The Biggest X-Factor in the 2018 NBA Finals Just Might Be a Good Night's Sleep

Tom Haberstroh@tomhaberstrohContributor IJune 5, 2018

Cleveland Cavaliers forward LeBron James (23) talks to JR Smith (5) during the second half of Game 3 of basketball's NBA Finals against the Golden State Warriors in Cleveland, Wednesday, June 7, 2017. (AP Photo/Tony Dejak)

It's 7 a.m. in a downtown San Francisco coffee shop, less than eight hours after J.R. Smith committed one of the most bizarre blunders in NBA Finals history. Standing in line for coffee are a pair of police officers shaking their heads.

The men are having the same conversation shared among countless other fans who watched Smith dribble out the final seconds of regulation in Game 1 instead of taking a potential game-winning shot underneath the basket.

"What was JR doing?" one officer says to the other. "He lose his mind?"

Sitting in front of me at the coffee shop is someone who makes a living thinking about and studying this very thing: why mental lapses occur on the field of play. Cheri Mah, MD is a physician scientist at the University of California, San Francisco Human Performance Center specializing in sleep for elite athletes. Mah consults with several pro teams, including the reigning NBA and NFL champions, the Golden State Warriors and Philadelphia Eagles. She has just returned to the Bay Area from giving a talk on sleep in sports at the American College of Sports Medicine in Minneapolis.

She watched the previous night's Game 1 like the rest of the country, but she looks through the discerning eye of a sleep scientist.

How quickly are players reacting? Do they look sluggish? Do they appear irritable and argumentative? Or are they poised and focused? And are they making unforced errors…like forgetting the score in a key moment and throwing away a golden opportunity to clinch a victory?

I can't help but bring up Smith's gaffe. Is that the sort of thing that catching more Z's could help prevent? It's a question that sends her into a fit of laughter; she was expecting it.

"I didn't go there, but I was waiting for someone else to go there," Mah says. "To me, that's a lapse of attention, which can happen if you're not getting enough sleep."

Sleep isn't just valuable to pro athletes because growth hormone is naturally secreted while they snooze. Numerous sleep studies have shown that NBA necessitiesquick reaction times, sharp attention spans and lightning-quick memory recallcan be corrupted by lack of sleep. To someone at home, mental lapses may seem completely random and uncontrollable.

"Sleep is a save button," Mah says.

Mah began studying sleep at Stanford more than a decade ago in 2002 and believes it is the next great frontier in sports.

"I know they had four days leading up to that game," Mah says of the Cavs in Game 1. "What was JR doing for those four days? Was he sleep-loading? How many hours was he getting?"

JR Smith's decision to dribble out the clock in regulation during Game 1 of the Finals cost the Cavaliers a chance to win a game they eventually lost in overtime.
JR Smith's decision to dribble out the clock in regulation during Game 1 of the Finals cost the Cavaliers a chance to win a game they eventually lost in overtime.Lachlan Cunningham/Getty Images

In a sea of reporters in between Games 1 and 2, Smith didn't divulge that information. But his sleep hygiene is the stuff of legend. Earlier this season, when former teammate Richard Jefferson asked Smith how he takes his pregame coffee on his Road Trippin' podcast, Smith responded: "I get an extra large coffee with eight creams and eight sugars."

It's the sort of thing that makes Mah shudder. How does one sleep with all that sugar and caffeine chugged down at night? Smith was asked about that on the podcast and his answer didn't clarify much.

"I don't sleep without coffee," Smith said. "So imagine me with coffee."

If Smith was anything like his teammate George Hill, there was no sleep after Game 1. Hill, who missed the potential game-winning free throw that led to the Smith debacle, admitted that he barely got a wink due to stress.

"This one hurt bad. ... One of the worst feelings ever," Hill told reporters on Saturday. "I stayed up most of the night rewatching the free throw, rewatching the play."

Sleep, or lack of it, has been a troubling mainstay in NBA headlines throughout the season. Three NBA coaches, including Cavs coach Tyronn Lue, Sacramento Kings coach Dave Joerger and Orlando Magic coach Steve Clifford then with the Hornets, took leaves of absence for health reasons related to sleep deprivation and/or stress. This comes on the heels of the NBA's new initiative to cut down the sleep-crippling back-to-backs that force teams to play the same day as a 3:00 a.m. check-in to a hotelconditions that have drawn the ire of sleep experts like Mah.

All the while, the sultan of sleep, LeBron James, is delivering an opus of untiring efforts night after night.

"That's the best recovery that you can possibly get," LeBron James asserted last month, "is when you're sleeping."

Which brings us to this: Is sleep, which has gained more attention in recent years across the NBA landscape, still the most untapped resource in the NBA? And with all the overnight travel and time-zone hopping, is consistently finding a good night's sleep in the NBA almost impossible?

Says Mah: "It's the perfect storm."

Two years ago, ESPN's Baxter Holmes came up with an idea: Could we predict when NBA teams would win and lose simply by looking at sleep windows in the schedule and nothing else?

Steve Clifford saw how a team's lack of sleep can degrade its performance as a group and the health issues it created for him.
Steve Clifford saw how a team's lack of sleep can degrade its performance as a group and the health issues it created for him.Brock Williams-Smith/Getty Images

It was a lofty goal, but the first expert that Holmes contacted was Dr. Mah, who had already explored the concept of enhancing sleep with a team of Stanford researchers in 2011. She found that the Stanford men's basketball team saw both its free-throw and three-point percentages rose by nine percentage points on average when they shifted from their normal sleep routine (6-8 hours of sleep) to trying to get as much sleep as possible with a goal of 10 hours in bed every night. The players also demonstrated faster sprint times in practice and reported feeling better both physically and mentally on the court.

So Mah thought maybe the impact of sleep could be analyzed in an NBA schedule, which has teams zipping around the country for 82 games in 170 days. Mah put her insights to the test and identified games on the schedule in which the sleep component, by proxy of rest days and travel, would be most lopsided.

With ESPN's help (full disclosure: I helped launch the project in 2016), Mah's model identified 42 games that were deemed "schedule losses" in 2016-17. The results were stunning. The model, which did not account for the strength of the team in question or its opponent on a given night, correctly predicted the winner in 29 of 42 instances, nailing 69 percent of picks informed by Mah Score, including 76.5 percent (13 of 17) of "red alert" cases when sleep windows were most compromised. In Vegas, a 57 percent success rate is the stuff of legend, let alone 77.

Maybe it was a lucky string of games. Mah and the ESPN team returned for 2017-18 by strengthening the model with more 10 seasons of data baked in. It did even better, predicting the winner with 77.8 percent accuracy (42 of 54 games). In the future, Mah hopes to compare the model against the spread.

Mah's work has made its way into pregame press conferences. Before a Hornets game in November 2016, in which Charlotte was playing its fourth game in five nights, Clifford told reporters, "ESPN said today that we have the lowest chance to win out of any game that will be played in the league this year."

The Hornets were trounced by the Dallas Mavericks 112-89. A year later, Clifford stepped away from the team to deal with health problems that were, at the time, undisclosed. He went through a battery of tests with doctors and neurologists. Was it a brain tumor? A stroke? The results came in.

Much to Clifford's relief, his condition was largely treatable. After missing 21 games, Clifford returned to the team and announced that for two years, he had been dealing with severe headaches that doctors said were the result of chronic sleep deprivation. Clifford said during one particular trip jetting from Charlotte to Toronto to Miami back to Charlotte for four games in seven days, he was getting "at most" two or three hours of sleep per night. A poll of 19 head coaches by NBA.com's David Aldridge revealed a range of three to eight hours of sleep per night, but not more. Mah recommends eight to 10 hours for players and a minimum of seven hours per night.

With time away from the grind, Clifford developed new sleeping habits and went on medication to help manage the NBA schedule.

"The biggest thing for me is a lack of sleep," Clifford told the Charlotte Observer's Rick Bonnell. "I have to change not just about my job, but how I live." 

Despite taking steps to lose 40 pounds, Kings coach Dave Joerger collapsed toward the end of a tiring road trip.
Despite taking steps to lose 40 pounds, Kings coach Dave Joerger collapsed toward the end of a tiring road trip.Eric Gay/Associated Press/Associated Press

Before a game in Charlotte, Sacramento coach Dave Joergerwho had lost 40 pounds over the previous year in an effort to maintain a healthier lifestylewas asked about the coaching grind in the NBA. It was a topical conversation. Joerger was in the middle of a mind-numbing January stretch of the Kings' schedule that saw the team play 13 consecutive games in different cities. And second, Clifford had just returned earlier that week from his longtime absence.

"I love Steve," Joerger told me. "It's a tough business. And if you get behind once the season starts, it's tough to catch up. Whether it be sleep, nutrition or exercise, it's easy to get out of a good habit and into a bad habits as far as eating late. We have food in front of us all the time. When you're traveling, all kinds of things are out of whack. You try to go into the season as well as you can and see if you can maintain it."

Six days later, during the 11th stop of the brutal 13-game tour crisscrossing the country, Joerger collapsed in the middle of a game against the San Antonio Spurs and left the court due to lightheadedness. He sat out the following game in New Orleans as a health precaution. He later attributed the health scare to a combination of dehydration, his weight loss and the gnawing stress of being an NBA coach for a young team.

"We all hear about stuff," Joerger told the Sacramento Bee's Ailene Voisin. "The fans, everybody has an opinion about who should be playing. That part wears on me. No question."

Clifford, 56, is grateful now. In his introductory press conference after being named the new coach of the Orlando Magic, he didn't shy away from talking about the career-threatening episode.

"Going through it was professionally the most difficult thing I've ever had to go through," Clifford said. "Personally, it was probably the best thing that ever happened to me."

Clifford's wake-up call and recovery caught the eye of the Orlando Magic, who hired him this summer.

"You have to kind of bear in mind that Steve comes from that Van Gundy tree, and those guys are famous for landing at three o'clock from a road trip and being in the office at five," Orlando president Jeff Weltman told Josh Robbins of the Orlando Sentinel. "I think that's who Steve Clifford is. He's a workaholic and he's a burn-it-at-both-ends guy all in the effort to make his players better and his teams better."

This is what Mah is fighting against. It's the myth that sleep is a crutch, buttressed by the "I'll sleep when I'm dead" platitude that fuels many athletes. A Stack.com headline once read "How Kobe Bryant Sacrificed Sleep For Greatness" with an embedded video tagged #mambamentality. On the Lowe Post podcast, legendary writer Jack McCallum said Michael Jordan didn't sleep before the 1992 Olympics gold medal game.

"There's this badge of honor that you don't need sleep and you should be able to execute and be on top of your game on five hours of sleep or less," Mah says. "All these athletes and coaches look for the one percent. This is so fascinating to me, because getting sleep is so much more than one percent."

Cheri Mah, MD @Cheri_Mah

Incredibly honored our sleep research was awarded @UCSF Dean’s Prize in Clinical & Translational Research. Thrilled to also receive Chih Award in Neuroscience for our sleep & performance MLB study. Beyond grateful for Dr. Luke who won Pathways Mentor Award! #InquirySymposium2018 https://t.co/OZ1uMm1Ccx

When Clifford's body tapped out in December, he experienced his awakening.

"Number one: You need to sleep," he said at his Magic introductory press conference. "You need to sleep."

It's a lesson that NBA Finals coaches Steve Kerr and Tyronn Lue learned as NBA lifers.

About 24 hours after the Smith blunder, Steve Kerr is posed a question at the off-day press conference. When did he get the most sleep: as a player, executive, broadcaster or coach?

"Player definitely," Kerr says. "The game-day nap."

The pregame nap is a mainstay in the NBA world. Klay Thompson, famous for his even demeanor and amazing track record in injury recovery, has mastered it. Kerr recalled what Jud Buechler, his former teammate with the Bulls who was just hired to be the New York Knicks assistant coach, told him when he retired.

"Do you miss the game?" Kerr asked Buechler.

"I miss two things: naps and per diem," Buechler told him.

Kerr hasn't experienced the same sleep-deprivation issues that have plagued his fellow coaches at times. He attributes that to a work-life balance philosophy instilled by the Zen Master Phil Jackson and Gregg Popovich.

"When I was a young player, I kind of wondered if coaches were holed up in their office all night sleeping on the cot," Kerr said. "I wasn't exactly sure how it worked. Both those guys had such diverse interests outside the game. ... How interested they were in our lives besides what was going on in basketball, I think they really influenced me."

Having Thompson, Stephen Curry, Draymond Green and Kevin Durant might help the Warriors' success a bit, too.

"When I became a coach, I was obviously lucky we had a lot of talent," Kerr said. "But it's evident pretty quickly that there's only about five or six ways to guard the screen-and-roll. If you think you're going to find another one by being in your office at 11 o'clock at night, you're mistaken. You've got to put the work in, but you've got to have a good life, too."

That work-life balance and prioritizing sleep? It is easier said than done. In March, Lue needed time off to deal with what he termed "chest pains and other troubling symptoms, compounded by a loss of sleep." Lue missed nine games and in a recent interview with ESPN, the Cavaliers coach said he was treated for anxiety and has received medication.

During his leave of absence, Lue received a phone call from Kerr, who had missed 43 games in 2015-16 because of complications resulting from back surgery. At a recent press conference, Kerr revealed his message.

"Sometimes I think in this job, because there is so much passion from the fan bases, and because everybody wants to win so badly, it feels bigger than it really is," Kerr said. "So just kind of a reminder that we're playing a sport. Get better."

With no back-to-backs in the playoffs, the Cavs have reached the Finals yet again.

"[Kerr] was very supportive," Lue said, per Melissa Rohlin of the Bay Area News Group. "Just told me to get myself healthy, and 'Let's make another strong run at it.' So here we are again."

After undergoing his own health-related absence a few seasons ago, Steve Kerr reached out to offer his advice to Tyronn Lue when the Cavaliers coach was forced to take nine games off to address anxiety issues.
After undergoing his own health-related absence a few seasons ago, Steve Kerr reached out to offer his advice to Tyronn Lue when the Cavaliers coach was forced to take nine games off to address anxiety issues.Noah Graham/Getty Images

And that's largely because of James, who cherishes sleep like it's an oasis in a desert. And he isn't shy about making it known. Mah believes James' public advocacy for sleep may be the best thing for the sleep industry.

When LeBron talks, people listen. In October 2014, James felt the league was misguided in experimenting with 44-minute preseason games as opposed to the normal 48. James instead advocated that the league look at the length of the 82-game schedule. "

"We all, as players, think it's too many games," James said at the time, per Chris Haynes, then of Cleveland.com.

How much James' words influenced the league's next moves is a mystery (James was elected VP of the National Basketball Players Association in 2015). But soon after, the NBA began a concerted effort to reduce the number of back-to-backs in the schedule as well as the brutal four games in five nights.

This year, the NBA built in more rest days than ever by lengthening the season (thanks to cutting some preseason games) and reducing back-to-backs from 16.3 per team to 14.4 as as well as eliminating four-in-fives altogether. Perhaps not coincidentally, James played all 82 games for the first time in his NBA career as the schedule optimized sleep windows.

Speaking at the Finals, commissioner Adam Silver reiterated his stance that 82 is not a magic number, and he emphasized that the league's statistical analysis doesn't suggest that the quantity of games is the issue. It's those sleep-killing back-to-backs.

"Where we do see a correlation [of injuries] is lack of rest," Silver said. "That's why we added a week to the schedule. We've dramatically reduced back-to-backs ... to create more space in our schedule. "

Interestingly enough, it's those pesky back-to-backs that have plagued the Cavs in recent years. In 2015-16, the Cavs went 11-8 (.579) on the second half of back-to-backs and 46-17 (.730) in all other games. In 2016-17, the trend was more pronounced: They were 7-11 (.389) in games with zero days of rest and 44-20 (.688) in all other games. With the improved schedule, the Cavs endured five fewer back-to-backs and went 7-6 (.538) in those games compared to 43-26 (.623) in the more rested contests this year.

Framing it that way, it becomes clearer how the Cavs have gotten to the Finals three years in a row without having the Eastern Conference's best record in any of those seasons. Perhaps the switch that they keep flipping is a schedule one: there are no back-to-backs in the playoffs, a huge boost for a team that has had the third-worst record against the spread on back-to-backs since 2015-16, according to TeamRankings.com data.

James is taking advantage. LeBron is famously in tune with his body and spends nearly every waking minute trying to prepare it for the next game. But sleep is James' not-so-secret ingredient for recovery, as he explained in echoing what Kerr said minutes before on the podium at a Finals media session.

"I think as you get older, you understand what benefits your body more and more, depending on what you put in your body as far as food and nutrition, things like that, how many hours a night you try to get," James said. "I found a great balance in what helps me be in the best possible shape I can be on a day-to-day basis."

But he wasn't always this way. Prioritizing sleep is something he learned over time. Like Clifford, he can't do the things he used to at a younger age.

With a regular nap schedule and no back-to-backs, LeBron James has been able to log almost 100 more minutes than any other player in the playoffs this year.
With a regular nap schedule and no back-to-backs, LeBron James has been able to log almost 100 more minutes than any other player in the playoffs this year.Marcio Jose Sanchez/Associated Press/Associated Press

"I was 18 when I came into the league," James said at Saturday's press conference. "I could do whatever I wanted to do. I could stay up throughout the whole night and play 48 minutes the next night and then not ice after the game and go right home. I didn't even tape my rookie year. I'm totally different."

Mah is thrilled when today's superstars like James and Tom Bradywho told GQ he gets into bed at 8:30 p.m. every nightspeak about their appreciation for sleep. 

"There's literally only a handful of us (sleep scientists focused on sports), maybe 10 of us around the world," Mah said. 

Dozens of sleeping pills have been introduced into the market, but Mah believes there might be a better way to get people to sleep better. It's about having open conversations about sleep and why chronic sleep deprivation is not a condition to be worshipped.

"The conversation has moved, and I'd like to say we've made progress," Mah said. "But it's still not there yet. It's still a badge of honor, but we're trying to shift that perspective."

While the sleep medicine industry is scrambling to find the miracle drug to sell to Americans, Mah is hopeful the NBA voices continue to speak up. And one player in particular.

"It is different when LeBron talks about it," Mah says. "The world listens to LeBron."

Correction: An earlier version of this story incorrectly credited the idea to predict when NBA teams might win or lose based on sleep windows to Dr. Cheri Mah. ESPN's Baxter Holmes originally came up with the concept and contacted Dr. Mah to help with the project. B/R regrets the error.       

Tom Haberstroh has covered the NBA full-time since 2010, joining B/R Mag after seven years with ESPN as an NBA insider and analytics expert. Haberstroh is also a co-founder of Count The Dings podcast network and regularly hosts the Back To Back podcast. Follow him on Twitter: @tomhaberstroh.