More Time In Bed Boosts Basketball Performance

Looking for that extra edge on the basketball court?  Want to increase your free throw percentage and gain an extra step in quickness?  Is it a new performance enhancing drug or training technique?  No, a new study suggests it may be as easy as spending a few extra hours in bed.

Cheri Mah and colleagues from Stanford University and the University of California, San Francisco recently published their research on sleep and athletic performance in the journal Sleep.  They introduce the study by noting that extensive research documents the adverse effect of limited sleep.  However, little research examines the effect of increased sleep on performance.  Their study objective was to do just that.

Members of the Stanford University mens basketball team were recruited for the study.  The study took place over two seasons and included a baseline period of usual sleep patterns.  Then the intervention group extended their sleep pattern with a goal of a minimum of 10 hours in bed daily.

Compliance with this intervention was measured through sleep journals and actigraphy.  Actigraphy is accomplished by a wrist device that is worn and measures movement.  From this data the total sleep time can be estimated.  Sleep journal data and activity data estimated the increase in total daily sleep time to be between 100 and 150 minutes of additional sleep during the intervention period.

Athletes in the intervention groups were tested on a variety of psychometric and basketball performance skills during the baseline and intervention period.  The results of the intervention were pretty impressive.  Here is a summary of the improvement noted in the study:

• Free throw percentage increased by 11%
• Three point percentage increased by 14%
• Sprint test time decreased by 4%

Other psychometric variables were improved including a reduction in time on the Psychomotor Vigilance Task, a reduction in the Epworth Sleepiness Scale score and improvement on multiple components of the Profile of Mood States including ratings of fatigue, depression and tension.

The authors note the study has some significant limitations in research design.  Only eleven athletes received the intervention.  Subjects were not blinded as to the intervention and it is possible a some of the improvement came from an expectancy effect.  Travel schedules made it difficult to assure compliance with the 10 hours in bed intervention for every day of the study.

However, this study does suggest that many athletes may be performing in the context of ongoing sleep deprivation.  Forcing compliance with an extended sleep duration holds promise of improving performance on the basketball court.  This effect appears to occur in the context of subjective improvement in psychological function.

If I were an NCAA basketball athlete, I would send a copy of this study to my coach and training staff.  Athletes now have some research to support the importance of getting plenty of sleep to achieve peak performance.

Photo of Los Angeles Clipper Player Blake Griffin Shooting Free Throw Courtesy of Tim Yates

Mah CD, Mah KE, Kezirian EJ, & Dement WC (2011). The Effects of Sleep Extension on the Athletic Performance of Collegiate Basketball Players. Sleep, 34 (7), 943-950 PMID: 21731144

ADHD and the Athlete

Athletes are not spared from the risk of developmental disorders like learning disabilities and attention deficit hyperactivity disorder (ADHD).  Once an athlete is diagnosed with ADHD, the effect of this disorder and it's treatment on athletic performance becomes important.  

Dr. J. W. Parr recently published a comprehensive review of recent research and understanding of ADHD in the athlete.   The review includes a look at diagnostic issues as well as a summary of the neurobiology of ADHD.  After this general introduction, the review focuses on some key issues in athletes with ADHD.


Although some children with ADHD have motor performance problems the majority do not.  The effect of ADHD on athletic performance is somewhat related to individual sporting activity.  ADHD may be more of a sport performance problem in sports requiring prolonged attention, i.e. fencing and less of a problem in large muscle performance sports such as swimming and track and field.  Indeed, some of the world's most successful athletes have been diagnosed with ADHD.  Parr notes that multiple Olympic gold medal winner Michael Phelps has made it publicly known he has ADHD.


Additionally, Parr notes that ADHD appears to be as common in athletes as in the general population.  Using his unpublished observations of athletes at Texas A & M University, he estimates that 7 to 9% of all athletes are receiving stimulant and nonstimulant medications for ADHD.  Given the estimated community prevalence of ADHD at 4 to 7%, the prevalence of ADHD medication use in the Texas A & M athlete population suggests a prevalence at least as high as the general population.

Parr reviews the risk of substance abuse with stimulant medication.  He notes that the oral stimulant drugs in ADHD typically lack significant euphoric effects found with intravenous stimulant illicit drug use (i.e. cocaine or methamphetamine). 


There is increasing research examining the effect of ADHD stimulant drug use and performance.  Acute administration of methylphenidate or placebo to a group of cyclists (without ADHD) resulted in prolonged peak performance.   Whether chronic administration of stimulants in those with ADHD improves performance in unclear.  However, there is some data that supports a drop in motor performance in athletes with ADHD on days they skip or miss their ADHD medication.

Athletes commonly develop a pattern of dosing their medication in a manner that accommodates their sporting activity and perceived effects of medication on performance.  Parr notes this is somewhat of an individual decision.  He notes some baseball pitchers that always use their ADHD medications on days they are charting pitches but many do not take it before days they actually pitch.


Dr. Parr does not recommend routine EKG testing of athletes taking medication for ADHD.  He feels that there is no data to support an increased risk of cardiac death in athletes with ADHD on stimulant treatment.  However, he does note one area of medical concern with athletes using ADHD medications.  Some stimulants may impair thermoregulation and increase the risk of heat exhaustion or heat stroke.  He notes physicians and trainers should make sure to provide athletes with ADHD adequate hydration and increased surveillance for heat-related illness.

Many college athletes with ADHD are diagnosed at an early age.  Dr. Parr recommends all college level athletes receiving ADHD drugs submit a copy of the prescribing physicians assessment and treatment recommendations.  The NCAA recommends student athlete documentation in ADHD include:

• Comprehensive clinical evaluation
• Observations and results from ADHD rating scales
• Specific diagnosis
• Recommended treatment

Such prior documentation is necessary should an athlete test positive for a stimulant on urine drug testing.  Disclosure of stimulant use for medical reasons at the time of submitting a urine sample and prior documentation will be needed to address any positive urine drug test results.

This review of ADHD in the athlete is well-written and information for physicians, trainers and other medical staff working in a sports medicine setting.

Photo of 2011 Spring Training game between St. Louis Cardinals and Minnesota Twins in Jupiter, Florida courtesy of Yates photography. 

Parr JW (2011). Attention-deficit hyperactivity disorder and the athlete: new advances and understanding. Clinics in sports medicine, 30 (3), 591-610 PMID: 21658550