Running Under Conditions of Extreme Sleep Deprivation and Exhaustion: An Analysis of Performance and Satisfaction of 200+ Mile (322+ Kilometer) Ultramarathon Runners

IntroductionUltramarathons are growing considerably in both popularity and distance. This study aimed to identify factors associated with performance and satisfaction in ultramarathons of 200 mi (322 km) or more.MethodsThis cross-sectional study surveyed ultramarathoners who recently competed in a 200+ mi (322+ km) race between June and September 2023. The survey assessed demographics, ultramarathon experience, training habits, sleep-related factors, sleep-related adverse events, and injuries. Logistic regression quantified associations between variables and race outcomes.ResultsA total of 117 participants (67% male; mean age 47.2 y) completed the survey. Median race distance was 217 mi (interquartile range [IQR]=203-314 mi); 349 km [IQR=327-505 km]). Median sleep during races was 5.63 h (IQR=3.25-15.75 h). The most common within-race sleep strategy was sleeping when exhausted (38%). Finishing in the top quartile was associated with being male (odds ratio [OR]=3.37, more than 3fold higher odds than females), lower body mass index (OR=0.85, 15% lower odds per body mass index unit increase), and sleeping <7 h the night before (OR=0.33, 67% lower odds vs ≥7 h). Higher Pittsburgh Sleep Quality Index score (OR=0.70, 30% lower odds per point) and Insomnia Severity Index scores (OR=0.80, 20% lower odds per point) were associated with reduced likelihood of exceeding performance expectations. Weekly alcohol consumption, compared with monthly or less, was associated with lower race satisfaction (OR=0.42, 58% lower odds).ConclusionsThis study identified several factors associated with performance and satisfaction in 200+ mi (322+ km) ultramarathons, highlighting prerace and race sleep as key modifiable factors for optimizing performance.