, notably as a sleep course. If you don’t understand something, or you just need clarification, you can always reach out to us on Instagram or via email.

References and Further Reading

Vyazovskiy, V. (2015). Sleep, recovery, and metaregulation: explaining the benefits of sleep. Nature and Science of Sleep, 171. http://doi.org/10.2147/nss.s54036

Sharma, S., & Kavuru, M. (2010). Sleep and Metabolism: An Overview. International Journal of Endocrinology, 2010, 1–12. http://doi.org/10.1155/2010/270832

Yoo, S.-S., Gujar, N., Hu, P., Jolesz, F. A., & Walker, M. P. (2007). The human emotional brain without sleep — a prefrontal amygdala disconnect. Current Biology, 17(20). http://doi.org/10.1016/j.cub.2007.08.007

Copinschi G. Metabolic and endocrine effects of sleep deprivation. Essent Psychopharmacol. 2005;6(6):341-7. PMID: 16459757. https://pubmed.ncbi.nlm.nih.gov/16459757/

Spiegel, K., Leproult, R., L’Hermite-Balériaux, M., Copinschi, G., Penev, P. D., & Cauter, E. V. (2004). Leptin Levels Are Dependent on Sleep Duration: Relationships with Sympathovagal Balance, Carbohydrate Regulation, Cortisol, and Thyrotropin. The Journal of Clinical Endocrinology & Metabolism, 89(11), 5762–5771. http://doi.org/10.1210/jc.2004-1003

Nedeltcheva, A. V., Kilkus, J. M., Imperial, J., Kasza, K., Schoeller, D. A., & Penev, P. D. (2008). Sleep curtailment is accompanied by increased intake of calories from snacks. The American Journal of Clinical Nutrition, 89(1), 126–133. http://doi.org/10.3945/ajcn.2008.26574

Mullington, J. M., Chan, J. L., Dongen, H. P. A. V., Szuba, M. P., Samaras, J., Price, N. J., … Mantzoros, C. S. (2003). Sleep Loss Reduces Diurnal Rhythm Amplitude of Leptin in Healthy Men. Journal of Neuroendocrinology, 15(9), 851–854. http://doi.org/10.1046/j.1365-2826.2003.01069.x

Leproult, R., & Cauter, E. V. (2009). Role of Sleep and Sleep Loss in Hormonal Release and Metabolism. Pediatric Neuroendocrinology Endocrine Development, 11–21. http://doi.org/10.1159/000262524

Spaeth, A. M., Dinges, D. F., & Goel, N. (2013). Effects of Experimental Sleep Restriction on Weight Gain, Caloric Intake, and Meal Timing in Healthy Adults. Sleep, 36(7), 981–990. http://doi.org/10.5665/sleep.2792

Calvin, A. D., Carter, R. E., Adachi, T., Macedo, P. G., Albuquerque, F. N., Walt, C. V. D., … Somers, V. K. (2013). Effects of Experimental Sleep Restriction on Caloric Intake and Activity Energy Expenditure. Chest, 144(1), 79–86. http://doi.org/10.1378/chest.12-2829

Markwald, R. R., Melanson, E. L., Smith, M. R., Higgins, J., Perreault, L., Eckel, R. H., & Wright, K. P. (2013). Impact of insufficient sleep on total daily energy expenditure, food intake, and weight gain. Proceedings of the National Academy of Sciences, 110(14), 5695–5700. http://doi.org/10.1073/pnas.1216951110

Cauter, E. V., Spiegel, K., Tasali, E., & Leproult, R. (2008). Metabolic consequences of sleep and sleep loss. Sleep Medicine, 9. http://doi.org/10.1016/s1389-9457(08)70013-3

Spiegel, K., Leproult, R., & Cauter, E. V. (1999). Impact of sleep debt on metabolic and endocrine function. The Lancet, 354(9188), 1435–1439. http://doi.org/10.1016/s0140-6736(99)01376-8

Ness, K. M., Strayer, S. M., Nahmod, N. G., Schade, M. M., Chang, A.-M., Shearer, G. C., & Buxton, O. M. (2019). Four nights of sleep restriction suppress the postprandial lipemic response and decrease satiety. Journal of Lipid Research, 60(11), 1935–1945. http://doi.org/10.1194/jlr.p094375

Hirotsu, C., Tufik, S., & Andersen, M. L. (2015). Interactions between sleep, stress, and metabolism: From physiological to pathological conditions. Sleep Science, 8(3), 143–152. http://doi.org/10.1016/j.slsci.2015.09.002

Morselli, L., Leproult, R., Balbo, M., & Spiegel, K. (2010). Role of sleep duration in the regulation of glucose metabolism and appetite. Best Practice & Research Clinical Endocrinology & Metabolism, 24(5), 687–702. http://doi.org/10.1016/j.beem.2010.07.005

Lamon, S., Morabito, A., Arentson-Lantz, E., Knowles, O., Vincent, G. E., Condo, D., … Aisbett, B. (2020). The effect of acute sleep deprivation on skeletal muscle protein synthesis and the hormonal environment. http://doi.org/10.1101/2020.03.09.984666

Lipton, J. O., & Sahin, M. (2014). The Neurology of mTOR. Neuron, 84(2), 275–291. http://doi.org/10.1016/j.neuron.2014.09.034

Tudor, J. C., Davis, E. J., Peixoto, L., Wimmer, M. E., Tilborg, E. V., Park, A. J., … Abel, T. (2016). Sleep deprivation impairs memory by attenuating mTORC1-dependent protein synthesis. Science Signaling, 9(425). http://doi.org/10.1126/scisignal.aad4949

Dattilo, M., Antunes, H., Medeiros, A., Neto, M. M., Souza, H., Tufik, S., & Mello, M. D. (2011). Sleep and muscle recovery: Endocrinological and molecular basis for a new and promising hypothesis. Medical Hypotheses, 77(2), 220–222. http://doi.org/10.1016/j.mehy.2011.04.017

Thornton, S. N., & Trabalon, M. (2014). Chronic dehydration is associated with obstructive sleep apnoea syndrome. Clinical Science, 128(3), 225–225. http://doi.org/10.1042/cs20140496

Rosinger, A. Y., Chang, A.-M., Buxton, O. M., Li, J., Wu, S., & Gao, X. (2018). Short sleep duration is associated with inadequate hydration: cross-cultural evidence from US and Chinese adults. Sleep, 42(2). http://doi.org/10.1093/sleep/zsy210

Watson, A. M. (2017). Sleep and Athletic Performance. Current Sports Medicine Reports, 16(6), 413–418. http://doi.org/10.1249/jsr.0000000000000418

Bonnar, D., Bartel, K., Kakoschke, N., & Lang, C. (2018). Sleep Interventions Designed to Improve Athletic Performance and Recovery: A Systematic Review of Current Approaches. Sports Medicine, 48(3), 683–703. http://doi.org/10.1007/s40279-017-0832-x

Saidi, O., Davenne, D., Lehorgne, C., & Duché, P. (2020). Effects of timing of moderate exercise in the evening on sleep and subsequent dietary intake in lean, young, healthy adults: randomized crossover study. European Journal of Applied Physiology, 120(7), 1551–1562. http://doi.org/10.1007/s00421-020-04386-6

Abedelmalek, S., Chtourou, H., Aloui, A., Aouichaoui, C., Souissi, N., & Tabka, Z. (2012). Effect of time of day and partial sleep deprivation on plasma concentrations of IL-6 during a short-term maximal performance. European Journal of Applied Physiology, 113(1), 241–248. http://doi.org/10.1007/s00421-012-2432-7

Azboy, O., & Kaygisiz, Z. (2009). Effects of sleep deprivation on cardiorespiratory functions of the runners and volleyball players during rest and exercise. Acta Physiologica Hungarica, 96(1), 29–36. http://doi.org/10.1556/aphysiol.96.2009.1.3

Bird, S. P. (2013). Sleep, Recovery, and Athletic Performance. Strength and Conditioning Journal, 35(5), 43–47. http://doi.org/10.1519/ssc.0b013e3182a62e2f

Blumert, P. A., Crum, A. J., Ernsting, M., Volek, J. S., Hollander, D. B., Haff, E. E., & Haff, G. G. (2007). The Acute Effects of Twenty-Four Hours of Sleep Loss on the Performance of National-Caliber Male Collegiate Weightlifters. The Journal of Strength and Conditioning Research, 21(4), 1146. http://doi.org/10.1519/r-21606.1

Chase, J. D., Roberson, P. A., Saunders, M. J., Hargens, T. A., Womack, C. J., & Luden, N. D. (2017). One night of sleep restriction following heavy exercise impairs 3-km cycling time-trial performance in the morning. Applied Physiology, Nutrition, and Metabolism, 42(9), 909–915. http://doi.org/10.1139/apnm-2016-0698

Edwards, B. J., & Waterhouse, J. (2009). Effects of One Night of Partial Sleep Deprivation upon Diurnal Rhythms of Accuracy and Consistency in Throwing Darts. Chronobiology International, 26(4), 756–768. http://doi.org/10.1080/07420520902929037

Fullagar, H. H. K., Skorski, S., Duffield, R., Hammes, D., Coutts, A. J., & Meyer, T. (2014). Sleep and Athletic Performance: The Effects of Sleep Loss on Exercise Performance, and Physiological and Cognitive Responses to Exercise. Sports Medicine, 45(2), 161–186. http://doi.org/10.1007/s40279-014-0260-0

Gupta, L., Morgan, K., & Gilchrist, S. (2016). Does Elite Sport Degrade Sleep Quality? A Systematic Review. Sports Medicine, 47(7), 1317–1333. http://doi.org/10.1007/s40279-016-0650-6

Hausswirth, C., Louis, J., Aubry, A., Bonnet, G., Duffield, R., & Meur, Y. L. (2014). Evidence of Disturbed Sleep and Increased Illness in Overreached Endurance Athletes. Medicine & Science in Sports & Exercise, 46(5), 1036–1045. http://doi.org/10.1249/mss.0000000000000177

Mah, C. D., Mah, K. E., Kezirian, E. J., & Dement, W. C. (2011). The Effects of Sleep Extension on the Athletic Performance of Collegiate Basketball Players. Sleep, 34(7), 943–950. http://doi.org/10.5665/sleep.1132

Milewski, M. D., Skaggs, D. L., Bishop, G. A., Pace, J. L., Ibrahim, D. A., Wren, T. A., & Barzdukas, A. (2014). Chronic Lack of Sleep is Associated With Increased Sports Injuries in Adolescent Athletes. Journal of Pediatric Orthopaedics, 34(2), 129–133. http://doi.org/10.1097/bpo.0000000000000151

Mougin, F., Bourdin, H., Simon-Rigaud, M., Didier, J., Toubin, G., & Kantelip, J. (1996). Effects of a Selective Sleep Deprivation on Subsequent Anaerobic Performance. International Journal of Sports Medicine, 17(02), 115–119. http://doi.org/10.1055/s-2007-972818

Oliver, S. J., Costa, R. J. S., Laing, S. J., Bilzon, J. L. J., & Walsh, N. P. (2009). One night of sleep deprivation decreases treadmill endurance performance. European Journal of Applied Physiology, 107(2), 155–161. http://doi.org/10.1007/s00421-009-1103-9

Pallesen, S., Gundersen, H. S., Kristoffersen, M., Bjorvatn, B., Thun, E., & Harris, A. (2017). The Effects of Sleep Deprivation on Soccer Skills. Perceptual and Motor Skills, 124(4), 812–829. http://doi.org/10.1177/0031512517707412

Reilly, T., & Piercy, M. (1994). The effect of partial sleep deprivation on weight-lifting performance. Ergonomics, 37(1), 107–115. http://doi.org/10.1080/00140139408963628

Rossa, K. R., Smith, S. S., Allan, A. C., & Sullivan, K. A. (2014). The Effects of Sleep Restriction on Executive Inhibitory Control and Affect in Young Adults. Journal of Adolescent Health, 55(2), 287–292. http://doi.org/10.1016/j.jadohealth.2013.12.034

Sargent, C., & Roach, G. D. (2016). Sleep duration is reduced in elite athletes following night-time competition. Chronobiology International, 33(6), 667–670. http://doi.org/10.3109/07420528.2016.1167715

Skein, M., Duffield, R., Edge, J., Short, M. J., & Mündel, T. (2011). Intermittent-Sprint Performance and Muscle Glycogen after 30 h of Sleep Deprivation. Medicine & Science in Sports & Exercise, 43(7), 1301–1311. http://doi.org/10.1249/mss.0b013e31820abc5a

Souissi, N., Sesboüé, B., Gauthier, A., Larue, J., & Davenne, D. (2003). Effects of one nights sleep deprivation on anaerobic performance the following day. European Journal of Applied Physiology, 89(3), 359–366. http://doi.org/10.1007/s00421-003-0793-7

Caia, J., Kelly, V. G., & Halson, S. L. (2017). The role of sleep in maximising performance in elite athletes. Sport, Recovery, and Performance, 151–167. http://doi.org/10.4324/9781315268149-11

Alley, J. R., Mazzochi, J. W., Smith, C. J., Morris, D. M., & Collier, S. R. (2015). Effects of Resistance Exercise Timing on Sleep Architecture and Nocturnal Blood Pressure. Journal of Strength and Conditioning Research, 29(5), 1378–1385. http://doi.org/10.1519/jsc.0000000000000750

Kovacevic, A., Mavros, Y., Heisz, J. J., & Singh, M. A. F. (2018). The effect of resistance exercise on sleep: A systematic review of randomized controlled trials. Sleep Medicine Reviews, 39, 52–68. http://doi.org/10.1016/j.smrv.2017.07.002

Herrick, J. E., Puri, S., & Richards, K. C. (2017). Resistance training does not alter same-day sleep architecture in institutionalized older adults. Journal of Sleep Research, 27(4). http://doi.org/10.1111/jsr.12590

Edinger, J. D., Morey, M. C., Sullivan, R. J., Higginbotham, M. B., Marsh, G. R., Dailey, D. S., & McCall, W. V. (1993). Aerobic fitness, acute exercise and sleep in older men. Sleep, 16(4), 351-359. https://doi.org/10.1093/sleep/16.4.351

King, A. C. (1997). Moderate-intensity exercise and self-rated quality of sleep in older adults. A randomized controlled trial. JAMA: The Journal of the American Medical Association, 277(1), 32–37. http://doi.org/10.1001/jama.277.1.32

Passos, G. S., Poyares, D., Santana, M. G., Garbuio, S. A., Tufik, S., & Mello, M. T. (2010). Effect of Acute Physical Exercise on Patients with Chronic Primary Insomnia. Journal of Clinical Sleep Medicine, 06(03), 270–275. http://doi.org/10.5664/jcsm.27825

Reid, K. J., Baron, K. G., Lu, B., Naylor, E., Wolfe, L., & Zee, P. C. (2010). Aerobic exercise improves self-reported sleep and quality of life in older adults with insomnia. Sleep Medicine, 11(9), 934–940. http://doi.org/10.1016/j.sleep.2010.04.014

Viana, V. A. R., Esteves, A. M., Boscolo, R. A., Grassmann, V., Santana, M. G., Tufik, S., & Mello, M. T. D. (2011). The effects of a session of resistance training on sleep patterns in the elderly. European Journal of Applied Physiology, 112(7), 2403–2408. http://doi.org/10.1007/s00421-011-2219-2

Herring, M., Kline, C., & Oconnor, P. (2015). Effects of Exercise Training On Self-reported Sleep Among Young Women with Generalized Anxiety Disorder (GAD). European Psychiatry, 30, 465. http://doi.org/10.1016/s0924-9338(15)31893-9

Kredlow, M. A., Capozzoli, M. C., Hearon, B. A., Calkins, A. W., & Otto, M. W. (2015). The effects of physical activity on sleep: a meta-analytic review. Journal of Behavioral Medicine, 38(3), 427–449. http://doi.org/10.1007/s10865-015-9617-6

Yang, P.-Y., Ho, K.-H., Chen, H.-C., & Chien, M.-Y. (2012). Exercise training improves sleep quality in middle-aged and older adults with sleep problems: a systematic review. Journal of Physiotherapy, 58(3), 157–163. http://doi.org/10.1016/s1836-9553(12)70106-6

Kline, C. E., Sui, X., Hall, M. H., Youngstedt, S. D., Blair, S. N., Earnest, C. P., & Church, T. S. (2012). Dose–response effects of exercise training on the subjective sleep quality of postmenopausal women: exploratory analyses of a randomised controlled trial. BMJ Open, 2(4). http://doi.org/10.1136/bmjopen-2012-001044

Fairbrother, K., Cartner, B. W., Triplett, N., Morris, D. M., & Collier, S. R. (2011). The Effects of Aerobic Exercise Timing on Sleep Architecture. Medicine & Science in Sports & Exercise, 43(Suppl 1), 879. http://doi.org/10.1249/01.mss.0000402452.16375.20

Youngstedt, S. D., & Kline, C. E. (2006). Epidemiology of exercise and sleep. Sleep and Biological Rhythms, 4(3), 215–221. http://doi.org/10.1111/j.1479-8425.2006.00235.x

Stenholm, S., Head, J., Kivimäki, M., Hanson, L. L. M., Pentti, J., Rod, N. H., … Vahtera, J. (2018). Sleep Duration and Sleep Disturbances as Predictors of Healthy and Chronic Disease–Free Life Expectancy Between Ages 50 and 75: A Pooled Analysis of Three Cohorts. The Journals of Gerontology: Series A, 74(2), 204–210. http://doi.org/10.1093/gerona/gly01

Xiao, Q., Keadle, S. K., Hollenbeck, A. R., & Matthews, C. E. (2014). Sleep Duration and Total and Cause-Specific Mortality in a Large US Cohort: Interrelationships With Physical Activity, Sedentary Behavior, and Body Mass Index. American Journal of Epidemiology, 180(10), 997–1006. http://doi.org/10.1093/aje/kwu222

Reynolds, A. C., Dorrian, J., Liu, P. Y., Dongen, H. P. A. V., Wittert, G. A., Harmer, L. J., & Banks, S. (2012). Impact of Five Nights of Sleep Restriction on Glucose Metabolism, Leptin and Testosterone in Young Adult Men. PLoS ONE, 7(7). http://doi.org/10.1371/journal.pone.0041218

Åkerstedt, T., Palmblad, J., Torre, B. D. L., Marana, R., & Gillberg, M. (1980). Adrenocortical and Gonadal Steroids During Sleep Deprivation. Sleep, 3(1), 23–30. http://doi.org/10.1093/sleep/3.1.23

Cortés-Gallegos, V., Castañeda, G., Alonso, R., Sojo, I., Carranco, A., Cervantes, C., & Parra, A. (1983). Sleep Deprivation Reduces Circulating Androgens in Healthy Men. Archives of Andrology, 10(1), 33–37. http://doi.org/10.3109/01485018308990167

González-Santos, M. R., Gajá-Rodíguez, O. V., Alonso-Uriarte, R., Sojo-Aranda, I., & Cortés-Gallegos, V. (1989). Sleep Deprivation and Adaptive Hormonal Responses of Healthy Men. Archives of Andrology, 22(3), 203–207. http://doi.org/10.3109/01485018908986773

Penev, P. D. (2007). Association Between Sleep and Morning Testosterone Levels In Older Men. Sleep, 30(4), 427–432. http://doi.org/10.1093/sleep/30.4.427

Kloss, J. D., Perlis, M. L., Zamzow, J. A., Culnan, E. J., & Gracia, C. R. (2015). Sleep, sleep disturbance, and fertility in women. Sleep Medicine Reviews, 22, 78–87. http://doi.org/10.1016/j.smrv.2014.10.005

Mahoney, M. M. (2010). Shift Work, Jet Lag, and Female Reproduction. International Journal of Endocrinology, 2010, 1–9. http://doi.org/10.1155/2010/813764

Labyak, S., Lava, S., Turek, F., & Zee, P. (2002). Effects Of Shiftwork On Sleep And Menstrual Function In Nurses. Health Care for Women International, 23(6-7), 703–714. http://doi.org/10.1080/07399330290107449

Pal, L., Bevilacqua, K., Zeitlian, G., Shu, J., & Santoro, N. (2008). Implications of diminished ovarian reserve (DOR) extend well beyond reproductive concerns. Menopause, 15(6), 1086–1094. http://doi.org/10.1097/gme.0b013e3181728467

Axelsson, G., Rylander, R., & Molin, I. (1989). Outcome of pregnancy in relation to irregular and inconvenient work schedules. Occupational and Environmental Medicine, 46(6), 393–398. http://doi.org/10.1136/oem.46.6.393

Bisanti, L., Olsen, J., Basso, O., Thonneau, P., & Karmaus, W. (1996). Shift Work and Subfecundity: A European Multicenter Study. Journal of Occupational & Environmental Medicine, 38(4), 352–358. http://doi.org/10.1097/00043764-199604000-00012

Rossmanith, W. G. (1998). The impact of sleep on gonadotropin secretion. Gynecological Endocrinology, 12(6), 381–389. http://doi.org/10.3109/09513599809012840

Fernando, S., & Rombauts, L. (2014). Melatonin: shedding light on infertility? – a review of the recent literature. Journal of Ovarian Research, 7(1). http://doi.org/10.1186/s13048-014-0098-y

Rocha, C., Rato, L., Martins, A., Alves, M., & Oliveira, P. (2015). Melatonin and Male Reproductive Health: Relevance of Darkness and Antioxidant Properties. Current Molecular Medicine, 15(4), 299–311. http://doi.org/10.2174/1566524015666150505155530

Song, C., Peng, W., Yin, S., Zhao, J., Fu, B., Zhang, J., … Zhang, Y. (2016). Melatonin improves age-induced fertility decline and attenuates ovarian mitochondrial oxidative stress in mice. Scientific Reports, 6(1). http://doi.org/10.1038/srep35165

Espino, J., Macedo, M., Lozano, G., Ortiz, Á., Rodríguez, C., Rodríguez, A. B., & Bejarano, I. (2019). Impact of Melatonin Supplementation in Women with Unexplained Infertility Undergoing Fertility Treatment. Antioxidants, 8(9), 338. http://doi.org/10.3390/antiox8090338

Tamura, H., Takasaki, A., Taketani, T., Tanabe, M., Kizuka, F., Lee, L., … Sugino, N. (2012). The role of melatonin as an antioxidant in the follicle. Journal of Ovarian Research, 5(1), 5. http://doi.org/10.1186/1757-2215-5-5

Saaresranta, T., & Polo, O. (2003). Sleep-disordered breathing and hormones. European Respiratory Journal, 22(1), 161–172. http://doi.org/10.1183/09031936.03.00062403

Cappuccio, F. P., Cooper, D., Delia, L., Strazzullo, P., & Miller, M. A. (2011). Sleep duration predicts cardiovascular outcomes: a systematic review and meta-analysis of prospective studies. European Heart Journal, 32(12), 1484–1492. http://doi.org/10.1093/eurheartj/ehr007

Jansen, E. C., Dunietz, G. L., Tsimpanouli, M.-E., Guyer, H. M., Shannon, C., Hershner, S. D., … Baylin, A. (2018). Sleep, Diet, and Cardiometabolic Health Investigations: a Systematic Review of Analytic Strategies. Current Nutrition Reports, 7(4), 235–258. http://doi.org/10.1007/s13668-018-0240-3

Knutson, K. L., Cauter, E. V., Rathouz, P. J., Yan, L. L., Hulley, S. B., Liu, K., & Lauderdale, D. S. (2009). Association Between Sleep and Blood Pressure in Midlife. Archives of Internal Medicine, 169(11), 1055. http://doi.org/10.1001/archinternmed.2009.119

Besedovsky, L., Lange, T., & Born, J. (2011). Sleep and immune function. Pflügers Archiv – European Journal of Physiology, 463(1), 121–137. http://doi.org/10.1007/s00424-011-1044-0

Besedovsky, L., Lange, T., & Haack, M. (2019). The Sleep-Immune Crosstalk in Health and Disease. Physiological Reviews, 99(3), 1325–1380. http://doi.org/10.1152/physrev.00010.2018

Orr, W. C., Fass, R., Sundaram, S. S., & Scheimann, A. O. (2020). The effect of sleep on gastrointestinal functioning in common digestive diseases. The Lancet Gastroenterology & Hepatology, 5(6), 616–624. http://doi.org/10.1016/s2468-1253(19)30412-1

Tang, Y., Preuss, F., Turek, F. W., Jakate, S., & Keshavarzian, A. (2009). Sleep deprivation worsens inflammation and delays recovery in a mouse model of colitis. Sleep Medicine, 10(6), 597–603. http://doi.org/10.1016/j.sleep.2008.12.009

Chen, Y., Tan, F., Wei, L., Li, X., Lyu, Z., Feng, X., … Li, N. (2018). Sleep duration and the risk of cancer: a systematic review and meta-analysis including dose–response relationship. BMC Cancer, 18(1). http://doi.org/10.1186/s12885-018-5025-y

Almendros, I., Martinez-Garcia, M. A., Farré, R., & Gozal, D. (2020). Obesity, sleep apnea, and cancer. International Journal of Obesity, 44(8), 1653–1667. http://doi.org/10.1038/s41366-020-0549-z

Erren, T. C., Falaturi, P., Morfeld, P., Knauth, P., Reiter, R. J., & Piekarski, C. (2010). Shift Work and Cancer. Deutsches Aerzteblatt Online. http://doi.org/10.3238/arztebl.2010.0657

Bernert, R. A., Kim, J. S., Iwata, N. G., & Perlis, M. L. (2015). Sleep Disturbances as an Evidence-Based Suicide Risk Factor. Current Psychiatry Reports, 17(3). http://doi.org/10.1007/s11920-015-0554-4

Kim, J.-H., Park, E.-C., Cho, W.-H., Park, J.-Y., Choi, W.-J., & Chang, H.-S. (2013). Association between Total Sleep Duration and Suicidal Ideation among the Korean General Adult Population. Sleep, 36(10), 1563–1572. http://doi.org/10.5665/sleep.3058

Mccall, W. V., & Black, C. G. (2013). The Link Between Suicide and Insomnia: Theoretical Mechanisms. Current Psychiatry Reports, 15(9). http://doi.org/10.1007/s11920-013-0389-9

Li, S. X., Lam, S. P., Zhang, J., Yu, M. W. M., Chan, J. W. Y., Chan, C. S. Y., … Wing, Y.-K. (2016). Sleep Disturbances and Suicide Risk in an 8-Year Longitudinal Study of Schizophrenia-Spectrum Disorders. Sleep, 39(6), 1275–1282. http://doi.org/10.5665/sleep.5852

Littlewood, D. L., Gooding, P., Kyle, S. D., Pratt, D., & Peters, S. (2016). Understanding the role of sleep in suicide risk: qualitative interview study. BMJ Open, 6(8). http://doi.org/10.1136/bmjopen-2016-012113

Lin, H.-T., Lai, C.-H., Perng, H.-J., Chung, C.-H., Wang, C.-C., Chen, W.-L., & Chien, W.-C. (2018). Insomnia as an independent predictor of suicide attempts: a nationwide population-based retrospective cohort study. BMC Psychiatry, 18(1). http://doi.org/10.1186/s12888-018-1702-2

Freeman, D., Sheaves, B., Waite, F., Harvey, A. G., & Harrison, P. J. (2020). Sleep disturbance and psychiatric disorders. The Lancet Psychiatry, 7(7), 628–637. http://doi.org/10.1016/s2215-0366(20)30136-x

Benca, R. M. (1992). Sleep and Psychiatric Disorders. Archives of General Psychiatry, 49(8), 651. http://doi.org/10.1001/archpsyc.1992.01820080059010

Breslau, N., Roth, T., Rosenthal, L., & Andreski, P. (1996). Sleep disturbance and psychiatric disorders: A longitudinal epidemiological study of young Adults. Biological Psychiatry, 39(6), 411–418. http://doi.org/10.1016/0006-3223(95)00188-3

Baglioni, C., Nanovska, S., Regen, W., Spiegelhalder, K., Feige, B., Nissen, C., … Riemann, D. (2016). Sleep and mental disorders: A meta-analysis of polysomnographic research. Psychological Bulletin, 142(9), 969–990. http://doi.org/10.1037/bul0000053

Goldstein, A. N., & Walker, M. P. (2014). The Role of Sleep in Emotional Brain Function. Annual Review of Clinical Psychology, 10(1), 679–708. http://doi.org/10.1146/annurev-clinpsy-032813-153716

Postuma, R. B., Iranzo, A., Hu, M., Högl, B., Boeve, B. F., Manni, R., … Pelletier, A. (2019). Risk and predictors of dementia and parkinsonism in idiopathic REM sleep behaviour disorder: a multicentre study. Brain, 142(3), 744–759. http://doi.org/10.1093/brain/awz030

Wintler, T., Schoch, H., Frank, M. G., & Peixoto, L. (2020). Sleep, brain development, and autism spectrum disorders: Insights from animal models. Journal of Neuroscience Research, 98(6), 1137–1149. http://doi.org/10.1002/jnr.24619

Shokri-Kojori, E., Wang, G.-J., Wiers, C. E., Demiral, S. B., Guo, M., Kim, S. W., … Volkow, N. D. (2018). β-Amyloid accumulation in the human brain after one night of sleep deprivation. Proceedings of the National Academy of Sciences, 115(17), 4483–4488. http://doi.org/10.1073/pnas.1721694115

Mantovani, S., Smith, S. S., Gordon, R., & Osullivan, J. D. (2018). An overview of sleep and circadian dysfunction in Parkinsons disease. Journal of Sleep Research, 27(3). http://doi.org/10.1111/jsr.12673

Malhotra, R. K. (2018). Neurodegenerative Disorders and Sleep. Sleep Medicine Clinics, 13(1), 63–70. http://doi.org/10.1016/j.jsmc.2017.09.006

Huang, L.-B., Tsai, M.-C., Chen, C.-Y., & Hsu, S.-C. (2013). The Effectiveness of Light/Dark Exposure to Treat Insomnia in Female Nurses Undertaking Shift Work during the Evening/Night Shift. Journal of Clinical Sleep Medicine, 09(07), 641–646. http://doi.org/10.5664/jcsm.2824

Zhang, Y., & Papantoniou, K. (2019). Night shift work and its carcinogenicity. The Lancet Oncology, 20(10). http://doi.org/10.1016/s1470-2045(19)30578-9

Perry-Jenkins, M., Goldberg, A. E., Pierce, C. P., & Sayer, A. G. (2007). Shift Work, Role Overload, and the Transition to Parenthood. Journal of Marriage and Family, 69(1), 123–138. http://doi.org/10.1111/j.1741-3737.2006.00349.x

Rodziewicz TL, Hipskind JE. Medical Error Prevention. 2020 May 5. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. PMID: 29763131. https://pubmed.ncbi.nlm.nih.gov/29763131/

Tanaka, K., Takahashi, M., Hiro, H., Kakinuma, M., Tanaka, M., Kamata, N., & Miyaoka, H. (2010). Differences in Medical Error Risk among Nurses Working Two- and Three-shift Systems at Teaching Hospitals: A Six-month Prospective Study. Industrial Health, 48(3), 357–364. http://doi.org/10.2486/indhealth.48.357

Admi H, Tzischinsky O, Epstein R, Herer P, Lavie P. Shift work in nursing: is it really a risk factor for nurses’ health and patients’ safety?. Nurs Econ. 2008;26(4):250-257. https://pubmed.ncbi.nlm.nih.gov/18777974/

Clendon, J., & Gibbons, V. (2015). 12h shifts and rates of error among nurses: A systematic review. International Journal of Nursing Studies, 52(7), 1231–1242. http://doi.org/10.1016/j.ijnurstu.2015.03.011

Hammadah, M., Kindya, B. R., Allard‐Ratick, M. P., Jazbeh, S., Eapen, D., Tang, W. W., & Sperling, L. (2017). Navigating air travel and cardiovascular concerns: Is the sky the limit?, Clinical Cardiology, 40 (9), 660–666. http://doi.org/10.1002/clc.22741

Lieber, B. A., Han, J., Appelboom, G., Taylor, B. E., Han, B., Agarwal, N., & Connolly, E. S. (2016). Association of Steroid Use with Deep Venous Thrombosis and Pulmonary Embolism in Neurosurgical Patients: A National Database Analysis. World Neurosurgery, 89, 126–132. http://doi.org/10.1016/j.wneu.2016.01.033

El-Menyar, A., Asim, M., & Al-Thani, H. (2017). Obesity Paradox in Patients With Deep Venous Thrombosis. Clinical and Applied Thrombosis/Hemostasis, 24(6), 986–992. http://doi.org/10.1177/1076029617727858

Klovaite, J., Benn, M., & Nordestgaard, B. G. (2014). Obesity as a causal risk factor for deep venous thrombosis: a Mendelian randomization study. Journal of Internal Medicine, 277(5), 573–584. http://doi.org/10.1111/joim.12299

Davies, H. O., Popplewell, M., Singhal, R., Smith, N., & Bradbury, A. W. (2016). Obesity and lower limb venous disease – The epidemic of phlebesity. Phlebology: The Journal of Venous Disease, 32(4), 227–233. http://doi.org/10.1177/0268355516649333

Liljeqvist, S., Helldén, A., Bergman, U., & Söderberg, M. (2008). Pulmonary embolism associated with the use of anabolic steroids. European Journal of Internal Medicine, 19(3), 214–215. http://doi.org/10.1016/j.ejim.2007.03.016

Linton MF, Yancey PG, Davies SS, Jerome WG (Jay), Linton EF, Vickers KC. The Role of Lipids and Lipoproteins in Atherosclerosis. In: De Groot LJ, Chrousos G, Dungan K, et al., eds. Endotext. South Dartmouth (MA): MDText.com, Inc.; 2000. http://www.ncbi.nlm.nih.gov/books/NBK343489/.

Rescheduling of meals may ease the effects of jet lag. (2017). Nursing Standard, 31(48), 16–16. http://doi.org/10.7748/ns.31.48.16.s17

Ruscitto, C., & Ogden, J. (2016). The impact of an implementation intention to improve mealtimes and reduce jet lag in long-haul cabin crew. Psychology & Health, 32(1), 61–77. http://doi.org/10.1080/08870446.2016.1240174

Reid, K. J., & Abbott, S. M. (2015). Jet Lag and Shift Work Disorder. Sleep Medicine Clinics, 10(4), 523–535. http://doi.org/10.1016/j.jsmc.2015.08.006

Srinivasan, V., Spence, D. W., Pandi-Perumal, S. R., Trakht, I., & Cardinali, D. P. (2008). Jet lag: Therapeutic use of melatonin and possible application of melatonin analogs. Travel Medicine and Infectious Disease, 6(1-2), 17–28. http://doi.org/10.1016/j.tmaid.2007.12.002

Edwards, B. J., Atkinson, G., Waterhouse, J., Reilly, T., Godfrey, R., & Budgett, R. (2000). Use of melatonin in recovery from jet-lag following an eastward flight across 10 time-zones. Ergonomics, 43(10), 1501–1513. http://doi.org/10.1080/001401300750003934

Zee, P. C., & Goldstein, C. A. (2010). Treatment of Shift Work Disorder and Jet Lag. Current Treatment Options in Neurology, 12(5), 396–411. http://doi.org/10.1007/s11940-010-0090-9

https://www.nhlbi.nih.gov/health-topics/circadian-rhythm-disorders

Borodkin, K., & Dagan, Y. (2013). Diagnostic Algorithm for Circadian Rhythm Sleep Disorders. Encyclopedia of Sleep, 66–73. http://doi.org/10.1016/b978-0-12-378610-4.00284-9

Lockley, S. (2013). Special Considerations and Future Directions in Circadian Rhythm Sleep Disorders Diagnosis. Encyclopedia of Sleep, 138–149. http://doi.org/10.1016/b978-0-12-378610-4.00299-0

Crowley, S., & Youngstedt, S. (2013). Pathophysiology, Associations, and Consequences of Circadian Rhythm Sleep Disorder. Encyclopedia of Sleep, 16–21. http://doi.org/10.1016/b978-0-12-378610-4.00266-7

Franken, P., & Dijk, D.-J. (2009). Circadian clock genes and sleep homeostasis. European Journal of Neuroscience, 29(9), 1820–1829. http://doi.org/10.1111/j.1460-9568.2009.06723.x

Burgess, H. J., & Emens, J. S. (2016). Circadian-Based Therapies for Circadian Rhythm Sleep-Wake Disorders. Current Sleep Medicine Reports, 2(3), 158–165. http://doi.org/10.1007/s40675-016-0052-1

Jones, C. R., Huang, A. L., Ptáček, L. J., & Fu, Y.-H. (2013). Genetic basis of human circadian rhythm disorders. Experimental Neurology, 243, 28–33. http://doi.org/10.1016/j.expneurol.2012.07.012

Toh KL. Basic science review on circadian rhythm biology and circadian sleep disorders. Ann Acad Med Singap. 2008;37(8):662-668. https://pubmed.ncbi.nlm.nih.gov/18797559/

Farhud D, Aryan Z. Circadian Rhythm, Lifestyle and Health: A Narrative Review. Iran J Public Health. 2018;47(8):1068-1076. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6123576/

Dodson, E. R., & Zee, P. C. (2010). Therapeutics for Circadian Rhythm Sleep Disorders. Sleep Medicine Clinics, 5(4), 701–715. http://doi.org/10.1016/j.jsmc.2010.08.001

Zhu, L., & Zee, P. C. (2012). Circadian Rhythm Sleep Disorders. Neurologic Clinics, 30(4), 1167–1191. http://doi.org/10.1016/j.ncl.2012.08.011

Kim MJ, Lee JH, Duffy JF. Circadian Rhythm Sleep Disorders. J Clin Outcomes Manag. 2013;20(11):513-528. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4212693/

Zhong, G., Naismith, S. L., Rogers, N. L., & Lewis, S. J. G. (2011). Sleep-wake disturbances in common neurodegenerative diseases: A closer look at selected aspects of the neural circuitry. Journal of the Neurological Sciences, 307(1-2), 9–14. http://doi.org/10.1016/j.jns.2011.04.020

Dijk, D.-J., Boulos, Z., Eastman, C. I., Lewy, A. J., Campbell, S. S., & Terman, M. (1995). Light Treatment for Sleep Disorders: Consensus Report. Journal of Biological Rhythms, 10(2), 113–125. http://doi.org/10.1177/074873049501000204

Barion, A., & Zee, P. C. (2007). A clinical approach to circadian rhythm sleep disorders. Sleep Medicine, 8(6), 566–577. http://doi.org/10.1016/j.sleep.2006.11.017

Horne JA, Ostberg O. A self-assessment questionnaire to determine morningness-eveningness in human circadian rhythms. Int J Chronobiol. 1976;4(2):97-110. https://pubmed.ncbi.nlm.nih.gov/1027738/

Adan, A., & Almirall, H. (1991). Horne & Östberg morningness-eveningness questionnaire: A reduced scale. Personality and Individual Differences, 12(3), 241–253. http://doi.org/10.1016/0191-8869(91)90110-w

Urbán, R., Magyaródi, T., & Rigó, A. (2011). Morningness-Eveningness, Chronotypes and Health-Impairing Behaviors in Adolescents. Chronobiology International, 28(3), 238–247. http://doi.org/10.3109/07420528.2010.549599

https://www.thewep.org/documentations/mctq

Buysse, D. J., Reynolds, C. F., Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989). The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research. Psychiatry Research, 28(2), 193–213. http://doi.org/10.1016/0165-1781(89)90047-4

Bastien, C. (2001). Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Medicine, 2(4), 297–307. http://doi.org/10.1016/s1389-9457(00)00065-4

Yang, M., Morin, C. M., Schaefer, K., & Wallenstein, G. V. (2009). Interpreting score differences in the Insomnia Severity Index: using health-related outcomes to define the minimally important difference. Current Medical Research and Opinion, 25(10), 2487–2494. http://doi.org/10.1185/03007990903167415

Morin, C. M., Belleville, G., Bélanger, L., & Ivers, H. (2011). The Insomnia Severity Index: Psychometric Indicators to Detect Insomnia Cases and Evaluate Treatment Response. Sleep, 34(5), 601–608. http://doi.org/10.1093/sleep/34.5.601

Castriotta RJ, Wilde MC, Lai JM, Atanasov S, Masel BE, Kuna ST. Prevalence and consequences of sleep disorders in traumatic brain injury. J Clin Sleep Med. 2007;3(4):349-356. https://pubmed.ncbi.nlm.nih.gov/17694722/

Chokroverty S. Overview of sleep & sleep disorders. Indian J Med Res. 2010;131:126-140. https://pubmed.ncbi.nlm.nih.gov/20308738/

Pavlova, M. K., & Latreille, V. (2019). Sleep Disorders. The American Journal of Medicine, 132(3), 292–299. http://doi.org/10.1016/j.amjmed.2018.09.021

Olejniczak, P. W., & Fisch, B. J. (2003). Sleep disorders. Medical Clinics of North America, 87(4), 803–833. http://doi.org/10.1016/s0025-7125(03)00006-3

https://www.nhlbi.nih.gov/health-topics/sleep-apnea

https://clevemed.com/what-is-sleep-apnea/patient-sleep-apnea-screener/

Spicuzza, L., Caruso, D., & Maria, G. D. (2015). Obstructive sleep apnoea syndrome and its management. Therapeutic Advances in Chronic Disease, 6(5), 273–285. http://doi.org/10.1177/2040622315590318

Bixler, E. O., Vgontzas, A. N., Lin, H.-M., Liao, D., Calhoun, S., Fedok, F., … Graff, G. (2008). Blood Pressure Associated With Sleep-Disordered Breathing in a Population Sample of Children. Hypertension, 52(5), 841–846. http://doi.org/10.1161/hypertensionaha.108.116756

Campos, A. I., García-Marín, L. M., Byrne, E. M., Martin, N. G., Cuéllar-Partida, G., & Rentería, M. E. (2020). Insights into the aetiology of snoring from observational and genetic investigations in the UK Biobank. Nature Communications, 11(1). http://doi.org/10.1038/s41467-020-14625-1

Morgenthaler, T. I., Kagramanov, V., Hanak, V., & Decker, P. A. (2006). Complex Sleep Apnea Syndrome: Is It a Unique Clinical Syndrome? Sleep, 29(9), 1203–1209. http://doi.org/10.1093/sleep/29.9.1203

El-Ad, B., & Lavie, P. (2005). Effect of sleep apnea on cognition and mood. International Review of Psychiatry, 17(4), 277–282. http://doi.org/10.1080/09540260500104508

Morgenstern, M., Wang, J., Beatty, N., Batemarco, T., Sica, A. L., & Greenberg, H. (2014). Obstructive Sleep Apnea. Endocrinology and Metabolism Clinics of North America, 43(1), 187–204. http://doi.org/10.1016/j.ecl.2013.09.002

Sleep–Related Breathing Disorders in Adults: Recommendations for Syndrome Definition and Measurement Techniques in Clinical Research. (1999). Sleep, 22(5), 667–689. http://doi.org/10.1093/sleep/22.5.667

Ruehland, W. R., Rochford, P. D., O’Donoghue, F. J., Pierce, R. J., Singh, P., & Thornton, A. T. (2009). The New AASM Criteria for Scoring Hypopneas: Impact on the Apnea Hypopnea Index. Sleep, 32(2), 150–157. http://doi.org/10.1093/sleep/32.2.150

Selim, B. J., Koo, B. B., Qin, L., Jeon, S., Won, C., Redeker, N. S., … Yaggi, H. K. (2016). The Association between Nocturnal Cardiac Arrhythmias and Sleep-Disordered Breathing: The DREAM Study. Journal of Clinical Sleep Medicine, 12(06), 829–837. http://doi.org/10.5664/jcsm.5880

Ahmed, M. H. (2010). Obstructive sleep apnea syndrome and fatty liver: Association or causal link? World Journal of Gastroenterology, 16(34), 4243. http://doi.org/10.3748/wjg.v16.i34.4243

Singh, H., Pollock, R., Uhanova, J., Kryger, M., Hawkins, K., & Minuk, G. Y. (2005). Symptoms of Obstructive Sleep Apnea in Patients with Nonalcoholic Fatty Liver Disease. Digestive Diseases and Sciences, 50(12), 2338–2343. http://doi.org/10.1007/s10620-005-3058-y

Lawati, N. M. A., Patel, S. R., & Ayas, N. T. (2009). Epidemiology, Risk Factors, and Consequences of Obstructive Sleep Apnea and Short Sleep Duration. Progress in Cardiovascular Diseases, 51(4), 285–293. http://doi.org/10.1016/j.pcad.2008.08.001

Young, T. (2004). Risk Factors for Obstructive Sleep Apnea in Adults. Jama, 291(16), 2013. http://doi.org/10.1001/jama.291.16.2013

Yaggi, H. K., Concato, J., Kernan, W. N., Lichtman, J. H., Brass, L. M., & Mohsenin, V. (2005). Obstructive Sleep Apnea as a Risk Factor for Stroke and Death. New England Journal of Medicine, 353(19), 2034–2041. http://doi.org/10.1056/nejmoa043104

Redline, S., Budhiraja, R., Kapur, V., Marcus, C. L., Mateika, J. H., Mehra, R., … Quan, A. S. F. (2007). The Scoring of Respiratory Events in Sleep: Reliability and Validity. Journal of Clinical Sleep Medicine, 03(02), 169–200. http://doi.org/10.5664/jcsm.26818

Basheer B, Hegde KS, Bhat SS, Umar D, Baroudi K. Influence of mouth breathing on the dentofacial growth of children: a cephalometric study. J Int Oral Health. 2014;6(6):50-55. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4295456/

Ruhle, K. H., & Nilius, G. (2008). Mouth Breathing in Obstructive Sleep Apnea prior to and during Nasal Continuous Positive Airway Pressure. Respiration, 76(1), 40–45. http://doi.org/10.1159/000111806

Izu, S. C., Itamoto, C. H., Pradella-Hallinan, M., Pizarro, G. U., Tufik, S., Pignatari, S., & Fujita, R. R. (2010). Obstructive sleep apnea syndrome (OSAS) in mouth breathing children. Brazilian Journal of Otorhinolaryngology, 76(5), 552–556. http://doi.org/10.1590/s1808-86942010000500003

Lee, S. H., Choi, J. H., Shin, C., Lee, H. M., Kwon, S. Y., & Lee, S. H. (2007). How Does Open-Mouth Breathing Influence Upper Airway Anatomy? The Laryngoscope, 117(6), 1102–1106. http://doi.org/10.1097/mlg.0b013e318042aef7

Tuomilehto, H. P. I., Seppä, J. M., Partinen, M. M., Peltonen, M., Gylling, H., Tuomilehto, J. O. I., … Uusitupa, M. (2009). Lifestyle Intervention with Weight Reduction. American Journal of Respiratory and Critical Care Medicine, 179(4), 320–327. http://doi.org/10.1164/rccm.200805-669oc

https://www.cdc.gov/nchs/fastats/obesity-overweight.htm

Neill, A. M., Angus, S. M., Sajkov, D., & Mcevoy, R. D. (1997). Effects of sleep posture on upper airway stability in patients with obstructive sleep apnea. American Journal of Respiratory and Critical Care Medicine, 155(1), 199–204. http://doi.org/10.1164/ajrccm.155.1.9001312

Loord, H., & Hultcrantz, E. (2007). Positioner–a method for preventing sleep apnea. Acta Oto-Laryngologica, 127(8), 861–868. http://doi.org/10.1080/00016480601089390

Szollosi, I., Roebuck, T., Thompson, B., & Naughton, M. T. (2006). Lateral Sleeping Position Reduces Severity of Central Sleep Apnea / Cheyne-Stokes Respiration. Sleep, 29(8), 1045–1051. http://doi.org/10.1093/sleep/29.8.1045

Silverberg DS, Iaina A, Oksenberg A. Treating obstructive sleep apnea improves essential hypertension and quality of life. Am Fam Physician. 2002;65(2):229-236. https://pubmed.ncbi.nlm.nih.gov/11820487/

Aurora, R. N., Chowdhuri, S., Ramar, K., Bista, S. R., Casey, K. R., Lamm, C. I., … Tracy, S. L. (2012). The Treatment of Central Sleep Apnea Syndromes in Adults: Practice Parameters with an Evidence-Based Literature Review and Meta-Analyses. Sleep, 35(1), 17–40. http://doi.org/10.5665/sleep.1580

Hsu, A. A. L., & Lo, C. (2003). Continuous positive airway pressure therapy in sleep apnoea. Respirology, 8(4), 447–454. http://doi.org/10.1046/j.1440-1843.2003.00494.x

Patel, S. R., White, D. P., Malhotra, A., Stanchina, M. L., & Ayas, N. T. (2003). Continuous Positive Airway Pressure Therapy for Treating gess in a Diverse Population With Obstructive Sleep Apnea. Archives of Internal Medicine, 163(5), 565. http://doi.org/10.1001/archinte.163.5.565

Sundaram, S., Lim, J., & Lasserson, T. J. (2005). Surgery for obstructive sleep apnoea in adults. Cochrane Database of Systematic Reviews. http://doi.org/10.1002/14651858.cd001004.pub2

Chen, H., & Lowe, A. A. (2012). Updates in oral appliance therapy for snoring and obstructive sleep apnea. Sleep and Breathing, 17(2), 473–486. http://doi.org/10.1007/s11325-012-0712-4

Gaisl, T., Haile, S. R., Thiel, S., Osswald, M., & Kohler, M. (2019). Efficacy of pharmacotherapy for OSA in adults: A systematic review and network meta-analysis. Sleep Medicine Reviews, 46, 74–86. http://doi.org/10.1016/j.smrv.2019.04.009

Ohayon, M., Wickwire, E. M., Hirshkowitz, M., Albert, S. M., Avidan, A., Daly, F. J., … Vitiello, M. V. (2017). National Sleep Foundations sleep quality recommendations: first report. Sleep Health, 3(1), 6–19. http://doi.org/10.1016/j.sleh.2016.11.006

Youngstedt, S. D., Goff, E. E., Reynolds, A. M., Kripke, D. F., Irwin, M. R., Bootzin, R. R., … Jean-Louis, G. (2016). Has adult sleep duration declined over the last 50 years? Sleep Medicine Reviews, 28, 69–85. http://doi.org/10.1016/j.smrv.2015.08.004

Chaput, J.-P., Mcneil, J., Després, J.-P., Bouchard, C., & Tremblay, A. (2013). Seven to Eight Hours of Sleep a Night Is Associated with a Lower Prevalence of the Metabolic Syndrome and Reduced Overall Cardiometabolic Risk in Adults. PLoS ONE, 8(9). http://doi.org/10.1371/journal.pone.0072832

Wild, C. J., Nichols, E. S., Battista, M. E., Stojanoski, B., & Owen, A. M. (2018). Dissociable effects of self-reported daily sleep duration on high-level cognitive abilities. Sleep, 41(12). http://doi.org/10.1093/sleep/zsy182

Hirshkowitz, M., Whiton, K., Albert, S. M., Alessi, C., Bruni, O., Doncarlos, L., … Hillard, P. J. A. (2015). National Sleep Foundation’s sleep time duration recommendations: methodology and results summary. Sleep Health, 1(1), 40–43. http://doi.org/10.1016/j.sleh.2014.12.010

Cappuccio, F. P., Delia, L., Strazzullo, P., & Miller, M. A. (2010). Sleep Duration and All-Cause Mortality: A Systematic Review and Meta-Analysis of Prospective Studies. Sleep, 33(5), 585–592. http://doi.org/10.1093/sleep/33.5.585

Gottlieb, D. J., Punjabi, N. M., Newman, A. B., Resnick, H. E., Redline, S., Baldwin, C. M., & Nieto, F. J. (2005). Association of Sleep Time With Diabetes Mellitus and Impaired Glucose Tolerance. Archives of Internal Medicine, 165(8), 863. http://doi.org/10.1001/archinte.165.8.863

Short, M. A., Agostini, A., Lushington, K., & Dorrian, J. (2015). A systematic review of the sleep, sleepiness, and performance implications of limited wake shift work schedules. Scandinavian Journal of Work, Environment & Health, 41(5), 425–440. http://doi.org/10.5271/sjweh.3509

Cappuccio, F. P., Taggart, F. M., Kandala, N.-B., Currie, A., Peile, E., Stranges, S., & Miller, M. A. (2008). Meta-Analysis of Short Sleep Duration and Obesity in Children and Adults. Sleep, 31(5), 619–626. http://doi.org/10.1093/sleep/31.5.619

Mong, J. A., & Cusmano, D. M. (2016). Sex differences in sleep: impact of biological sex and sex steroids. Philosophical Transactions of the Royal Society B: Biological Sciences, 371(1688), 20150110. http://doi.org/10.1098/rstb.2015.0110

Krishnan, V., & Collop, N. A. (2006). Gender differences in sleep disorders. Current Opinion in Pulmonary Medicine, 12(6), 383–389. http://doi.org/10.1097/01.mcp.0000245705.69440.6a

Mehta, N., Shafi, F., & Bhat, A. (2015). Unique Aspects of Sleep in Women. Missouri medicine, 112(6), 430–434. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6168103/

Moline, M. L., Broch, L., & Zak, R. (2004). Sleep in women across the life cycle from adulthood through menopause. Medical Clinics of North America, 88(3), 705–736. http://doi.org/10.1016/j.mcna.2004.01.009

He, Y., Jones, C. R., Fujiki, N., Xu, Y., Guo, B., Holder, J. L., … Fu, Y.-H. (2009). The Transcriptional Repressor DEC2 Regulates Sleep Length in Mammals. Science, 325(5942), 866–870. http://doi.org/10.1126/science.1174443

Theorell-Haglöw, J., Berglund, L., Berne, C., & Lindberg, E. (2014). Both habitual short sleepers and long sleepers are at greater risk of obesity: a population-based 10-year follow-up in women. Sleep Medicine, 15(10), 1204–1211. http://doi.org/10.1016/j.sleep.2014.02.014

Mezick, E. J., Wing, R. R., & Mccaffery, J. M. (2014). Associations of self-reported and actigraphy-assessed sleep characteristics with body mass index and waist circumference in adults: moderation by gender. Sleep Medicine, 15(1), 64–70. http://doi.org/10.1016/j.sleep.2013.08.784

Kim, S. J. (2011). Relationship Between Weekend Catch-up Sleep and Poor Performance on Attention Tasks in Korean Adolescents. Archives of Pediatrics & Adolescent Medicine, 165(9), 806. http://doi.org/10.1001/archpediatrics.2011.128

Kim, C.-W., Choi, M.-K., Im, H.-J., Kim, O.-H., Lee, H.-J., Song, J., … Park, K.-H. (2012). Weekend catch-up sleep is associated with decreased risk of being overweight among fifth-grade students with short sleep duration. Journal of Sleep Research, 21(5), 546–551. http://doi.org/10.1111/j.1365-2869.2012.01013.x

Sun, W., Ling, J., Zhu, X., Lee, T. M.-C., & Li, S. X. (2019). Associations of weekday-to-weekend sleep differences with academic performance and health-related outcomes in school-age children and youths. Sleep Medicine Reviews, 46, 27–53. http://doi.org/10.1016/j.smrv.2019.04.003

Kang, S.-G., Lee, Y. J., Kim, S. J., Lim, W., Lee, H.-J., Park, Y.-M., … Hong, J. P. (2014). Weekend catch-up sleep is independently associated with suicide attempts and self-injury in Korean adolescents. Comprehensive Psychiatry, 55(2), 319–325. http://doi.org/10.1016/j.comppsych.2013.08.023

Zhao, M., Tuo, H., Wang, S., & Zhao, L. (2020). The Effects of Dietary Nutrition on Sleep and Sleep Disorders. Mediators of Inflammation, 2020, 1–7. http://doi.org/10.1155/2020/3142874

Doherty, Madigan, Warrington, & Ellis. (2019). Sleep and Nutrition Interactions: Implications for Athletes. Nutrients, 11(4), 822. http://doi.org/10.3390/nu11040822

Sutanto CN, Wang MX, Tan D, Kim JE. Association of Sleep Quality and Macronutrient Distribution: A Systematic Review and Meta-Regression. Nutrients. 2020 Jan 2;12(1):126. doi: 10.3390/nu12010126. PMID: 31906452; PMCID: PMC7019667. https://pubmed.ncbi.nlm.nih.gov/31906452/

Peuhkuri, K., Sihvola, N., & Korpela, R. (2012). Diet promotes sleep duration and quality. Nutrition Research, 32(5), 309–319. http://doi.org/10.1016/j.nutres.2012.03.009

Afaghi, A., Oconnor, H., & Chow, C. M. (2007). High-glycemic-index carbohydrate meals shorten sleep onset. The American Journal of Clinical Nutrition, 85(2), 426–430. http://doi.org/10.1093/ajcn/85.2.426

Golem, D. L., Martin-Biggers, J. T., Koenings, M. M., Davis, K. F., & Byrd-Bredbenner, C. (2014). An Integrative Review of Sleep for Nutrition Professionals. Advances in Nutrition, 5(6), 742–759. http://doi.org/10.3945/an.114.006809

Grandner, M. A., Jackson, N., Gerstner, J. R., & Knutson, K. L. (2013). Sleep symptoms associated with intake of specific dietary nutrients. Journal of Sleep Research, 23(1), 22–34. http://doi.org/10.1111/jsr.12084

Porter, J., & Horne, J. (1981). Bed-time food supplements and sleep: Effects of different carbohydrate levels. Electroencephalography and Clinical Neurophysiology, 51(4), 426–433. http://doi.org/10.1016/0013-4694(81)90106-1

Halson, S. L. (2014). Sleep in Elite Athletes and Nutritional Interventions to Enhance Sleep. Sports Medicine, 44(S1), 13–23. http://doi.org/10.1007/s40279-014-0147-0

Rondanelli, M., Opizzi, A., Monteferrario, F., Antoniello, N., Manni, R., & Klersy, C. (2011). The Effect of Melatonin, Magnesium, and Zinc on Primary Insomnia in Long-Term Care Facility Residents in Italy: A Double-Blind, Placebo-Controlled Clinical Trial. Journal of the American Geriatrics Society, 59(1), 82–90. http://doi.org/10.1111/j.1532-5415.2010.03232.x

Tahara, Y., & Shibata, S. (2014). Chrono-biology, Chrono-pharmacology, and Chrono-nutrition. Journal of Pharmacological Sciences, 124(3), 320–335. http://doi.org/10.1254/jphs.13r06cr

Landolt, H.-P., Werth, E., Borbély, A. A., & Dijk, D.-J. (1995). Caffeine intake (200 mg) in the morning affects human sleep and EEG power spectra at night. Brain Research, 675(1-2), 67–74. http://doi.org/10.1016/0006-8993(95)00040-w

Gottesmann, C. (2002). GABA mechanisms and sleep. Neuroscience, 111(2), 231–239. http://doi.org/10.1016/s0306-4522(02)00034-9

Campbell, S. S., Dawson, D., & Anderson, M. W. (1993). Alleviation of Sleep Maintenance Insomnia with Timed Exposure to Bright Light. Journal of the American Geriatrics Society, 41(8), 829–836. http://doi.org/10.1111/j.1532-5415.1993.tb06179.x

Zhao, J., Tian, Y., Nie, J., Xu, J., & Liu, D. (2012). Red Light and the Sleep Quality and Endurance Performance of Chinese Female Basketball Players. Journal of Athletic Training, 47(6), 673–678. http://doi.org/10.4085/1062-6050-47.6.08

Smolensky, M. H., Sackett-Lundeen, L. L., & Portaluppi, F. (2015). Nocturnal light pollution and underexposure to daytime sunlight: Complementary mechanisms of circadian disruption and related diseases. Chronobiology International, 32(8), 1029–1048. http://doi.org/10.3109/07420528.2015.1072002

Düzgün, G., & Akyol, A. D. (2017). Effect of Natural Sunlight on Sleep Problems and Sleep Quality of the Elderly Staying in the Nursing Home. Holistic Nursing Practice, 31(5), 295–302. http://doi.org/10.1097/hnp.0000000000000206

Valham, F., Sahlin, C., Stenlund, H., & Franklin, K. A. (2012). Ambient Temperature and Obstructive Sleep Apnea: Effects on Sleep, Sleep Apnea, and Morning Alertness. Sleep, 35(4), 513–517. http://doi.org/10.5665/sleep.1736

Okamoto-Mizuno, K., Tsuzuki, K., & Mizuno, K. (2004). Effects of mild heat exposure on sleep stages and body temperature in older men. International Journal of Biometeorology, 49(1). http://doi.org/10.1007/s00484-004-0209-3

St-Onge, M.-P., & Shechter, A. (2014). Sleep disturbances, body fat distribution, food intake and/or energy expenditure: pathophysiological aspects. Hormone Molecular Biology and Clinical Investigation, 17(1). http://doi.org/10.1515/hmbci-2013-0066

Chaput, J.-P., Després, J.-P., Bouchard, C., & Tremblay, A. (2008). The Association Between Sleep Duration and Weight Gain in Adults: A 6-Year Prospective Study from the Quebec Family Study. Sleep, 31(4), 517–523. http://doi.org/10.1093/sleep/31.4.517

Dekker, S. A., Noordam, R., Biermasz, N. R., Roos, A., Lamb, H. J., Rosendaal, F. R., … Mutsert, R. (2018). Habitual Sleep Measures are Associated with Overall Body Fat, and not Specifically with Visceral Fat, in Men and Women. Obesity, 26(10), 1651–1658. http://doi.org/10.1002/oby.22289

Tunnicliffe, J. M., Erdman, K. A., Reimer, R. A., Lun, V., & Shearer, J. (2008). Consumption of dietary caffeine and coffee in physically active populations: physiological interactions. Applied Physiology, Nutrition, and Metabolism, 33(6), 1301–1310. http://doi.org/10.1139/h08-124

Mahoney, C. R., Giles, G. E., Marriott, B. P., Judelson, D. A., Glickman, E. L., Geiselman, P. J., & Lieberman, H. R. (2019). Intake of caffeine from all sources and reasons for use by college students. Clinical Nutrition, 38(2), 668–675. http://doi.org/10.1016/j.clnu.2018.04.004

Binks, H., Vincent, G. E., Gupta, C., Irwin, C., & Khalesi, S. (2020). Effects of Diet on Sleep: A Narrative Review. Nutrients, 12(4), 936. http://doi.org/10.3390/nu12040936

Rao, T. P., Ozeki, M., & Juneja, L. R. (2015). In Search of a Safe Natural Sleep Aid. Journal of the American College of Nutrition, 34(5), 436–447. http://doi.org/10.1080/07315724.2014.926153

Abbasi B, Kimiagar M, Sadeghniiat K, Shirazi MM, Hedayati M, Rashidkhani B. The effect of magnesium supplementation on primary insomnia in elderly: A double-blind placebo-controlled clinical trial. J Res Med Sci. 2012 Dec;17(12):1161-9. https://pubmed.ncbi.nlm.nih.gov/23853635/

Aspy, D. J., Madden, N. A., & Delfabbro, P. (2018). Effects of Vitamin B6 (Pyridoxine) and a B Complex Preparation on Dreaming and Sleep. Perceptual and Motor Skills, 003151251877032. http://doi.org/10.1177/0031512518770326

Parazzini F. Resveratrol, tryptophanum, glycine and vitamin E: a nutraceutical approach to sleep disturbance and irritability in peri- and post-menopause. Minerva Ginecol. 2015;67(1):1-5. https://pubmed.ncbi.nlm.nih.gov/25660429/

Siegel JM. The neurotransmitters of sleep. J Clin Psychiatry. 2004;65 Suppl 16:4-7. https://pubmed.ncbi.nlm.nih.gov/15575797/

Djeridane, Y., Touitou, Y. Chronic diazepam administration differentially affects melatonin synthesis in rat pineal and Harderian glands. Psychopharmacology154, 403–407 (2001). https://doi.org/10.1007/s002130000631

Betti L, Palego L, Demontis GC, Miraglia F, Giannaccini G. Hydroxyindole-O-methyltransferase (HIOMT) activity in the retina of melatonin-proficient mice. Heliyon. 2019;5(9):e02417. Published 2019 Sep 14. doi:10.1016/j.heliyon.2019.e02417

Haduch, A., Bromek, E., Wójcikowski, J., Gołembiowska, K., Daniel, W.. Melatonin Supports Serotonin Formation by Brain CYP2D. Drug Metabolism and DispositionMarch 1, 2016, 44 (3) 445-452; DOI: https://doi.org/10.1124/dmd.115.067413

Morton, D. J. (1987). Mechanism of Inhibition of Bovine Pineal Gland Hydroxyindole-O-Methyltransferase (EC 2.1.1.4) by Divalent Cations. Journal of Pineal Research, 4(3), 295–303. http://doi.org/10.1111/j.1600-079x.1987.tb00867.x

Markova-Car, E. P., Jurišić, D., Ilić, N., & Pavelić, S. K. (2014). Running for time: circadian rhythms and melanoma. Tumor Biology, 35(9), 8359–8368. http://doi.org/10.1007/s13277-014-1904-2

Slominski AT, Zmijewski MA, Skobowiat C, Zbytek B, Slominski RM, Steketee JD. Sensing the environment: regulation of local and global homeostasis by the skin’s neuroendocrine system. Adv Anat Embryol Cell Biol. 2012;212:v-115. doi:10.1007/978-3-642-19683-6_1 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3422784/

Chalupsky, K., Kračun, D., Kanchev, I., Bertram, K., & Görlach, A. (2015). Folic Acid Promotes Recycling of Tetrahydrobiopterin and Protects Against Hypoxia-Induced Pulmonary Hypertension by Recoupling Endothelial Nitric Oxide Synthase. Antioxidants & Redox Signaling, 23(14), 1076–1091. http://doi.org/10.1089/ars.2015.6329

Dianzani, I., Sanctis, L. D., Smooker, P. M., Gough, T. J., Alliaudi, C., Brusco, A., … Cotton, R. G. H. (1998). Dihydropteridine reductase deficiency: Physical structure of the QDPR gene, identification of two new mutations and genotype–phenotype correlations. Human Mutation, 12(4), 267–273. http://doi.org/10.1002/(sici)1098-1004(1998)12:4<267::aid-humu8>3.0.co;2-c

Nichol, C. A., Lee, C. L., Edelstein, M. P., Chao, J. Y., & Duch, D. S. (1983). Biosynthesis of tetrahydrobiopterin by de novo and salvage pathways in adrenal medulla extracts, mammalian cell cultures, and rat brain in vivo. Proceedings of the National Academy of Sciences, 80(6), 1546–1550. http://doi.org/10.1073/pnas.80.6.1546

Titus, F., Dávalos, A., Alom, J., & Codina, A. (1986). 5-Hydroxytryptophan versus Methysergide in the Prophylaxis of Migraine. European Neurology, 25(5), 327–329. http://doi.org/10.1159/000116030

Birdsall TC. 5-Hydroxytryptophan: a clinically-effective serotonin precursor. Altern Med Rev. 1998;3(4):271-280. https://pubmed.ncbi.nlm.nih.gov/9727088/

Volpi-Abadie J, Kaye AM, Kaye AD. Serotonin syndrome. Ochsner J. 2013;13(4):533-540. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3865832/

Valadas, J. S., Esposito, G., Vandekerkhove, D., Miskiewicz, K., Deaulmerie, L., Raitano, S., … Verstreken, P. (2018). ER Lipid Defects in Neuropeptidergic Neurons Impair Sleep Patterns in Parkinson’s Disease. Neuron, 98(6). http://doi.org/10.1016/j.neuron.2018.05.022

Chung SY, Moriyama T, Uezu E, et al. Administration of phosphatidylcholine increases brain acetylcholine concentration and improves memory in mice with dementia. J Nutr. 1995;125(6):1484-1489. doi:10.1093/jn/125.6.1484 https://pubmed.ncbi.nlm.nih.gov/7782901/

Montgomery, P., Burton, J. R., Sewell, R. P., Spreckelsen, T. F., & Richardson, A. J. (2014). Fatty acids and sleep in UK children: subjective and pilot objective sleep results from the DOLAB study – a randomized controlled trial. Journal of Sleep Research, 23(4), 364–388. http://doi.org/10.1111/jsr.12135

Alzoubi, K. H., Mayyas, F., & Zamzam, H. I. A. (2019). Omega-3 fatty acids protects against chronic sleep-deprivation induced memory impairment. Life Sciences, 227, 1–7. http://doi.org/10.1016/j.lfs.2019.04.028

Nasehi, M., Mosavi-Nezhad, S.-M., Khakpai, F., & Zarrindast, M.-R. (2018). The role of omega-3 on modulation of cognitive deficiency induced by REM sleep deprivation in rats. Behavioural Brain Research, 351, 152–160. http://doi.org/10.1016/j.bbr.2018.06.002

Jahangard, L., Sadeghi, A., Ahmadpanah, M., Holsboer-Trachsler, E., Bahmani, D. S., Haghighi, M., & Brand, S. (2018). Influence of adjuvant omega-3-polyunsaturated fatty acids on depression, sleep, and emotion regulation among outpatients with major depressive disorders – Results from a double-blind, randomized and placebo-controlled clinical trial. Journal of Psychiatric Research, 107, 48–56. http://doi.org/10.1016/j.jpsychires.2018.09.016

Scorza, F. A., Cavalheiro, E. A., Scorza, C. A., Galduróz, J. C. F., Tufik, S., & Andersen, M. L. (2013). Sleep Apnea and Inflammation – Getting a Good Night’s Sleep with Omega-3 Supplementation. Frontiers in Neurology, 4. http://doi.org/10.3389/fneur.2013.00193

Hansen, A. L., Dahl, L., Olson, G., Thornton, D., Graff, I. E., Frøyland, L., … Pallesen, S. (2014). Fish Consumption, Sleep, Daily Functioning, and Heart Rate Variability. Journal of Clinical Sleep Medicine, 10(05), 567–575. http://doi.org/10.5664/jcsm.3714

Xie, L., Kang, H., Xu, Q., Chen, M. J., Liao, Y., Thiyagarajan, M., … Nedergaard, M. (2013). Sleep Drives Metabolite Clearance from the Adult Brain. Science, 342(6156), 373–377. http://doi.org/10.1126/science.1241224

Varshavsky, A. (2012). Augmented generation of protein fragments during wakefulness as the molecular cause of sleep: a hypothesis. Protein Science, 21(11), 1634–1661. http://doi.org/10.1002/pro.2148

Mackiewicz, M., Shockley, K. R., Romer, M. A., Galante, R. J., Zimmerman, J. E., Naidoo, N., … Pack, A. I. (2007). Macromolecule biosynthesis: a key function of sleep. Physiological Genomics, 31(3), 441–457. http://doi.org/10.1152/physiolgenomics.00275.2006

Scharf, M. T., Naidoo, N., Zimmerman, J. E., & Pack, A. I. (2008). The energy hypothesis of sleep revisited. Progress in Neurobiology, 86(3), 264–280. http://doi.org/10.1016/j.pneurobio.2008.08.003

Horne, J. (2009). REM sleep, energy balance and ‘optimal foraging.’ Neuroscience & Biobehavioral Reviews, 33(3), 466–474. http://doi.org/10.1016/j.neubiorev.2008.12.002

Berger, R. J., & Phillips, N. H. (1995). Energy conservation and sleep. Behavioural Brain Research, 69(1-2), 65–73. http://doi.org/10.1016/0166-4328(95)00002-b

Benington, J. H., & Heller, H. C. (1995). Restoration of brain energy metabolism as the function of sleep. Progress in Neurobiology, 45(4), 347–360. http://doi.org/10.1016/0301-0082(94)00057-o

Abel, T., Havekes, R., Saletin, J. M., & Walker, M. P. (2013). Sleep, Plasticity and Memory from Molecules to Whole-Brain Networks. Current Biology, 23(17). http://doi.org/10.1016/j.cub.2013.07.025

Rasch, B., & Born, J. (2013). About Sleeps Role in Memory. Physiological Reviews, 93(2), 681–766. http://doi.org/10.1152/physrev.00032.2012

Cirelli, C., & Tononi, G. (2008). Is Sleep Essential? PLoS Biology, 6(8). http://doi.org/10.1371/journal.pbio.0060216

Siegel, J. M. (2005). Clues to the functions of mammalian sleep. Nature, 437(7063), 1264–1271. http://doi.org/10.1038/nature04285

Campbell, S. S., & Tobler, I. (1984). Animal sleep: A review of sleep duration across phylogeny. Neuroscience & Biobehavioral Reviews, 8(3), 269–300. http://doi.org/10.1016/0149-7634(84)90054-x

Tobler, I. (1995). Is sleep fundamentally different between mammalian species? Behavioural Brain Research, 69(1-2), 35–41. http://doi.org/10.1016/0166-4328(95)00025-o

Tononi, G., & Cirelli, C. (2006). Sleep function and synaptic homeostasis. Sleep Medicine Reviews, 10(1), 49–62. http://doi.org/10.1016/j.smrv.2005.05.002

Dongen, H. P. A. V., Vitellaro, K. M., & Dinges, D. F. (2005). Individual Differences in Adult Human Sleep and Wakefulness: Leitmotif for a Research Agenda. Sleep, 28(4), 479–498. http://doi.org/10.1093/sleep/28.4.479

Vyazovskiy, V. V., & Delogu, A. (2014). NREM and REM Sleep. The Neuroscientist, 20(3), 203–219. http://doi.org/10.1177/1073858413518152

Mignot, E. (2008). Why We Sleep: The Temporal Organization of Recovery. PLoS Biology, 6(4). http://doi.org/10.1371/journal.pbio.0060106

Siegel, J. M. (2009). Sleep viewed as a state of adaptive inactivity. Nature Reviews Neuroscience, 10(10), 747–753. http://doi.org/10.1038/nrn2697

Horne, J. (2000). REM sleep — by default? Neuroscience & Biobehavioral Reviews, 24(8), 777–797. http://doi.org/10.1016/s0149-7634(00)00037-3

Baran, B., Pace-Schott, E. F., Ericson, C., & Spencer, R. M. C. (2012). Processing of Emotional Reactivity and Emotional Memory over Sleep. Journal of Neuroscience, 32(3), 1035–1042. http://doi.org/10.1523/jneurosci.2532-11.2012

Tononi, G., & Cirelli, C. (2014). Sleep and the Price of Plasticity: From Synaptic and Cellular Homeostasis to Memory Consolidation and Integration. Neuron, 81(1), 12–34. http://doi.org/10.1016/j.neuron.2013.12.025

Li, J., Vitiello, M. V., & Gooneratne, N. S. (2018). Sleep in Normal Aging. Sleep Medicine Clinics, 13(1), 1–11. http://doi.org/10.1016/j.jsmc.2017.09.001

Murillo-Rodriguez, E., Arias-Carrion, O., Zavala-Garcia, A., Sarro-Ramirez, A., & Huitron-Resendiz, S. (2012). Basic Sleep Mechanisms: An Integrative Review. Central Nervous System Agents in Medicinal Chemistry, 12(1), 38–54. http://doi.org/10.2174/187152412800229107

Weber, F. D. (2018). Sleep: Eye-Opener Highlights Sleep’s Organization. Current Biology, 28(5). http://doi.org/10.1016/j.cub.2018.01.054

Yetton, B. D., Mcdevitt, E. A., Cellini, N., Shelton, C., & Mednick, S. C. (2018). Quantifying sleep architecture dynamics and individual differences using big data and Bayesian networks. Plos One, 13(4). http://doi.org/10.1371/journal.pone.0194604

Colrain, I. M., Nicholas, C. L., & Baker, F. C. (2014). Alcohol and the sleeping brain. Handbook of Clinical Neurology Alcohol and the Nervous System, 415–431. http://doi.org/10.1016/b978-0-444-62619-6.00024-0

Zisapel, N. (2018). New perspectives on the role of melatonin in human sleep, circadian rhythms and their regulation. British Journal of Pharmacology, 175(16), 3190–3199. http://doi.org/10.1111/bph.14116

Tosini, G., Baba, K., Hwang, C. K., & Iuvone, P. M. (2012). Melatonin: An underappreciated player in retinal physiology and pathophysiology. Experimental Eye Research, 103, 82–89. http://doi.org/10.1016/j.exer.2012.08.009

Blasiak, J., Reiter, R. J., & Kaarniranta, K. (2016). Melatonin in Retinal Physiology and Pathology: The Case of Age-Related Macular Degeneration. Oxidative Medicine and Cellular Longevity, 2016, 1–12. http://doi.org/10.1155/2016/6819736

Bellingham, J., Chaurasia, S. S., Melyan, Z., Liu, C., Cameron, M. A., Tarttelin, E. E., … Lucas, R. J. (2006). Evolution of Melanopsin Photoreceptors: Discovery and Characterization of a New Melanopsin in Nonmammalian Vertebrates. PLoS Biology, 4(8). http://doi.org/10.1371/journal.pbio.0040254

Zaidi, F. H., Hull, J. T., Peirson, S. N., Wulff, K., Aeschbach, D., Gooley, J. J., … Lockley, S. W. (2007). Short-Wavelength Light Sensitivity of Circadian, Pupillary, and Visual Awareness in Humans Lacking an Outer Retina. Current Biology, 17(24), 2122–2128. http://doi.org/10.1016/j.cub.2007.11.034

Legates, T. A., Altimus, C. M., Wang, H., Lee, H.-K., Yang, S., Zhao, H., … Hattar, S. (2012). Aberrant light directly impairs mood and learning through melanopsin-expressing neurons. Nature, 491(7425), 594–598. http://doi.org/10.1038/nature11673

Sikka, G., Hussmann, G. P., Pandey, D., Cao, S., Hori, D., Park, J. T., … Berkowitz, D. E. (2014). Melanopsin mediates light-dependent relaxation in blood vessels. Proceedings of the National Academy of Sciences, 111(50), 17977–17982. http://doi.org/10.1073/pnas.1420258111

Buhr, E. D., Yoo, S.-H., & Takahashi, J. S. (2010). Temperature as a Universal Resetting Cue for Mammalian Circadian Oscillators. Science, 330(6002), 379–385. http://doi.org/10.1126/science.1195262

Robbins, R., Grandner, M. A., Buxton, O. M., Hale, L., Buysse, D. J., Knutson, K. L., … Jean-Louis, G. (2019). Sleep myths: an expert-led study to identify false beliefs about sleep that impinge upon population sleep health practices. Sleep Health, 5(4), 409–417. http://doi.org/10.1016/j.sleh.2019.02.002

Damiola, F. (2000). Restricted feeding uncouples circadian oscillators in peripheral tissues from the central pacemaker in the suprachiasmatic nucleus. Genes & Development, 14(23), 2950–2961. http://doi.org/10.1101/gad.183500

Abel, T., Havekes, R., Saletin, J. M., & Walker, M. P. (2013). Sleep, Plasticity and Memory from Molecules to Whole-Brain Networks. Current Biology, 23(17). http://doi.org/10.1016/j.cub.2013.07.025

Muzet, A., Ehrhart, J., Candas, V., Libert, J. P., & Vogt, J. J. (1983). Rem Sleep and Ambient Temperature in Man. International Journal of Neuroscience, 18(1-2), 117–125. http://doi.org/10.3109/00207458308985885

Saini, C., Morf, J., Stratmann, M., Gos, P., & Schibler, U. (2012). Simulated body temperature rhythms reveal the phase-shifting behavior and plasticity of mammalian circadian oscillators. Genes & Development, 26(6), 567–580. http://doi.org/10.1101/gad.183251.111

Franco P, Szliwowski H, Dramaix M, Kahn A. Influence of ambient temperature on sleep characteristics and autonomic nervous control in healthy infants. Sleep. 2000 May 1;23(3):401-7. https://pubmed.ncbi.nlm.nih.gov/10811384/

Libert JP, Candas V, Muzet A, Ehrhart J. Thermoregulatory adjustments to thermal transients during slow wave sleep and REM sleep in man. J Physiol (Paris). 1982;78(3):251-7 https://pubmed.ncbi.nlm.nih.gov/7166740/

Palca, J. W., Walker, J. M., & Berger, R. J. (1986). Thermoregulation, metabolism, and stages of sleep in cold-exposed men. Journal of Applied Physiology, 61(3), 940–947. http://doi.org/10.1152/jappl.1986.61.3.940

Lack. (2009). Chronotype differences in circadian rhythms of temperature, melatonin, and sleepiness as measured in a modified constant routine protocol. Nature and Science of Sleep, 1. http://doi.org/10.2147/nss.s6234

Samson, D. R., Crittenden, A. N., Mabulla, I. A., Mabulla, A. Z. P., & Nunn, C. L. (2017). Chronotype variation drives night-time sentinel-like behaviour in hunter–gatherers. Proceedings of the Royal Society B: Biological Sciences, 284(1858), 20170967. http://doi.org/10.1098/rspb.2017.0967

Walker, R. J., Kribs, Z. D., Christopher, A. N., Shewach, O. R., & Wieth, M. B. (2014). Age, the Big Five, and time-of-day preference: A mediational model. Personality and Individual Differences, 56, 170–174. http://doi.org/10.1016/j.paid.2013.09.003

Bjorness, T., & Greene, R. (2009). Adenosine and Sleep. Current Neuropharmacology, 7(3), 238–245. http://doi.org/10.2174/157015909789152182

Dworak, M., Diel, P., Voss, S., Hollmann, W., & Strüder, H. (2007). Intense exercise increases adenosine concentrations in rat brain: Implications for a homeostatic sleep drive. Neuroscience, 150(4), 789–795. http://doi.org/10.1016/j.neuroscience.2007.09.062

Rainnie, D., Grunze, H., Mccarley, R., & Greene, R. (1994). Adenosine inhibition of mesopontine cholinergic neurons: implications for EEG arousal. Science, 263(5147), 689–692. http://doi.org/10.1126/science.8303279

Daly, J. W., Shi, D., Nikodijevic, O., & Jacobson, K. A. (1994). The role of adenosine receptors in the central action of caffeine. Pharmacopsychoecologia, 7(2), 201–213. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4373791/

Author

  • Paddy Farrell

    Hey, I'm Paddy!

    I am a coach who loves to help people master their health and fitness. I am a personal trainer, strength and conditioning coach, and I have a degree in Biochemistry and Biomolecular Science. I have been coaching people for over 10 years now.

    When I grew up, you couldn't find great health and fitness information, and you still can't really. So my content aims to solve that!

    I enjoy training in the gym, doing martial arts, hiking in the mountains (around Europe, mainly), drawing and coding. I am also an avid reader of philosophy, history, and science. When I am not in the mountains, exercising or reading, you will likely find me in a museum.

    View all posts