Exercise is Medicine:

The influence of acute and chronic

exercise on sleep
Holly Reid
EPHE 441 - Exercise Physiology

Introduction
Eutherian mammals spend approximately 1/3rd of a lifetime asleep (Benington & Heller,
1995), suggesting that sleep is fundamental to mammalian physiology, although an exact purpose
remains unclear. Observing the debilitating and even lethal effects in both humans and animals as
a result of sleep deprivation offers evidence that there is a physiological need for sleep
(Benington & Heller, 1995). One suggestion for the purpose of sleep is to restore physiological
homeostasis as it is disrupted throughout the day, and is difficult to restore while awake and
moving (Benington & Heller, 1995). It has also been suggested that sleep plays a key role in
memory consolidation, as Diekelmann and Born (2010) found that a lack of slow-wave sleep
(SWS) inhibited the consolidation and later retrieval of memories after learning sessions.
Additionally, sleep may provide a means of energy conservation, as it allows a reduction in
energy expenditure to below what is attainable during awake, resting levels (Shams, Kamrani,
Dehkordi, & Mohajeri, 2013). Lack of or interrupted sleep has also shown to affect melatonin
production, metabolism, immunity, cognition and quality of life (Wu, Kwong & Jiang, 2015).
Sleep habits and quality vary throughout a life-time, however it is relatively common to
develop sleep disorders or difficulties, especially with age (Wu et al., 2015). The most common
sleep disorders include sleep apnea, restless leg syndrome, and insomnia; while other sleep
related issues include difficulty falling asleep, night time and early morning awakening, and the
need for napping (Wu et al., 2015). Sleep disorders increase the risk for weight gain, obesity, and
a sedentary lifestyle, which in turn worsen the severity of the sleep disorder (Tan, Saarinen,
Mikkola, Tenhunen, Matinmaki, Rahikainen & Cheng, 2013). A lack of sleep is often
accompanied by chronic fatigue, and may lead to a decline in mental health and well-being,
particularly when combined with inactivity (Tan et al., 2013). There are many interventions

which aim to improve sleep, however majority are expensive, impractical, and may have
negative side effects. Exercise is an accessible, affordable and relatively safe alternative
approach to improving sleep, and has been shown to be effective for many sleep disorders and
the accompanying symptoms.
The sleep cycle is ultimately controlled by the circadian rhythm, which receives input
from the pineal gland through the secretion of melatonin (Cajochen, Krauchi & Wirz-Justice,
2003). The circadian rhythm enables adaptation to the light-dark cycles created by the rotation of
the earth, and is controlled through a negative feedback loop (Mogi, Yokoi, & Suzuki, 2015).
One cycle of the circadian rhythm corresponds to the 24-hour cycle mediated by the
suprachiasmatic nucleus (SCN), which receives input from the retina (Mogi et al., 2015). When
photoreceptors on the retina detect light, they generate a signal which is transmitted to the SCN
via the retinohypothalamic tract (Mogi et al., 2015). Once the SCN has received an excitatory
signal from the retina, it sends an inhibitory signal to the pineal gland to stop the secretion of
melatonin (David, Potora & Popa, 2015). When the photoreceptors stop detecting any light, the
pineal gland receives an excitation signal through the same pathway, and melatonin secretion is
initiated (Mogi et al., 2015). Support for the role of melatonin in sleep is demonstrated by the
effect of administering melatonin and observing the changes which take place. Melatonin
supplementation has shown to effectively induce sleep when sleep drive is insufficient, inhibit
the drive for wakefulness, and induce a phase shift leading to sleep drive occurring at a new time
(Cajochen et al., 2003). Melatonin secretion changes depending on environmental stress, body
temperature, and factors that alter sympathetic nervous system activity (David et al., 2015).
Melatonin secretion is inversely related to core body temperature, and can be observed in
the thermoregulatory cascade which occurs at circadian rhythm phase shifts, typically in the

evening (Cajochen et al., 2003). This cascade begins with a rise of melatonin secretion from the
pineal gland, and is accompanied by a decrease in heat production and an increase in heat
dissipation (Cajochen et al., 2003). However, a rise and subsequent fall in core body temperature
can stimulate melatonin secretion at a time when there isnt a circadian rhythm shift (Cajochen et
al., 2003), suggesting it is also respondent to temperature changes independent of time of day.
Since exercise is known to increase core body temperature, it becomes evident that there is likely
an accompanying change in melatonin levels during and after an exercise session which may
alter sleep.
Meditative Movements
An area that has recently received attention for the benefits on sleep is that of meditative
movements such as tai chi, qi gong, and yoga (Wu et al., 2015). Meditative movement
incorporates light physical activity with relaxation and deep breathing, with an aim to decrease
tension, and promote full body relaxation through slow and controlled movement (Wu et al.,
2015). A recent study by Wu and colleagues found that meditative movement practices done a
minimum of 3 times per week resulted in significantly better sleep scores compared to those who
maintained their usual therapy (2015). However, the results showed that additional sessions
didnt offer further improvements to sleep quality or duration. Meditative movement
incorporates breathing exercises such as holding of the breath at the top of the inhale, followed
by a prolonged exhalation. Controlled, slow breathing stimulates the vagal nerve, which
increases parasympathetic nervous system (PNS) activity, and decreases sympathetic nervous
system activity (SNS), leading to a state of relaxation (Derrow, 2016). In addition, mindful
breathing leads to a transition in brain wave frequency from beta waves, which are associated
with alertness, to theta and delta waves which are associated with relaxed states and deep sleep

(Derrow, 2016). The combined effects of increased PNS activity, decreased SNS activity, and the
transition of brain wave frequency may then lead to an easier transition into sleep (Derrow,
2016). Poor sleep quality has been associated with a lack of slow wave sleep (SWS), therefore
meditative movement practices may provide an effective means of transitioning to and spending
more time in SWS (Wu et al., 2015). Research has mainly focused on the acute responses to
meditative movement mentioned above, and further research is needed to understand the chronic
effects on sleep. Meditative movement practices are an affordable and accessible way to improve
sleep by altering autonomic nervous system function without a direct influence on melatonin
activity (Derrow, 2016).
Strength Training
Age appears to play a major role in declining sleep quality, as sleep disorders are most
common in older populations, particularly obstructive sleep apnea (OSA) (Wu et al., 2015).
There are three suggested mechanisms responsible for the decrease in pulmonary function and
increased risk of OSA with age, including: decreased lung recoil, decreased chest wall
compliance, and decreased strength of respiratory muscles (Herrick, Bliwise, Puri, Rogers &
Richards, 2014). Strength training programs have shown to improve sleep duration and overall
sleep quality, particularly in those suffering from OSA (Richards, Lambert, Beck, Bliwise,
Evans, Kalra & Sullivan, 2011). A recent study by Richards et al. investigated how a 7 week
resistance training program influenced sleep in elderly patients in an assisted living facility, 46%
of whom had OSA (2011). Results indicated that those in the exercise intervention group showed
a significant increase in total sleep time and less nocturnal awakenings compared to the control
group. A similar study also using a 7 week resistance training program found a decrease in OSA
severity by 17%, which in turn led to improved sleep quality as there were less sleep

interruptions due to improved breathing ability (Herrick et al., 2014). The decreased severity of
OSA was accompanied by no change in body mass index (BMI), suggesting that weight loss was
not a contributing factor to improved sleep (Richards et al., 2011; Herrick et al., 2014).
Endurance & Aerobic Exercise
Aerobic and endurance exercise may be a more accessible and user-friendly alternative to
strength training, particularly for those who face financial or personal barriers to accessing
facilities. Aerobic exercise sessions have shown to be effective in improving sleep over the
course of an 8 week intervention, consisting of 2 sessions per week lasting 35 minutes (Shams, et
al., 2013). Participants were assigned to a low intensity group (40-50% HR max), a moderate
intensity group (60-70% HRmax) or a control group. Results showed the moderate intensity group
had significantly better sleep quality than both the control and the low intensity groups. In
addition, the low intensity group showed improvement in sleep quality over the control group,
although the improvements were not statistically significant. These findings suggest that
exercising for 35 minutes twice per week at a moderate intensity can improve sleep quality
(Shams et al., 2013). Aerobic exercise appears to have a substantial role in improving sleep for
those suffering from insomnia, as indicated by the results of a 16 week exercise intervention
(Reid, Baron, Lu, Naylor, Wolfe & Lee, 2010). Participants completed a 4-6 week preconditioning period in which they increased the intensity each week until they could exercise at
75% HRmax for longer than 20 minutes. After the conditioning phase, participants were assigned
40 minutes of aerobic exercise 4 days per week at an intensity of 75% HR max for the duration of
the 16 week study. Participants chose to walk outside, on a treadmill, or ride a stationary bicycle,
and the sessions were required to be within the times of 1:00pm-7:00pm. Results indicated a

significant improvement in sleep quality scores, total time sleeping, and decreased sleep onset
latency.
It becomes evident that meditative movement practices, strength training and aerobic
exercise all show improvements in various components of sleep. Although the type of activity is
different, the acute and chronic physiological mechanisms responsible for the sleep adaptations
are markedly similar.
Physiological Mechanisms
Acute Exercise
A widely suggested mechanism responsible for the changes in sleep function resulting
from acute exercise is the thermoregulation hypothesis. There is a direct relationship between
body temperature and melatonin levels, such that as core temperature decreases, plasma
melatonin levels increase (Buxton, L'Hermite-Baleriaux Hirschfeld, & Van Cauter, 1997). Body
temperature is tightly synced to circadian rhythm phase shifts, and typically decreases in the
evening, accompanied by the rise in plasma melatonin levels (Cajochen et al., 2003). The
thermoregulation hypothesis postulates that since acute exercise increases core body
temperature, it then initiates the subsequent thermogenic response to reduce core temperature
(Taylor, 2001). This appears to mimic the sleep-onset temperature reduction which occurs during
circadian rhythm phase shift. Due to the relationship between temperature and circadian rhythm
shifts, it is important to consider the timing of exercise sessions when using exercise as a method
to alter sleep quality. A study by Buxton et al., investigated the acute and delayed effects of
exercise on melatonin secretion, and the role that time of day played (1997). Results revealed
that late evening exercise when melatonin levels were naturally rising stopped the levels from

rising further. These findings suggest that exercising in the evening may interfere with the natural
melatonin secretion which occurs during the evening circadian rhythm phase. The researchers
suggested this may be due to the increase in core body temperature occurring too close to bed
time, and the body is then unable to initiate the thermogenic response effectively enough to
increase sleep drive (Buxton et al., 1997). A similar hypothesis for why acute exercise improves
sleep quality is the increase in peripheral blood flow, which creates a heat gradient between core
temperature and distal skin temperature (Cajochen et al., 2003). During the circadian rhythm
phase shift in the evening there is a natural increase in blood flow to distal skin regions, which
has been suggested to be mimicked by exercise induced sweating (Cajochen et al., 2003). This
increase in blood flow allows a greater heat dissipation and corresponding increase in plasma
melatonin levels (Cajochen et al., 2003). There appears to not only be a response following an
exercise session, but also a change in melatonin secretion during exercise (David, et al., 2015).
Researchers investigated the immediate effects of exercise on melatonin, and found an increase
in melatonin levels for the duration of the exercise session and continuing afterwards.
Furthermore, results indicated that day time exercise sessions led to faster phase shifts during the
next circadian rhythm shift, leading researchers to suggest that exercise plays a role in
accelerating entrainment of new sleep schedules. This suggests those with shift work may be able
to adapt more efficiently to adjustments of the circadian rhythm by exercising (David et al.,
2015). Sleep conservation theory offers an alternative to the thermoregulation hypothesis. This
theory suggests that sleep reduces energy expenditure below attainable resting levels, which is
necessary to balance the energy budget (Shams et al., 2013). Since exercise increases metabolic
expenditure to a large extent, there is an increase in subsequent sleep drive to promote energy
preservation (Shams et al., 2013).

Chronic Exercise
Chronic exercise programs have shown beneficial effects on sleep, although a clear
mechanism has not been agreed upon by researchers. Suggested mechanisms include
psychological, physical, and chemical adaptations which lead to improved sleep quality.
In a study of athletes and non-athletes, the athletes reported having better sleep patterns
including quality, onset latency, fewer awakenings, and feeling less tired than non-athletes
(Brand, Gerber, Beck, Hatzinger, Puhse & Holsboer-Trachsler, 2010). It was suggested that
having a scheduled exercise and sleep routine may benefit homeostatic sleep regulation and
circadian rhythm due to psychological adaptations (Brand et al., 2010). By enforcing a regulated
schedule of exercising and sleeping, perhaps athletes have better sleep as a result of habitual
practice.
One suggested reason for the reduction in OSA severity and the improved sleep quality as
a result of exercise is suggested to be due to an increase in respiratory muscle strength (Herrick
et al., 2014). In addition, sedentary lifestyles are associated with inflammation and fluid
accumulation, which leads to worsening of OSA and sleep quality (Iftikhar, Kline & Youngstetd,
2014). Therefore, exercise may reduce OSA severity and improve sleep quality by reducing
inflammation and fluid accumulation, particularly near respiratory areas (Iftikhar et al., 2014). In
addition, chronic exercise has shown to improve the amount of time spent in slow wave sleep,
which has been suggested to be due to the adjustment of the circadian rhythm as a result of a
consistent timing of exercise sessions (Souissi, Chtourour, Zrane, Cheikh, Dogui Tabka, &
Souissi, 2012).
Contraindications & Guidelines

Any new exercise program poses potential risks to participants, particularly those with
compromised health. Contraindications include the risk of overtraining, injury, and worsened
sleep quality. The best approach for an effective exercise program for improving sleep quality is
one that is prescribed specifically for the participant, and is tailored to match their abilities and
needs. The Canadian Sleep Society suggests starting with 30 minute exercise sessions 3-6 hours
before bed, and observing the changes in sleep quality (2004).
Technological Interventions
Technology is often thought to have detrimental effects on sleep, however, in some cases
there are benefits to using the right type of technology. Currently there are many different videos
and audio recordings which offer guided relaxation techniques to help with falling asleep and
promoting full body relaxation before bed. More recently there have been several applications
developed for electronic devices, which alter the light being displayed by the screen. Humans
have been shown to have high sensitivity to short wavelengths, as it negatively alters melatonin
secretion, alertness, thermoregulation and heart rate; all of which play a key role in sleep
(Cajochen, Munch, Kobialka, Krauchi, Steiner, Oelhafen & Wirz-Justice, 2005). Flux and
Twilight are two common apps which remove the short wavelength (blue light) from the visible
light spectrum emitted by the device. Blue light has shown to have an inhibitory effect on
melatonin secretion, which can have negative effects on sleep, particularly if exposure occurs
close to the nocturnal circadian rhythm shift (West, Jablonski, Warfield, Cecil, James Ayers &
Hanifin, 2011).
Pharmacological Interventions

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Sleep disorders and disturbances are often treated with a medicinal approach, such as
over the counter sleep aids, antihistamines, or other sleep inducing substances. However,
medications often have unwanted side effects and may have addictive properties (Ozdemir,
Karadag, Selvi, Boysan, Bilgili, Aydin & Onder, 2014). Allergy medications that contain
antihistamines have shown to effectively improve sleep quality and duration, but may lead to
mood disturbances and unpredictable daytime fatigue (Ozdemir et al., 2014). Supplementing
with synthetic melatonin is a more natural approach since melatonin naturally exists within the
body. However, consuming melatonin on a regular basis to improve sleep may reduce the bodys
natural ability to produce and secrete melatonin appropriately with circadian rhythm phase shifts
(Cajochen et al., 2003).
There are many methods of treating sleep disorders and disturbances which show to be
effective in improving the quality and quantity of sleep. Those who suffer from sleep problems
are often seeking a solution that will offer immediate improvements in sleep, as it is difficult to
be productive while suffering from sleep deprivation. Exercise appears to be a solution which
improves sleep in as little as one session, whether the style of exercise is meditative practice,
aerobic/endurance, or resistance training. In addition, exercise is a low cost, accessible treatment
that is accompanied by a very low risk of negative side effects or contraindications. Sleep greatly
varies between individuals, and the best method of exercise will be different for everyone.
Therefore it is best to begin with a few sessions per week several hours before bed, and noting
any changes in sleep quality. Adjustments can then be made to the exercise program, and
additional resources such as audio recordings of progressive relaxation may need to be added.
The best approach for improved sleep quality is likely a combination of exercise, stress
reduction, and developing an effective sleep routine.

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