Video Games, Sleep, & Athletic Performance

Electronic sports, or esports, have exploded in popularity over the last decade and are now recognized by many to be legitimate forms of professional competition. What were once small, community events have transformed into globally streamed, culturally significant tournaments with international representation. Millions of viewers tune into watch video games like Fortnite and Dota 2 that have offered up to $40 million in total prize pool earnings for a single tournament (Shaw, 2021). This recent rise in video game popularity can partially be attributed to the financial incentives associated with professional esports play and the obsessive behaviors of gaming addiction. 

Multiple articles have been published regarding the care of esports athletes, their training habits, and the physiological effects of esports, but the majority of gamers are not paid professionals (Stanishiva, 2023). However, the findings from these studies are still relevant to amateur gamers who play competitive esports titles like first person shooters (FPS), multiplayer online battle arenas (MOBA), or real time strategy (RTS) games. Lower-skilled, nonprofessional gamers tend to focus on “grinding” through matches to gradually increase their matchmaking rating (MMR) and may only find joy in the hobby of gaming after a win (Aeschbach, 2023). Many players believe their true MMR is higher than their player rating and may fixate on playing daily and for long durations to improve their rank and escape “ELO Hell” (Ismail et al., 2019). “ELO Hell” is the belief that one has been mistakenly placed into a ranking that is lower than where they belong and are paired with incompetent teammates who cause team losses (Aeschbach, 2023). Therefore, one player is unfairly “stuck” in a stressful social environment. Gaming addiction symptoms can arise because most players understand that more playing time is required to improve their skill level and leave ELO hell (Mohammed et al., 2023; Nagorsky & Wiemeyer, 2020). 

Unlike other professional sports that require practice fields, special equipment, or structured organizations to play, anyone with a computer can engage with esports titles from the comfort of their home. The accessibility of online gaming allows children, adolescents, and adults to regularly participate in high-stress, competitive environments where sessions can last for multiple hours and occur in close proximity to bedtime (Lee et al., 2021). This fixation on competition that is available at all hours of the night can cause emotional distress, mental fatigue, interfere with sleep quality, and these side effects may negatively affect athletic performance (Palanichamy et al, 2020; Knowles et al., 2018). This review will discuss the relationships between video games, sleep, and subsequent athletic performance.

Physical & Mental Health Side Effects of Gaming

While sleep loss is a major focus of this review, gaming has other significant side effects on a player’s mental and physical health. This section will begin by examining the physical health consequences of extended, repeat gaming sessions and how those issues may affect athletic performance. The ergonomics of PC gaming have been shown to be associated with musculoskeletal (MSK) pain in the low back, neck, and shoulders (Lindberg et al., 2020). In a 2020 study from Denmark, researchers found that over 30% of professional gamers surveyed had chronic low back pain and that pain prevented them from practicing as often as they’d like (Lindberg et al., 2020). Repetitive use injuries and MSK pain caused by prolonged gaming time spent in a seated position with flexion occurring in the hips, lumbar, and thoracic spine, along with internal rotation of the shoulders may also pose injury issues in athletes who participate in contact sports (Watson, 2001). Therefore, it is possible that athletes who game often in a seated position may have a higher risk of injury than their peers who do not spend as much time seated.

Long periods of sitting associated with gaming have also been linked to lower scores in body composition and cardiovascular health (Monteiro Pereira et al., 2022; Emara et al., 2020). A review by Pereira et al. (2022) examined lifestyle and health differences between esports athletes and their age-matched peers who are not professional gamers. The paper showed that esports athletes are more sedentary than age-matched peers, have higher BMI and less lean tissue, higher blood pressure and heart rate, and poorer self-reported mental health scores (Pereira et al., 2019). Gamers may also be at risk of health complications due to poor circulation from sitting and an overall lack of physical activity (Palanichamy et al, 2020). When combined, lower BMI scores and poor cardiovascular health from extended gaming sessions may contribute to worsened recovery and less lean tissue development in athletes.

Gamers may also suffer from mental health complications that include gaming addiction, social and emotional stress, and mental fatigue, which can directly and indirectly affect athletic performance. Gaming addiction is defined by Mohammed et al. (2023) as a “steady and repetitive use of the Internet to play games frequently with different gamers, potentially leading to negative consequences in many aspects of life.” A 2020 systematic review found that “long hours of online gaming was associated with the presence of depression, social phobia, obsession–compulsion, interpersonal sensitivity, hostility, phobic anxiety, paranoid ideation, psychoticism attention-deficit hyperactivity disorder, and gaming addiction” (Palanichamy et al, 2020). Gaming addiction is a novel and controversial substance abuse diagnosis, but its effect on an athlete’s mental health could result in lower competitive success outcomes in team sports if the disorder causes the athlete to be less cooperative and hostile with teammates. 

Finally, long periods of gaming may result in mental fatigue, including central nervous system (CNS) fatigue, that can worsen decision making and decrease neuromuscular efficiency (Davis, 1995; Ismail et al., 2019; Targum et al., 2014). A systematic review from Brown et al. (2020) showed that mentally exhausting tasks of more or less than 30 minutes can result in significantly worsened performance outcomes regarding resistance training and aerobic exercise. Mental fatigue has also been shown to decrease time to exhaustion in endurance athletes (Marcora, Staiano, & Manning, 2009). It is possible that this athletic performance drop is due to acute mental exhaustion, but it may eventually develop into chronic CNS fatigue, or “a negative central influence that exists despite the subject’s full motivation” (Davis, 1995), in gamers who habitually play esports titles for long hours (Kemp et al., 2021). Therefore, it’s important for athletes, gamers, and their coaches to understand the physical performance costs of esports titles and how gaming-induced mental fatigue can affect athletic activities. 

Video Games & Sleep

Video games can also impact athletic performance by causing lifestyle changes that impact emotional health, disrupt sleep quality, delay the onset of sleep, and shift circadian rhythms in adult and adolescent gamers (Copenhaver & Diamond, 2017; Palanichamy et al, 2020). In a 2021 study, the sleep quantity, sleep quality, sleep patterns, and self-reported emotional states of 17 professional gamers were evaluated to determine if gaming had any significant effect on these markers (Lee et al., 2021). The results showed that there was a significant correlation between time spent gaming, sleep quality, and depression. The data from this paper also indicate that gaming at night can shift or delay circadian rhythms in esports athletes, possibly resulting in poorer mental health and decreased sleep quality in the later half of the sleeping period. Bonnar et al. (2022) also showed that a circadian rhythm shift in professional gamers can be corrected, indicating that the negative outcomes of extended, late-night gaming sessions are the results of lifestyle choices. Casual gamers may not participate in the same training schedules as professional esports athletes, but they may be at risk of developing many of the same sleep issues with regular play late at night (Kemp et al., 2021). This is especially true in student athletes who must adhere to a strict schedule that revolves around school and sports practice.

Adolescent student athletes are a high-risk population group for sleep disturbances (Copenhaver & Diamond, 2017). Due to adolescents’ unique sleep architecture that favors R.E.M. sleep in the second half of the night, sleep dependent pubertal development processes, and nighttime motor learning and cognitive maturation, quality sleep is essential for the healthy growth of this population (Copenhaver & Diamond, 2017). However, their sensitivity to blue light can cause nighttime gaming to delay sleep onset (Copenhaver & Diamond, 2017). This can be seen in a paper published by Jones et al. (2019) that showed Tweeting late at night can cause basketball players to suffer next day performance issues in shooting accuracy. Therefore, it’s likely the stress from competitive online gaming combined with late-night blue light exposure can significantly disrupt the sleep quality, sleep onset, and cause developmental issues along with recovery problems in young athletes. 

Adolescent student athlete gamers and adult hobbyist gamers may have different lifestyle factors that affect sleep quality, but both groups can be negatively affected by sleep loss. Data show that cognitive and athletic performance issues from sleep deprivation in athletes include slower reaction times, slower visual processing speeds, decreased aerobic endurance, decreased muscular strength, and a skewed sense of perceived effort (Bonnar et al., 2019; Patrick et al., 2017; Vitale et al., 2019). These issues can be more severe in training sessions that occur in the afternoon, or further away from an acute loss in sleep (Craven et al., 2022). Most studies show that significant losses in athletic performance occur after multiple nights of inadequate sleep rather than an isolated night of acute sleep deprivation (Knowles et al., 2018). These data suggest that late-night gamers who are student athletes or work early morning hours may experience chronic athletic performance issues if they suffer from truncated sleep caused by habitually gaming late at night.

Conclusion

In conclusion, video games may affect athletic performance by causing significant amounts of mental or CNS fatigue, negatively impacting the emotional and social health of gamers which can lead to depression, and by interfering with restorative sleep habits. It’s important for gamers, athletes, parents, and coaches to understand the potential impact of late-night gaming sessions and how they might impact athletic performance at practice and on game days. To date, there is little available research that investigates the mental workload requirements of long player-vs-player gaming sessions and its effect on subsequent physical performance metrics (muscular strength and power, aerobic endurance, etc). More data in this area will be useful for sports organizations as coaches and parents work to implement healthy boundaries that allow for optimal gaming participation and sports performance. 

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