A study from Norway has found that men who use muscle-boosting steroids are more likely to suffer from poor sleep quality. The findings, published in BMC Psychiatry, suggest that these sleep issues might persist even after steroid use ends, highlighting the need for increased awareness of the side effects associated with these substances.
Anabolic-androgenic steroids, commonly referred to simply as “steroids,” are synthetic substances that mimic the effects of the male sex hormone testosterone. They are used medically to treat conditions like delayed puberty and muscle loss from certain diseases. However, steroids are more commonly known for their use by athletes and bodybuilders to enhance muscle mass, strength, and physical performance.
The motivation for this study stemmed from the observation that steroid hormones naturally present in the body have a profound influence on sleep patterns. Since steroids are derivatives of these natural hormones, there was a scientific interest in understanding whether and how synthetic steroids might affect sleep. Prior evidence suggested that individuals using steroids could experience sleep disturbances, but there was a lack of extensive research exploring this connection.
“Anabolic-androgenic steroids (AAS) and their relations to sleep and psychological distress are areas that still hold many unanswered questions,” said study author Sandra Klonteig of Oslo University Hospital.
“Being a relatively new substance, introduced in the 80s, we are still exploring the long-term effects of AAS. Given the reported sleep problems among men who use AAS and the established relationship between sleep and psychological distress, it was interesting to delve deeper into these relations, in particular how sleep quality varies during on/off periods of AAS use and its relations to psychological distress.”
The study included a sample of 126 adult male weightlifters, with 68 being current or past users of steroids and 58 non-users serving as a control group. Recruitment channels included social media outreach, online forums dedicated to weightlifting and bodybuilding, and direct contact within gyms in the Oslo region. The study sought participants deeply engaged in heavy resistance training, which was quantified by the ability to bench press a minimum of 220 pounds. For the steroid users, a minimum of one year of cumulative steroid use was required for inclusion.
The researchers collected data using detailed questionnaires, which the participants filled out to report on their sleep quality, medication use, and any side effects from steroid use. To measure sleep quality, the study employed the Pittsburgh Sleep Quality Index (PSQI) and the Jenkins Sleep Scale — both established tools in the assessment of sleep issues. Participants’ mental health was also evaluated using the Hopkins Symptom Checklist, a recognized gauge for symptoms of anxiety and depression.
The sleep quality of steroid users, as per the PSQI , was significantly worse than that of the control group. The researchers discovered that nearly all components of the PSQI showed greater disturbance among steroid users, except for sleep latency — the time it takes to fall asleep. This was supported by Jenkins Sleep Scale scores, which also pointed to troubled sleep among steroid users.
Furthermore, a notable proportion of the steroid-using participants, approximately two-thirds, reported experiencing sleep problems as a side effect of their steroid use. This self-reported data provided real-world corroboration of the clinical measurements.
The researchers observed a strong association between poor sleep and psychological distress. Using the Hopkins Symptom Checklist, they found that symptoms of depression and anxiety were not only more prevalent among steroid users but were also closely linked to the poor sleep outcomes measured by the PSQI. Interestingly, while depression seemed to partially mediate the relationship between steroid use and poor sleep, anxiety did not have a significant mediating effect.
For a more nuanced analysis, a subset of 22 participants was closely observed over approximately 22 weeks, covering periods of active steroid use (“on-cycle”) and abstinence (“off-cycle”). This sub-study aimed to understand the impact of hormonal fluctuations on sleep during and after steroid use.
The findings from this subset reinforced the broader results. It showed that sleep quality fluctuated with the cycles of steroid use. During periods of active steroid use and withdrawal, the participants’ sleep quality was worse than that of the control group, with the withdrawal periods marked by particularly poor sleep. This suggests that the hormonal fluctuations associated with periods of steroid use and cessation may play a significant role in sleep disturbance.
“Our study found that poor sleep quality is a common side effect of AAS use, with 66% of men with current or previous long-term AAS use reporting sleep problems, and 38% reporting use of sleep medications,” Klonteig told PsyPost. “There’s a strong association between poor sleep and psychological distress, but psychological distress does not fully mediate the relationship between AAS use and poor sleep.”
“We found that sleep quality was poorest during withdrawal from AAS, potentially due to anabolic steroid-induced hypogonadism. The link between mental health, AAS use, and sleep underlines the importance of addressing sleep problems when devising treatment strategies for AAS use and mental health issues.”
However, the study wasn’t without its caveats. The cross-sectional nature of the data meant that the researchers couldn’t confirm if steroid use caused the sleep problems, just that there was a connection. The research, focused on a Norwegian male population, may not apply universally. There were also potential lifestyle factors related to steroid use that weren’t fully accounted for, which could influence sleep, such as diet or other substance use.
Despite these limitations, the research paves the way for future studies to delve deeper, perhaps including a wider demographic and employing longitudinal follow-ups with a variety of measurements to better understand the biological and psychological mechanisms at play.
The implications of this study are significant for public health, particularly for those involved in sports and fitness who might consider or are using steroids. It suggests that individuals using steroids could be at risk of not just short-term sleep disturbances but potentially long-term sleep-related and mental health issues. The study underscores the importance of awareness around the side effects of steroid use and provides a strong foundation for further research that might lead to better support and treatment for those affected.
The study, “Sleep pathology and use of anabolic androgen steroids among male weightlifters in Norway,” was authored by Sandra Klonteig, Morgan Scarth, and Astrid Bjørnebekk.
