International Journal of

Environmental Research
and Public Health

Brief Report
The Effect of Autogenic Training in a Form of Audio Recording
on Sleep Quality and Physiological Stress Reactions of
University Athletes—Pilot Study
Kamila Litwic-Kaminska 1, * , Martyna Kotyśko 2 , Tadeusz Pracki 1 , Monika Wiłkość-D˛ebczyńska 1
and Błażej Stankiewicz 3

1 Faculty of Psychology, Kazimierz Wielki University, 85-064 Bydgoszcz, Poland

2 Department of Clinical Psychology, Development and Education, Faculty of Social Sciences,
University of Warmia and Mazury in Olsztyn, 10-719 Olsztyn, Poland
3 Institute of Physical Culture, Kazimierz Wielki University, 85-064 Bydgoszcz, Poland
* Correspondence: k.litwic@ukw.edu.pl

Abstract: Despite the growing popularity of relaxation training, the effectiveness of an autogenic
training (AT) as a method of dealing with sleep problems in group of student athletes is unknown.
Therefore, this study aimed to fill this gap. University athletes with decreased sleep quality (selected
from 209 participants) were randomly assigned to the experimental (EG, n = 11) and control (CG,
n = 11) groups similar in terms of sleep quality, age, gender, type of sport discipline and sport
experience. During the 14 days dedicated to performing relaxation training in the form of an
audio recording, electronic daily logs and actigraphy were used to monitor the athletes’ sleep and
Citation: Litwic-Kaminska, K.;
daily activity. The EG listened to the recording with suggestions based on AT and CG only to the
Kotyśko, M.; Pracki, T.;
background music. Pre- and post-measurements of sleep quality by means of the Pittsburg Sleep
Wiłkość-D˛ebczyńska, M.;
Quality Index (PSQI) and physiological stress reactions by biofeedback device were performed.
Stankiewicz, B. The Effect of
Autogenic Training in a Form of
In EG and CG, the parameters of sleep and daily activity obtained by actigraphy and daily logs
Audio Recording on Sleep Quality as well as physiological indicators of emotional reactivity did not differ. Sleep quality in PSQI
and Physiological Stress Reactions of significantly increased after AT usage in EG. AT seems to be an effective method for university
University Athletes—Pilot Study. Int. athletes in improving subjective sleep quality, but further studies are necessary.
J. Environ. Res. Public Health 2022, 19,
16043. https://doi.org/10.3390/ Keywords: sleep; sleep quality; autogenic training; athletes; ecological momentary assessment;
ijerph192316043 actigraphy; physiological stress response
Academic Editors: Nai-Jen Chang
and Yi-Ju Tsai

Received: 8 October 2022 1. Introduction

Accepted: 24 November 2022
Sleep plays an important role in physical and mental health [1]. University athletes
Published: 30 November 2022
have to combine both demanding roles of an athlete and a student [2]. Being overloaded
Publisher’s Note: MDPI stays neutral with everyday tasks, university athletes may experience worse sleep quality and increased
with regard to jurisdictional claims in sleep-related difficulties [3]. In university students, these difficulties are generally frequent
published maps and institutional affil- and affect up to 60% of this population [4]. As for sleep, not only its amount but also its
iations. quality is important. According to Buysse, Reynolds, Monk, Berman, and Kupfer [5] sleep
quality, as a general construct, should be evaluated in terms of seven aspects related to sleep,
which are: “subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency,
sleep disturbances, use of sleeping medications, and daytime dysfunction” (p. 195).
Copyright: © 2022 by the authors.
Although physical activity is recognised to improve sleep quality and quantity [6,7],
Licensee MDPI, Basel, Switzerland.
This article is an open access article
the prevalence of poor sleep quality—as measured by the Pittsburgh Sleep Quality In-
distributed under the terms and
dex (PSQI)—is also quite high among athletes, reaching up to 64% [8–11]. It should be
conditions of the Creative Commons noted that the definition of poor sleepers varies depending on the PSQI score criterion
Attribution (CC BY) license (https:// adopted: ≥5 or >5 [8]. Difficulties with sleep may apply to athletes due to a number of
creativecommons.org/licenses/by/ sport-related requirements, such as acute (e.g., playing away, excitement) and chronic
4.0/).

Int. J. Environ. Res. Public Health 2022, 19, 16043. https://doi.org/10.3390/ijerph192316043 https://www.mdpi.com/journal/ijerph
Int. J. Environ. Res. Public Health 2022, 19, 16043 2 of 8

stressors (e.g., different match schedules) resulting from intensive trainings and compe-
titions [12,13]. Based on research to date, it can therefore be assumed that the prevalence
of sleep problems and reduced sleep quality among athletes is significant and cannot be
ignored. This is also pointed out by athletes themselves and their coaches, while indicating
that sleep-related difficulties may cause short-term fatigue [14]. Since the athletes may be
prone to sleep problems it is worthwhile to verify the efficacy of different types of sleep
interventions [8,15,16].
As an alternative to pharmacological interventions, usage of relaxation techniques
turns out to be an effective method of improving the sleep quality in the case of functional
sleep disturbances [17]. Literature review indicated that relaxation techniques helped to
improve the quality of sleep (less awakenings at night, longer sleep time) and decrease the
sense of fatigue after waking up in oncological patients, where sleep problems arise as a
consequence of the disease e.g., [18], in older adults [19] and were shown to be an effective,
non-pharmacological treatment for insomnia [20]. Relaxation methods provided medium
effects for sleep quality and sleep problems in college students [21]. There are many reports
showing that athletes used the relaxation techniques to reduce competitive anxiety or to
improve athletic performance, e.g., [22]. However, there is a lack of studies on the use of
relaxation techniques by athletes aimed at improving the quality of sleep. To date, we have
found only one article presenting an experimental study on a very small sample (n = 12) of
female football players [23].
Two broad reviews [21,24] showed that among the relaxation techniques applied in
research on improving the sleep quality were, among others, progressive muscle relaxation,
mindfulness meditation, biofeedback, relaxing music, or autogenic training (AT). When
searching for an effective method to improve sleep quality in a group of student-athletes,
we chose Schulz autogenic training. Review of studies in groups of students [21] and
meta-analysis of clinical outcome studies [17] showed that AT is an effective method to help
counteract sleep problems by improving the quality of sleep, sleep latency, the duration
of sleep and the energy level after waking up. We assumed that the relaxation training
enhances subjective sleep quality and sleep timing parameters also in university athletes.
Taken into account the results of our previous study on the interrelation between sleep
quality and stress [25] and reports indicating the impact of AT on stress response [26,27]
we also controlled the physiological response to stress.
Thus, the main aim of this research was to evaluate the effect of the AT on sleep quality
and physiological stress reactions in a group of university athletes.

2. Materials and Methods

2.1. Participants
Two hundred and nine students from one of the Polish universities actively involved
in sport (i.e., active membership in a sport club or academic sport association, where
participants train or have an individual training routine) took part in the recruitment
process and were screened for eligibility. Exclusion criteria was a history of chronic disease
that might affect circadian rhythms, or cause fatigue, for example anaemia, asthma, diabetes,
depression and related to it medication intake. Gupta et al. [7] in the research review on
sleep quality among elite athletes adopted three cut-off values based on PSQI scores, i.e.,
≥5, >5 and >8. In our study, the inclusion criteria were set at PSQI score ≥ 5. After rejecting
participants due to incomplete questionnaires (n = 2), 85 athletes with reduced sleep quality
were invited to participate in the experimental part of study. Thirty-one participants who
accepted the invitation were allocated to the experimental (EG; including 6 women and
10 men) or control group (CG; including 6 women and 9 men). The data collected from
9 participants were excluded because an insufficient number (less than 6) of relaxation
sessions were conducted (n = 7) or the participant did not report for the post-measurement
(n = 2). As a result, the full data were obtained and analysed from 22 athletes—equally for
EG and CG. The selection process is shown on a flowchart in Figure 1.
Int. J. Environ. Res. Public Health 2022, 19, x 3 of 8

tion sessions were conducted (n = 7) or the participant did not report for the post-meas-
Int. J. Environ. Res. Public Health 2022, 19, 16043 3 of 8
urement (n = 2). As a result, the full data were obtained and analysed from 22 athletes—
equally for EG and CG. The selection process is shown on a flowchart in Figure 1.

Figure
Figure1.1.Participants
Participantsflowchart.
flowchart.

2.2.Procedure
2.2. Procedure
Thepresented
The presentedstudy
studywas
wasan anexperimental
experimentalresearch
researchofofrandomized
randomizedblockblockdesign
designwith
with
single blind repeated measures. Pre- and post-measurements were conducted
single blind repeated measures. Pre- and post-measurements were conducted two weeks two weeks
aparttotocheck
apart checkfor
forchanges
changesinin sleep
sleep quality
quality (using
(using the
the PSQI)
PSQI) and
and emotional
emotionalreactivity
reactivity(using
(us-
biofeedback devices). Physiological parameters were measured in
ing biofeedback devices). Physiological parameters were measured in a sitting a sitting position and
position
at the same time of day so that the circadian rhythm did not affect physiological
and at the same time of day so that the circadian rhythm did not affect physiological data. data.
Allthe
All the measurements
measurements were
were conducted
conducted by principal
by principal investigator
investigator and twoandtrained
two trained final
final year
year psychology
psychology students,
students, in laboratory—severe
in laboratory—severe room,room,
wherewhere only table
only table with biofeedback
with biofeedback de-
device, relaxing chair and metal wardrobe was installed.
vice, relaxing chair and metal wardrobe was installed.
During the two-week period, the Ecological Momentary Assessment (EMA) procedure
During the two-week period, the Ecological Momentary Assessment (EMA) proce-
was used. Each participant wore an actigraph, completed the daily log (by Android appli-
dure was used. Each participant wore an actigraph, completed the daily log (by Android
cation) and listened to the recording (implemented in the application). Experimental group
application) and listened to the recording (implemented in the application). Experimental
(EG) had to listen to the recording with the relaxation training (based on the AT method),
group (EG) had to listen to the recording with the relaxation training (based on the AT
control group (CG) listened to the background music without suggestions, containing only
method), control group (CG) listened to the background music without suggestions, con-
introductory and final instructions (e.g., which position of the body to take). Both groups
taining only introductory and final instructions (e.g., which position of the body to take).
were supposed to perform themselves the training every day in the evening and not right
Both groups were supposed to perform themselves the training every day in the evening
after physical activity during the two-week period of intervention.
and not right after physical activity during the two-week period of intervention.
The study was conducted according to the guidelines of the Declaration of Helsinki and
was approved by the university ethics committee for scientific research. Before the study,
all the students were given a written study information and filled the informed consent.
Int. J. Environ. Res. Public Health 2022, 19, 16043 4 of 8

2.3. Instruments
2.3.1. Sleep Quality
The PSQI [5] as a retrospective method assesses sleep quality over a one-month time
interval. It includes 19 items that allow to distinguish seven components which are summed
to produce a global score. Results above 5 points indicate “poor sleep” [5], however in the
study cut-off criteria were set at five or more points according to Samuels study [28].

2.3.2. Physiological Parameters

Physiological stress reactions were measured using common non-invasive techniques
for detecting stress [29]. Measurements were taken with the Biofeedback device: Biograph
Infiniti, Thought Technology. The Blood Volume Pulse with Heart Rate (BVP+HR), Skin
Conductance (SC), Temperature was recorded using four sensors attached to the fingers.
Additionally, a breath measurement was included. Respiration sensor was placed around
the abdomen. Each of the participants underwent the same procedure according to the task
force’s recommendation [30]. The experimental design (both pre- and post-measurements)
containing three 5-minutes’ stages: baseline (anticipation of stress), event (arithmetic task-
induced stress) and post-event (post-activity rest).

2.3.3. Actigraphy
Actigraphy is indicated as a reliable tool to study the impact of treatments to improve
sleep [31]. The Actiwatch AW4 (Cambridge Neurotechnology, Cambridge, UK) and the
Actiwatch 2 (Philips Respironics, Hong Kong, China) actigraph wrist watches were used
to monitor continuously movement activity (excluding the time of training, bathing, and
the circumstances in which physical damage to the equipment could occur) for two weeks.
Before the research all watches were calibrated, and the subjects used the same devices in
subsequent measurements. A 2 min epoch length was applied. The actigraphy analysis
included sleep duration.

2.3.4. Daily Logs—ADS Application

A self-constructed Android application was used to collect data about athletes’ daily
activity that may influence sleep quality and quantity (undertaken physical activity and its
intensity—on a 5-point Likert scale) and to check the sleep parameters (sleep duration, and
in a Likert scale survey: subjective sleep quality, level of energy, level of stress).

2.3.5. Relaxation Training

Self-created audio recording SAT-relax that is based on the conception of the Schultz’s
AT was used [32]. It involves suggestions related to passive concentration of bodily
perceptions of heaviness and warmth as well as a slow breath which are supposed to
induce a state of relaxation [33]. Nine-minute recording was implemented in the ADS
application. Background music used in the recording was selected based on the assessments
of competent judges and purchased from https://audiojungle.net/item/nature-ambient/
14431334?s_rank=6. (accessed on 8 February 2017)

2.4. Data Analysis

Data were analysed with IBM SPSS v28 (IBM, Armonk, NY, USA). Initial compar-
ison of EG and CG included: sex ratio and sport discipline (chi square test with Yates’
correction), age and number of relaxation sessions (t-test for independent samples). Due
to non-fulfilment of the assumption of normality of distribution for multiple variables,
non-parametric statistics were used. Main comparisons between the groups were analysed
with Mann–Whitney U test. Data collected by actigraphy and daily logs were organized
into pre- (first four nights) and post- (last four night) measurements. All pre- and post-
measurements were analysed with Wilcoxon signed-rank test (for dependent samples).
Correlation coefficient r was
√ used as an effect size (ES) for Wilcoxon test. It was calculated
with the formula: r = Z/ n [34] and interpreted according to Cohen’s guidelines [35].
Int. J. Environ. Res. Public Health 2022, 19, 16043 5 of 8

Spearman correlation coefficient was used to verify relation between the number of re-
laxation sessions, time spent on physical activity and its mean intensity, and change in
subjective sleep quality from PSQI (delta calculated as the difference between pre- and
post- measurement).

3. Results
The result of the chi square test confirmed that the groups did not differ in terms of sex
ratio (EG: Women, n = 3, Men, n = 8; CG: Women, n= 6, Men, n = 5; X2 = 0.752, p = 0.386).
Additionally, age (MEG = 22.36, MCG = 21.73, t = 0.725, p = 0.477) and number of relaxation
sessions (MEG = 11.00, MCG = 10.36, t = 0.530, p = 0.602) was similar in compared groups.
In both EG and CG, the same number of participants were representatives of individual
(n = 7) and team sports (n = 4).
The main comparison between EG and CG includedsleep quality measured with
PSQI, sleep parameters collected via actigraphy and daily log, and physiological data.
Detailed information is shown in Tables S1 and S2 (Supplementary Material). According
to the analysis, both groups, when independently compared with Mann–Whitney U test,
presented similar results in all analysed pre and post measurements. Differences were
noted in EG pre-post dependent results, where PSQI score significantly decreased—sleep
quality improvement (Z = 2.54, p = 0.011, ES: r = 0.54) and sleep duration obtained via
daily log increased (Z = 2.13, p = 0.033, ES: r = 0.45). The presented values of ES were large
and medium, according to Cohen’s interpretation suggestions [35]. Change in pre-post
PSQI subjective sleep quality (delta) in both groups was correlated with the number of
relaxation sessions. A statistical tendency was present in EG, where R = 0.53, p = 0.093,
but not in CG, R = 0.12, p = 0.728. Mean time spent on physical activity and its intensity
during the 2-week period were correlated also with PSQI delta. Among EG no statistically
significant relations were noted, but in CG the relationship between change in sleep quality
and physical activity intensity was significant (R = −0.63, p = 0.038).

4. Discussion
In our study, we checked the effects of AT on sleep quality and physiological stress
responses of university athletes in an experimental procedure. The results showed that in
the EG (where AT was used) the overall sleep quality measured with PSQI increased. In the
CG (where only background music was used), there was no significant change between pre-
and post-measurement. We can assume that the AT, as a relaxation method can be more
effective in enhancing the subjective assessment of the sleep quality than the background
music alone. It is consistent with the basic assumptions of AT that it may be used to relax
the body by relaxing the mind [33].
According to the meta-analysis carried out by Stetter and Kupper [17] in clinical
groups, AT should be treated as an add-on support to medical treatment. The outcome
presented in this article shows that treatment with AT can be sufficient for healthy people,
such as academic athletes for enhancing their subjective quality of sleep. The effect of
AT on sleep quality was large which shows that AT, as an alternative to pharmacological
interventions (medications or supplements), might play an important role in helping
academic athletes improve their sleep quality. This is a positive conclusion, considering
that such relaxation trainings are an accessible form of impact and (especially in the shape
of audio recording) are easy to use and seem to have no side effects. It should also be
mentioned that changes in sleep quality after AT in the EG occurred independently of the
amount and intensity of physical activity. In contrast, in the CG, the greater intensity of
physical activity was connected with the reduced change in PSQI score.
Concerning the lack of differences in most of the objective indices of sleep as well as
physiological stress responses, we assume a few possible explanations of that. Firstly, the
problems with sleep examined in the experiment group were rather mild (8 points was the
highest noted result in PSQI).
Int. J. Environ. Res. Public Health 2022, 19, 16043 6 of 8

Secondly, the duration of intervention was quite short. However, our results are
in line with Schlarb, Friedrich and Classen [36], where also a 2-week training (CBT and
hypnotherapy) was implemented among university students, and similarly the change was
recorded in the PSQI but not in actigraphy. Generally, there are large discrepancies in the
duration and frequency of relaxation trainings in prior studies [17,21,24]—from very brief
of a few hours, through intense, everyday sessions for a couple weeks (as in our study)
to several months of two or three times a week training sessions. We are aware that the
effectiveness of the intervention may increase with its duration [37]. Relaxation training
is a long-term process requiring regularity, as it aims to fully automate the reactions [33].
Perhaps a longer period of training application would allow to collect more data on its
effectiveness. The presented research was a pilot study, so we used the shorter period
reported in the literature. Therefore, it may provide indications for the design of subsequent
interventions. To some extent, this has a reference in the trend noted in our study, where,
in the experimental group, the change in PSQI (sleep improvement) was positively related
(at the level of statistical tendency) to the number of training sessions completed.
Thirdly, the lack of significant change in physiological parameters may be due to
the fact that the implementation of AT is not aimed at changing specific physiological
parameters (as in biofeedback trainings [38]), but rather at subjective feelings of calmness
and relaxation.
The results may inspire athletes and people working with them to include the AT in
mental trainings, not only in case of dealing with competitive anxiety or improve athletic
performance (the efficiency of which has been previously proven), but also in case of some
problems with sleep.
The presented study is not free from limitations. The major is the lack of the con-
trol group without any intervention (any relaxation training between pre- and post-
measurements). Therefore, we can demonstrate only the effect of suggestions based on
autogenic training and we cannot conclude about the effectiveness of the music itself. Due
to the non-normality of the distribution, it was not possible to perform an ANOVA which
would have given a more complete possibility of inference.
The subjects did not wear actiwatches all the time. We controlled, by the daily logs,
the reasons for taking off the watches. Moreover, the students of subsequent years had
different class schedules covering different number of physical activities. According to these
circumstances, it was checked whether there were no differences between EG and CG in
terms of the initial level of sleep quality, length of sleep, time spent on physical activity and
its intensity. Lack of significant differences between groups strengthens the obtained result
in the use of relaxation training as a form of intervention for sleep quality improvement.

5. Conclusions
The presented preliminary results found that autogenic training may be used as a
tool that improves the sleep quality in healthy university athletes more than the relaxing
background music alone. However, further analyses, in a larger group, considering such
variables as sports level or type of sport discipline, are necessary.

Supplementary Materials: The following supporting information can be downloaded at: https:
//www.mdpi.com/article/10.3390/ijerph192316043/s1, Table S1: Comparison of PRE and POST
measurements among EG and CG and between the groups. Table S2: Mean and standard deviation
values for PRE and POST measurements among EG and CG
Author Contributions: Conceptualization, K.L.-K.; methodology, K.L.-K. and M.K.; software, K.L.-K.
and M.K.; formal analysis, K.L.-K., M.K., T.P.; investigation, K.L.-K., M.K., B.S.; resources, K.L.-K.; data
curation, K.L.-K., M.K.; writing—original draft preparation, K.L.-K., M.K., T.P.; writing—review and
editing, K.L.-K., M.K., T.P., M.W.-D., B.S.; project administration, K.L.-K., M.K.; funding acquisition,
K.L.-K. All authors have read and agreed to the published version of the manuscript.
Int. J. Environ. Res. Public Health 2022, 19, 16043 7 of 8

Funding: This research was a part of the project financed under the program of the Polish Ministry
of Science and Higher Education called “Academic Sport Development” in years 2015–2018 (project
number: 0010/RS3/2015/53).
Institutional Review Board Statement: The study was conducted in accordance with the Declaration
of Helsinki and approved by the Institutional Ethics Committee of Kazimierz Wielki University (date
of approval 8-07-2015).
Informed Consent Statement: Informed consent was obtained from all subjects involved in the study.
Data Availability Statement: The data presented in this study are available on request from the
corresponding author.
Acknowledgments: We would like to express our gratitude to Dominik Bernatowicz for his help at
the research design stage and Rafał Osowicki (IT Craft) for his technical support and the implemen-
tation of the Android application. We would also like to thank students Monika Hamerska, Maria
Kolmetz, Marta Krakowiak, Mateusz Minda and Agata Piasecka for their help in data collection and
database organizing.
Conflicts of Interest: The authors declare no conflict of interest. The funders had no role in the design
of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or
in the decision to publish the results.

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