It's been six years since my onset of OTS. It took three years to feel mostly normal and four years to sleep mostly normal. I say mostly normal because various life stresses can upset me very quickly and I enter a pattern of poor sleep.

For those 4 years of, on average 4-6 hours of disturbed sleeep I lacked that groggy feeling that one gets upon waking where you feel so full of sleep hormones.

I still play table tennis which can have a negative impact on my sleep. If it weren't for my son playing it as well then I would give it up.

Recently, this covid-19 lockdown has closed down table tennis activities for all so I'm doing no exercise and I've slept the best I've ever slept in these six years.

My current lockdown pattern of sleep is that I wake up in the middle of the night for the toilet or being too hot and my heart rate is erratic and I notice that some reading and calm mindfulness can send my heart rate down and into a non erratic pattern and necessarily back to sleep for a good 7-8 hours. Upon waking in the morning my heart rate is high but I notice even this is coming down. This all hints to me that my HPA axis is still out of kilter (but very slowly it's fixing itself) and I feel I could recover one day as long as my sleep continues to improve because I read that sleep is the most powerful thing one can do to correct a HPA imbalance.

Without doubt the worst thing I ever did was overtrain. And high up on that same list is tell the medical profession about it. I was met with so much ridicule by doctors who couldn't understand that such a thing could exist if they weren't taught about it on their medical degrees. I've read the recent posts and it's good to know that some experts exist and that they are making in roads for it to be described in the medical journals as a recognised syndrome.

Hotspace, good to hear from you again. You are so right, I also feel that Overtraining was the worse thing that I ever did to myself. In the last seven years, there has not been a single day that I do not think about it and wish I could turn back the clock. It has essentially changed who I am.
I too have been so frustrated with the medical profession. Hard to believe that in this day and age, we can’t get answers that could help lead to a recovery.

Fantastic thread. I've now read all of it. Thank you to all who have contributed.

Does anyone happen to have a reliable log of any of the following, before, during, and after their experience with overtraining?

1. Time asleep, on average, nightly. (Not time in bed, but actually asleep).
2. Body weight data daily, weekly average, or otherwise.
3. Training volume and intensity data
4. RHR, training HR's, and max HR.
5. Some discussion of other outside stressors in your life. (Birth of children, passing of loved ones, financial stress, increased work hours, shift work/night shift, sport performance anxiety/despair you name it).

Would be very interesting.

Where I'm going with this:

In the early discussion of OTS in the field of sport physiology it was very much focused on training volume and intensity management. Little, but some, focus on outside stressor management. Little, but some, focus on nutrition. No focus on anxiety and depression. Wrongheaded focus on sleep loss as a result of OTS, rather than a likely cause.

I think there is a MUCH stronger link between mild (or more serious) anxiety and depression, lack of time asleep, and overall fatigue management with regard to all of life + training volume/intensity than was first given credence to, in the OTS discussion, and in the medical field.

In the past the OTS discussion went like this among sport scientists:

1. How much are you training? If lots, maybe OTS.
2. How hard are you training? If hard on average, maybe OTS.
3. Are you losing weight? If yes, maybe OTS.
4. Have you started losing sleep yet? If yes, could be a symptom of OTS.
5. Is your RHR elevated? If yes, maybe OTS.
6. Is your max HR depressed? If yes, maybe OTS.
7. Are your training HR's elevated for the work rate? If yes, maybe OTS.

I think the conversation should go more like.

"Let's talk about fatigue management in your training and life in general."

1. Tell me about your training volume and intensity. Compare it to recent and distant past.
2. How much are you sleeping, actually, on average, each night. Not the good nights. All the nights, no matter the reason that sleep may have been in short supply. Take an average of the last 30 days.
3. Have you lost any weight? Has anyone told you that you're looking leaner, fitter, or smaller, if you're not tracking your weight?
4. Then cross compare number 1 & 3.

Keeping in mind that for a healthy population who exercises only mildly ~3 hrs per week, it can be expected that they will exhibit chronic fatigue, increased incidence of anxiety and depression, and other mood/attention-related issues if they sleep an average of 7.5 per night, as compared to 8.5 per night. In folks who are training with at least moderate intensity, let alone high-intensity occasionally, for 10-15hr/wk, I'd estimate sleep needs for sufficient recovery are closer to 9.5-10hr per night, depending on body composition and other outside stressors. If we start talking about >20hr/wk of training, sleep need is very likely closer to 11 hrs per 24-hr cycle. 10.5 overnight and 0.5 nap for example.

Random research tidbits ...

• Restless Leg Syndrome (RLS) increases in prevalence with recently-increased volume or intensity of training.
• RLS appears to be centrally mediated (brain!), at least in part. Anything anxiolytic appears to reduce it's incidence and severity, including massage... of the shoulders, if that's relaxing to the person.
• Multiple sclerosis (autoimmune neurodegenerative disease) severity has yet-unknown independent links outside of vitamin D to magnitude and intensity of light exposure.
• Light exposure patterns and magnitude have a powerful affect on sleep and reward centers of the brain, among other hormones including insulin.
• Sleep loss among athletes is associated with dramatically poorer body composition outcomes and lower testosterone and higher cortisol. Sleep loss is often studied among folks training 4-8hr/wk, not 15+. Those effects would be exacerbated at higher training volumes.

Personal tidbits, context, and biases, in no specific order:

• I experience seasonal affective disorder but only in very oppressively cloudy environments (Seattle in winter). No amount of bright lamp exposure or vit D consumption touches it. No amount of outside time, if cloudy, improves my symptoms. It doesn't take 15 minutes of sun exposure to dramatically enhance my mood for the day... it takes literally the sun hitting my face... under 3 seconds. Regardless of if I have outdoor plans at all that day or if I'll be at my computer for 16 hrs. Remarkable mood improvement, immediately. Far faster than anything vitamin, hormone, or circadian rhythm related. I noticed this when I first moved into an RV full-time because it was the first time in my life that in the winter, I could wake up and draw the blinds open and immediately have sun on my face. I remember smiling one morning and wondering why.
  
  
• I have abused sleep quantity in the name of productivity or doing something I think may be more important... like this post. The ability to function with such sleep loss has been enhanced by my own personal diagnosis of adult-onset ADHD (I had ADHD as a kid too, no one diagnosed me until I identified it in my doctoral program), and subsequent treatment with Adderall, a powerful stimulant. I have never disclosed this publicly before. (See: stigma!)
  
  
• When I have used Adderall as a work-time-extender (skipping sleep or cutting it to 3-4 hr/night), rather than simply as an attention aid with normal sleep habits, it has provided a very unique look into what chronic sleep deficit looks and feels like, alongside various quantities of endurance training. It has allowed me to do things I would never have chosen to do (like exercise more and still function at work, on far too little sleep, when in the past I'd have foregone exercise or work, or both, for sleep). It is only once the stimulant wears off that I have an honest look and feel at how I am recovering and adapting to training. It has effectively allowed me to have enough false feedback about my energy and recovery that I could push well into non-functional overreaching and OTS, and not feel any of it, until...
  
  
• In 2019, for insurance/logistical reasons, I ceased taking Adderall, cold turkey. I had known from past experience that the fatigue I was about to feel was going to be remarkable. I thought I'd be "really tired" and "need to sleep more."
  
  I underestimated it in breadth and intensity. I felt the full experience of everything my wife had told me about her experience with non-functional overreaching and probable OTS, and nothing else. The symptom overlap was uncanny. Deep fatigue. Zero motivation to train. Depression. "Dead" or weak feeling muscles. Worst of all, my first experience with anxiety, which by the way, is easily the worst feeling on the planet, in my limited experience. And of course, inability to elevate HR in training. No amount of rest, or eating, was going to solve my inability to push the pedals. My legs were powerless. My arms were powerless. It felt like I could barely lift them. Not only did I lack the motivation to use them fully, but even if I had wanted to, they just wouldn't go hard. I remember being in the pool lane and just watching my wife swim laps because I couldn't bring myself to do another lap. I had done ~400 yds, total. (I've done a marathon swim before).
  
  I had planned to sleep 12+ hr per night, and not exercise for a week. I actually slept closer to 16 hours per "night" for a week and then continued sleeping 10-12hr/night for another couple months. Once I was recovered in terms of sleep/training/work balance, my legs were fine again and all OTS-related symptoms had vanished.
  
  I think it's VERY important not to conflate resting with being recovered (as in, lack of activity or restorative activities like yoga, massage, etc). Sleeping allows recovery. Reduced or eliminated training does not guarantee any physiological recovery in the absence of sleep, let alone recovery from something as severe as OTS.
  
  
• I coached a client who sought me out because she believed her triathlon career was done due to overtraining and she wanted to give it one last chance. She'd taken 6 months off from any exercise at all. She was showing no signs of improvement in ability to exercise, and her anxiety had increased because now when she returned to a pittance of her old exercise habits, her HR was sky high. The fact was, she was out of shape. Less blood volume. Less fitness all around. I took 6 months rebuild her fitness. We started with 10 minutes in z1 on a bike. Rest 3 days. Jog 400 yards. Rest 2 days. Talk to me. Still concerned with high HR, still not sleeping more than 6-7hr/night. I assured her that she was just unfit but that it would come back. This story isn't sunshine and rainbows. But it is hopeful. She eventually worked up to 6-7hr/wk training again, and with some serious intensity about 30-80min per week. Her sleep was still poor at 6-7hr/night. Her performance started improving and she approached old PRs. But without being able to increase her hours slept nightly, it became clear that if we pushed for more training, we'd repeat her OTS experience, which was not a cliff either of us wanted to be anywhere near. I suspect that had she been able to reorganize her life (huge ask) to facilitate 8-9hr/night, pushing up to 7-10hr/week of training would have been no issue.
  
  
• Back when I trained seriously for bobsled, roughly 12-24hr/wk, depending on training phase, I intentionally slept 9.5-10.5 hr/night, and felt notably worse if I got a couple nights of 8-8.5. Bobsled training is anaerobic and FAR less immunologically taxing than endurance training. Had that load been endurance training, I'm certain I'd have needed 11+ hr/night of sleep to function at all and certainly to be willing to choose to continue with such a high volume training program. The consequences of not sleeping aggressively when endurance training volumes are >20hr/wk are immediate and deep fatigue, illness, and remarkable drops in training performance, which I have seen come on lightning fast.
  
  
• My wife manages to train 15-25hr/wk most of the time. She sleeps 6.5-hr/night, average, in a bad week. Or 7.75 hr/night on a "good" week. The nightly hours are of course much more sporadic due to anxiety/insomnia and the cumulative stressors in her life. During her bad weeks, she deals with ever-present training motivation issues, inability to elevate HR, leg fatigue, deep/intense general fatigue, post-training malaise, inattentiveness, and anxiety/depression serious in nature, crippling self-doubt and moderate/severe hypochondria. On good weeks, it's just mild anxiety, almost unnoticeable depression, mild self-doubt, "okay" motivation to train, and still chronic fatigue but less to the degree of "I'd rather kill myself than go do a 2hr z2 ride." For context, she works <20hr/wk and I manage most household/logistical/sporting stuff. Her measurable outside stressors are relatively low. Her anxiety, perfectionism, and fear of failure drive her onward, to make the decision to train even in the face of borderline suicidal-level fatigue.
  
  
• I suspect that this undercurrent of at least mild anxiety and perfectionism is common among sufferers of OTS because it's almost necessary to have something like that to drive you to continue to perform high volume training while fatigue mounts. My clients who have reported experience with OTS or similar all certainly have been able to compel themselves to train more hours per week than I ever could, in the absence of matched sleep.
  
  
• There appears among myself, my wife, and many of my most closely-monitored athletes to be a more pronounced link between sleep loss and the onset of OTS than training volume or intensity. There is definitely an interplay. But if I had to say which was most important as a causative factor of OTS, I would say sleep loss.

All the above taken together, I think the interplay between light exposure, sleep-based fatigue management, central nervous system issues like RLS, MS, ME, etc, etc, anxiety/depression, and OTS is much more important than "how hard and how much are you training?" And I think there is still a couple decades worth of research to be done before evidence-based recommendations can be doled out across the board.


If I had to make recommendations TODAY based on a loose combo of research, professional and personal experience, and intuition as to where the research will lead in the future... To anyone dealing with OTS or staring down the barrel of it, I would say the following:

1. Sleep more. A LOT more. Target 10hr/night. If you achieve that and still feel deep fatigue, malaise, and poor training, then target 11 hr/night. Google sleep hygiene if not a practicing expert in it already.
2. Reduce training intensity immediately, if you're still training. Nothing higher than Z2 until number 1 is achieved.
3. Seek sunshine. Not just outdoor time. Actual sun on your face. Ideally early in the day.
4. Seek counseling for even the mildest of anxiety, perfectionism, fear of failure, compulsive or neurotic tendencies. It's been beneficial for me, in ways that extend far beyond the topics covered in counseling.
5. Do things that actually bring you joy. Not long-term satisfaction. Those are good too. But immediate joy.
6. Simplify and organize every aspect of your life so that your logistical outside stressors are lowered.
7. Maintain your body weight, or gain 2-3 pounds then maintain it. Maintenance involves fluctuation within a 5-6 pound range, within a week, for most people. Make the monthly trend a flat line, roughly.
8. When you seek to increase training load, do so incredibly slowly, and with low intensities only for at least a month. Preferably much more. If you were a marathoner and haven't run in a year because of OTS, jog 400m your first day back. Do so little that it's like you didn't do anything at all, and you're "wasting your time." Then take a rest day. Not joking here. Take a month or something to work back up to a 2-mile run. Consistent linear progression is possible for a long while. It'll add up quick in month 2-4... be patient.

I don't intend to have any hard answers. There are certainly things discussed in this thread that are beyond (but perhaps related to) OTS and way outside the scope of sport physiology. But this is indeed one of the most comprehensive and frank discussions of all things OTS that I've ever seen, so I thought it might be handy if anyone is willing to share a bit more info about number 1 through 5, above.


I may elect not to respond to any further messages out of protection for my own time and well-being. My intention of this post is one giant FYI, in case it helps someone.

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Dr. Alex Harrison | Founder & CEO | Sport Physiology & Performance PhD
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