Behavioral interventions and behavior change techniques used to improve sleep outcomes in athlete populations: A scoping review

Figures & data

Table 1. Study inclusion criteria using the population, concept, context framework.

Study Component	Inclusion	Exclusion
Population	Athletes currently engaged in sport at any level from trained/developmental to world class (Tier 2–5 of McKay et al. (2022) framework)* Mean age ≥18 years	Non-athlete population, para-athlete* Participants inclusion contingent on diagnosed sleep disorder at baseline
Concept	Prospective sleep intervention with ≥ 1 behavioral component Report ≥1 sleep outcome pre- and post-intervention, no restriction on type of outcome	Intervention including medication or pharmacological component Intervention including circadian realignment following travel between time zones Outcomes related to, but not directly assessing, sleep (e.g., daytime sleepiness or attention)
Context	No restriction on context or setting
Types of sources	Experimental and quasi-experimental study designs	Descriptive observational study designs, qualitative studies, and text and opinion papers Systematic reviews, meta-analyses and other review types Any gray literature

*The McKay et al. (2022) framework was specified following the pilot exercise to allow retrospective classification of performance level using standardized definitions. The exclusion of studies with para-athletes were specified following the pilot exercise as certain disabilities can impact sleep regulation (Grade et al., 2023).

Figure 1. Search results and study selection and inclusion process (Page et al., 2021).

Table 2. Characteristics of included studies.

Study	Country, Sport, and Level	Intervention Components		Design and duration	Participant Characteristics	Sleep Parameters	Outcomes	QA	BCT Total
Education
Caia et al. (2018)	Australia,rugby league, professional	Group education sessions (2×30-min) during competitive season. 50% with shortest TST assigned to INT.CON = no education sessions		Non-randomized parallel groups pre-post 14-d BL, 14-d INT, 14-d FU at 1-m post-INT	n: 24 age: 27 ± 4 (INT), 25 ± 3 (CON) gender: all M	Actigraphy: SE, SOL, SOT, TIB, TST, WUT,	↑ TIB (25-min), ↑ TST (20-min), advanced SOT (23-min) post-INT vs BL. ↑ TIB (51-min), delayed WUT (3-min), ↓ SE (4.2%) at FU vs BL.	5/9	3
Driller et al. (2019)	New Zealand, cricket, professional	Group education session (50-min), personalized feedback and recommendations from 1-to-1 consultation (30-min)		Single group pre-post 3-wk BL, 3-wk INT	n: 9 age: 23 ± 4 gender: all M	Actigraphy: SE, SOL, SOT, SOV, TIB, TST, WASO, WE, WED, WUT, WV Questionnaire: PSQI	↑ SE (5%), ↓ SOL (29-min), SOV (28-min), ↓ PSQI global (2-pt)	7/9	4
Dunican et al. (2021)	Australia, basketball, professional	Group education session (2-hr) during competitive season, and personalized feedback and recommendations from 1-to-1 consultation (20-min)		Single group pre-post (Athlete sub-study) 1-m BL, 1-m INT	n: 12 age: 25 ± 2 gender: all F	Actigraphy: SE, SOL, SOT, TIB, TST, WASO, WUT,	No significant findings	7/9	2
Dunican et al. (2023)	Australia, swimming, amateur	Group education session (2.5-hr) with recommendations during training programme		Single group pre-post 7-wk BL, 7-wk INT	n: 24 age: 39 ± 11 gender: 54% F	Actigraphy: FI, SE, SOL, SOT, TIB, TST, WASO, WUT	Delayed SOT and WUT (both 12-min)	7/9	2
Harada et al. (2016)	Japan, football, student-athlete	Educational leaflet with 8 sleep hygiene recommendations		Single group pre-post 1-m INT, FU at 3-m post-INT	n: 84 age: 18–22 gender: all M	Questionnaire: Undefined sleep quality questionnaire	↑ sleep quality at FU vs pre-INT	7/9	1
Jenkins et al. (2021)	UK, rugby union, professional	Group education session (30-min) during competitive season and daily actigraphy feedback		Single group pre-post 3-wk BL, 3-wk INT, 2-wk FU	n: 14 age: 24 ± 4 gender: all M	Actigraphy: SE, sleep quality (1–10 derived from actigraph), SOL, SOT, SOV, TST, TIB, WASO, WE, WED, WUT, WV	No significant findings	7/9	3
Kaier et al. (2016)	USA, multiple, student-athlete	Group workshop: education, simulated sleep deprivation, brainstorming, recommendations		Single group pre-post BL, 1-d INT, FU within 14-d (FU1) and 3-to-4-m (FU2) post-INT	n: 104 age: 19 ± 2 gender: 69% F	Questionnaire: PSQI, SHI	No significant findings	6/9	6
O’Donnell and Driller (2017)	New Zealand, netball, professional	Group sleep hygiene education (50-min) with recommendations and daily reminders		Single group pre-post 1-wk BL, 1-wk INT	n: 26 age: 23 ± 6 gender: all F	Actigraphy: SE, SOL, SOT, SOV, TIB, TST, WE, WED, WUT, WV	↑ TST (22-min), ↓ WED (3-min), ↓ WV (21-min)	8/9	3
Sargent et al. (2021)	Australia, cricket, professional	Group workshop: feedback, education, individual target setting, encouraged to nap CON = no workshop		Randomised control trial 1-wk BL, 1-wk INT	n: 15 age: 22 ± 2 (INT), 26 ± 4 (CON) gender: all M	Actigraphy: SE, SOL, SOT, TIB, TIB (incl. naps), TST, TST (incl. naps), WUT,	↑ TIB (42-min) and ↑ TST (36-min) (both incl. naps) in INT. ↓ TIB (incl. naps; 24-min) in CON	8/13	5
Van Ryswyk et al. (2017)	Australia, Australian football, professional	Group education sessions (2 × 1-hr) with written and verbal information. Weekly group feedback and optional individual consultation. Additional individual feedback if < 7-hr self-report sleep duration		Single group pre-post 6-wk INT	n: 25 age: 23 ± 2 gender: all M	Actigraphy: TIB, TST (incl. naps), SE, SOL, WASO Sleep diary: SE, TIB, TST (incl. naps) Questionnaire: PSQI	↑ sleep diary TST (incl. naps; 20-min) and sleep diary SE (2%)	4/9	3
Vitale et al. (2019)	Italy, football, amateur	Group education session (45-min) with recommendations following evening training. CON: no session		Randomised control trial 2-d BL, 1-d INT, 1-d FU	n: 29 age: 26 ± 6 (INT), 25 ± 7 (CON) gender: all M	Actigraphy: FI, SE, SOL, SOT, TST, WASO, WUT Questionnaire: sleep quality (0–10 Likert scale)	Group x time interactions: ↓ SOL, ↑ sleep quality	10/13	2
Mind-body practices
Chen et al. (2018)	Taiwan, baseball, amateur	Mindfulness training protocol (4 × 2.5 to 3-hr sessions) including breathing, yoga, and meditation		Single group pre-post 28-d INT, FU at 28-d post-INT	n: 21 age: 26 ± 3 gender: all M	Questionnaire: PSQI (Chinese version)	↓ PSQI (Chinese version) global (0.9-pt) at FU vs pre-INT	7/9	1
Datta et al. (2022)	India, multiple, unknown	Yoga nidra or progressive muscle relaxation training protocol (3–4 × supervised sessions, daily self-led practice). Individual sleep education session pre-protocol		Randomised control trial 14-d BL, 28-d INT, 14-d FU	n: 45 age: 21 ± 4 gender: all M	Actigraphy + EEG module (n = 20):SE, sleep stages (S1-S3), SOL, TIB, TST, WASO Sleep diary:SE, sleep quality (undefined), SOL, TIB, TST, WASO	Actigraphy: ↓ SOL (26-min) and ↓ TIB (31-min) at FU vs BL Sleep diary: ↑ SE, ↑ TIB, ↓ SOL in yoga nidra vs progressive muscle relaxation at FU vs BL	6/13	5
Jones et al. (2020)	USA, rowing, student-athlete	Mindfulness-based stress reduction protocol (8 × 75-min supervised sessions, self-practice). CON: no protocol		Quasi-randomized control trial 3-to-7-d BL, 56-d INT, 7-d FU at 42-d post-INT	n: 27 age: 18–23 gender: all F	Actigraphy:SE, TST, WASO Questionnaire: PSQI	↑ SE in INT and ↓ SE in CON at FU vs BL, ↓ PSQI global (group x time interaction) at FU vs BL	7/13	3
L. J. McCloughan et al. (2016)^3	Australia, dance, student-athlete	Daily self-led progressive muscle relaxation (8.5-min audio). Analysis split by SOL and trait anxiety at BL		Single group pre-post 7-d BL, 7-d INT	n: 12 age: 20 ± 1 gender: all F	Actigraphy:SE, SOL, SOT, TIB, TST, WASO, WUT, Questionnaire: sleep quality (1–5 Likert scale)	↓ SOL (4-min) in high SOL/high trait social evaluation anxiety group, ↑ sleep quality (0.2 units) in high SOL/high trait social evaluation anxiety group	7/9	4
Rijken et al. (2016)	Netherlands, multiple, professional	Mental coaching protocol (4 × 2.5 hr sessions) including stress awareness, breathing techniques, and mindfulness. Additional heart rate variability feedback training using app (INT1) or alpha power feedback using EEG system (INT2)		Non-randomized parallel groups pre-post 35-d INT, FU at 42-d post-INT	n = 21 age: 21–32 (INT1), 16–38 (INT2) gender: all M (INT1), 80% M (INT2)	Questionnaire: PSQI	No significant findings	7/9	1
Direct
O. A. Famodu et al. (2017)^# 2	USA, athletics, student-athlete	Target increase in TIB of 1-hr above individual baseline		Single group pre-post 7-d BL, 7-d INT	n: 21 age: 20 ± 2 gender: all F	Actigraphy: TST	↑ TST (22-min)	–	1
Leduc et al. (2022)	UK, rugby union, student-athlete	Target 10 hr TIB after evening training session at the expense of a recovery session the following morning. CON: no sleep extension, attended recovery session		Randomised cross-over 2-d BL, 1-d INT, 2-d FU, 48-hr washout	n: 10 age: 21 ± 1 gender: all M	Actigraphy: FI, SE, SOL, SOT, WUT, TIB, TST, WASO	Delayed WUT (3.5-hr), ↑ TIB (3.3-hr), ↑ TST (2.5 hr), ↑ WASO(3-min) in INT vs CON	11/13	2
Mah et al. (2011)	USA, basketball, student-athlete	Target 10 hr TIB		Single group pre-post 14-to-28-d BL, 35-to-49-d INT	n: 11 age: 19 ± 1 gender: all M	Actigraphy: TST Sleep diary: napping, TIB, TST, WASO, WUT	Actigraphy: ↑ TST (1.8-hr) Sleep diary: ↑TST (2.6-hr)	7/9	1
Mah et al. (2017)^#	USA, baseball, professional	Target 10 hr TIB. CON: maintain habitual sleep		Randomised control trial 2-d BL, 5-d INT	n: 17 age: - gender: all M	Actigraphy: TST Sleep diary: TST	Actigraphy: ↑ TST (0.6-hr) Sleep diary: ↑TST (1.2-hr)	–	1
Roberts et al. (2019)^4	Australia, cycling, amateur	Target 30% extension of TIB, with SOT and WUT tailored to chronotype. CON: maintain habitual sleep (additional 30% restriction of TIB condition present but not reported)		Randomised cross-over 3-d INT, >1-wk washout	n: 9 age: 30 ± 6 gender: all M	Actigraphy: SE, TST Questionnaire: sleep quality (1–5 Likert scale)	↑ TST on all nights (1.3–1.8 hr), ↓ SE on night 2 and 3 (3–4%) in INT vs CON, ↓ sleep quality on night 3 (0.6-units) in INT vs CON	7/13	1
Schwartz and Simon (2015)	USA, tennis, student-athlete	Target 9 hr sleep duration including naps		Single group pre-post 1-wk BL, 1-wk INT	n: 12 age: 18–22 gender: 58% F	Sleep diary: napping, SOT, TST, WUT,	↑ TST (1.7-hr)	6/9	1
Swinbourne et al. (2018)	New Zealand, rugby union, professional	Target 10 hr TIB, and sleep education (format and duration unclear)		Single group pre-post 3-wk BL, 3-wk INT	n: 25 age: 25 ± 3 gender: all M	Actigraphy:SE, SOL, TIB, TST, WASO Questionnaire: PSQI	↑ TST (1-hr), ↓ PSQI global (1.9-pt)	6/9	2
Multi-component
Charest et al. (2017) ^#	Canada, speed skating, professional	Daily napping, increased target TIB, sleep hygiene routine including electronic device removal and blue light glasses		Single group pre-post 2-wk INT	n: 7 age: 24 ± 4 gender: 57% M	Sleep diary: sleep satisfaction, SOL, TST, WE Questionnaire: ASSQ	↑ TST, ↓ SOL, ↑ sleep satisfaction, ↓ ASSQ sleep difficulty score	–	0
de Mello et al. (2020)	Brazil, swimming, professional	Daily light therapy (30-min) and sleep hygiene recommendations during competition period		Single group pre-post 10-d INT	n: 14 age: 27 ± 2 gender: 71% M	Actigraphy: TST, SE, SOL, WE	↑ TST (51-min)	4/9	1
Duffield et al. (2014)	Australia, tennis, professional	Acute cold water immersion, compression garments and sleep hygiene recommendations following high physical loading. CON = 15-min stretching post-session		Randomised cross-over 1-d INT, >1-d washout	n: 8 age: 21 ± 4 gender: all M	Actigraphy: SE, SOL, TIB, TST	No significant findings (Large ES for ↑ TST and ↑ TIB in INT vs CON)	7/13	1
Fullagar et al. (2016)	Germany, football, amateur	Acute environmental changes, electronics curfew, and set time in bedroom/lights out post-match. CON = usual post-match routine, time in bedroom delayed		Randomised cross-over 1-d BL, 1-d INT, 7-d washout	n: 20 age: - gender: all M	Actigraphy:napping,SOL, SOT, TST, WE, WED, WUT	↑ TST (1.7-hr) post-match and ↑ WE (4.6 episodes) in INT vs CON	8/13	1
Grandner et al. (2017)^# 1	USA, Unknown, student-athlete	Initial sleep education session (1.5-hr), sleep/fitness tracking, text reminders, peer and researcher support		Single group pre-post 10-wk INT	n: 35 age: - gender: -	Questionnaire: PSQI (and PSQI-derived SOL, SOT, TST, WUT)	↓ PSQI global (1.3-pt), ↓ SOL (12-min), advanced WUT (32-min)	–	5
Vachon et al. (2022)	France, rugby union, professional (U21)	Sleep education, relaxation strategies, mattress change, foam rolling, and cold water immersion during training taper.		Single group pre-post 3-wk BL, 7-d INT	n: 18 age: 19 ± 1 gender: all M	Questionnaire: PSQI	↓ PSQI global (1.3-pt) with greatest ↓ in participants classified as functional overreaching training status	6/9	4
Vachon et al. (2023)	France, rugby union, professional (U21)	Group education sessions (2 × 1.5-hr) and mind-body practice sessions (3 × 45-to-60-min) including hypnosis, progressive muscle relaxation, and paradoxical interventions		Single group pre-post 4-wk INT, 4-wk BL	n: 11 age: 19 ± 1 gender: all M	Actigraphy: SE, SOL, SOT, TIB, TST, WASO, WE	↓ SOL and ↑ SE at BL vs pre-INT	4/9	5
Other
Bender et al. (2018)	Canada, multiple, professional	Standardised clinical sleep interview, follow-up interview if classed as moderate/severe sleep difficulty, general recommendations (sleep education sheet) and individualized treatment (e.g., travel/jet-lag management, CBT-Insomnia program, light therapy)		Randomised single-group pre-post (Clinical validation sub-study) 1-d BL, INT duration variable, FU at ~ 151-d post-INT start	n: 44 age: 24 ± 4 gender: 62% F (age and gender from full study, n = 199)	Questionnaire: ASSQ	↓ ASSQ sleep difficulty score (1.5-pt) at FU vs pre-INT, greatest ↓ in participants with greater sleep difficulty at BL	5/9	2
Jakowski and Stork (2022)	Germany, multiple, student-athlete	Downloaded either Sleep Score (INT1) or Sleep Cycle (INT2) app, used sleep tracking and reports in week 1 then added smart alarm in week 2 alongside sleep diary. CON1: no INT, CON2: sleep diary only.		Randomised control trial 2-wk INT	n: 98 age: 21 ± 2 gender: 62% F	Sleep diary: SE,SOL, SOT, TIB, TST, WE, WED, WUT Questionnaire: PSQI	No significant findings	7/13	1
Tuomilehto et al. (2017)	Finland, ice hockey, professional	Group education session (2-hr). If potential sleep disorder at BL (n = 14), additional polysomnography assessment and individual treatment plan (e.g., typical treatment for clinical insomnia or sleep disordered breathing)		Single group pre-post (sub-study) INT duration variable, FU at 12-m post-INT start	n: 40 age: 17–40 (from main study, n = 109) gender: all M	Questionnaire: sleep quality (1–10 Likert scale)	↑ sleep quality (0.6-units) at FU with greatest ↑ in those with lower BL sleep quality	5/9	2

#Presented as an abstract.

Additional studies identified presenting the same research: ¹Alfonso-Miller et al. (2017) and Athey et al. (2017); ²O. Famodu et al. (2014); ³L. McCloughan et al. (2014); ⁴ Roberts et al. (2022)

Duration abbreviations: BL: baseline; CON: control; FU: follow-up; INT: Intervention.

Measure abbreviations: ASSQ: Athlete Sleep Screening Questionnaire; FI: fragmentation index;; PSQI: Pittsburgh Sleep Quality Index; SE: sleep efficiency; SOL: sleep onset latency; SOT: sleep onset time; SOV: sleep onset variance; TIB: time in bed; TST: total sleep time; WASO: wake after sleep onset; WE: wake episodes; WV: wake variance; WUT: wake up time.

Figure 2. Frequency of coded BCTs by BCT grouping and split by intervention category.

Table 3. Example BCTs for integration into group sessions.

BCT Grouping and BCT	Definition	Example
Shaping knowledge 4.3 Re-attribution	Elicit perceived causes of behavior andsuggest alternative explanations (e.g.external or internal and stable or unstable)	Ask athletes to reflect on what they believe drives their current sleep behaviors (e.g. lack of time) and offer alternatives to consider and reflect upon (e.g., electronics use before bed)
Natural consequences 5.6 Information about emotional consequences	Provide information (e.g. written, verbal, visual) about emotional consequences of performing the behavior	During a group session, shift the focus away from sport and highlight the relationships with sleep, mental wellbeing, and mood outcomes
Comparison of behavior 6.3 Information about others’ approval	Provide information about what other people think about the behavior. The information clarifies whether others will like, approve or disapprove of what the person is doing or will do	Collate information from coaches and sport practitioners on how they value sleep as a recovery modality to share with athletes
Comparison of outcomes 9.2 Pros and cons	Advise the person to identify and compare reasons for wanting (pros) and not wanting to (cons) change the behavior (includes “Decisional balance”)	Have athletes come up with and discuss the pros and cons of their current sleep practices
Self-belief 15.3 Focus on past success	Advise to think about or list previous successes in performing the behavior (orparts of it)	Ask athletes to reflect on a time that they engaged with healthy sleep practices, and the downstream effects they experienced when doing so

BCT definitions from Michie et al. (2013).

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Data availability statement

Data supporting the findings of this study are available within the article and its supplementary materials.