Want to reduce your COVID-19 risk? You should sleep more.

Observations about sleep and its health benefits date back at least 2,000 years.

Aristotle’s publication On sleep and sleep It was suggested in 350 BCE that digestion in the stomach produces hot vapors that cause sleepiness, and people suffering from fever experience something similar, requiring them to take a nap to help with the healing process. is.

Although the idea of ​​vaping was not revealed, decades of scientific evidence suggest that sleep is a solid way to strengthen the immune system against colds, influenza, and respiratory infections. This work suggests that sleep can be a powerful tool to fight epidemics – not by reducing the likelihood or severity of infection. Sleep may ultimately boost the effectiveness of COVID-19 vaccines when they become available, and there is a rash of studies underway about how much health buffer we obtain against coronovirus from sowing.

Psychiatrist Monica Hak of Harvard Medical School in Boston says, “We have a lot of evidence that if you have enough sleep, you can definitely help prevent or fight any kind of infection. ” “If you sleep properly, how many deaths can you prevent, or how low is the severity of your symptoms? I think more research is needed. “

Unless a vaccine is available, the key to avoiding COVID-19 may be reducing the risk of infection. As new data rolls into sleep and the disease, scientists hope to improve the complex functioning of the immune system, as well as clear guidelines on how to use sleep as a weapon to prevent the epidemic. Are also given.

Sleep-infection relationship

Humans are not the only animals to benefit from sleep. Serious studies from the late 1800s have shown that when dogs and mice are completely sleep deprived, animals die within a few weeks. For people, chronic sleep deprivation also has long-term consequences, taking risks for type 2 diabetes, heart disease, dementia, and depression. Some of those chronic conditions are risk factors that increase susceptibility to COVID-19.

When people get tired, people also take more risks, according to Lt. Col. Vincent Capaldi, head of the behavioral department of the Walter Reed Army Institute of Military Psychiatry and Neuropsychology Research, Silver Spring, Maryland. Sleep loss is particularly common among soldiers, and Walter Reed dedicates an entire research center to understand how being awake affects one’s ability to think and act.

“You’re putting yourself at risk of making a mistake when it comes to protecting yourself when sleep deprived,” says Colonel Capali. To the general public, that wearing a mask may appear as sloppy or forgetful, adding an additional strain on the immune system.

Increasing evidence also shows that lack of sleep hinders a person’s ability to fight a disease after becoming infected. In many studies, people with sleep disorders, people who close the eye for less than five or six hours at night, and people with low levels of sleep efficiency (the percentage of time spent snoozing during the night) report higher rates Respiratory diseases, head cold, and related illnesses.

Over 10 hours of sleep a night has been associated with higher rates of illness, but experts say that excess snoozing does not make people sick. Instead, underlying health conditions that include depression may be the cause of overselling. Or a condition like diabetes or sleep apnea may be the cause of poor sleep quality, which can lead to more nights with less sleep.

Some studies have even tracked the straight road from sleep to illness, just to see if sleep is associated with infection. Researchers at the University of California, San Francisco, and Carnegie Mellon at the University of Pittsburgh recruited 164 healthy adults to wear Fitbit-type devices that tracked their sleep habits for a week. Then, they went to the lab, where the researchers squeezed rhinovirus (common cold) drops before calming them in a hotel for five days.

The virus was equally likely to invade and replicate people’s bodies, regardless of how much sleep they got, the team reported in 2015. But those who slept less than six hours were 4.5 times more likely to develop symptoms of cold than those who slept more than seven hours a night. Rhinoviruses are good corollaries to coronaviruses; For one thing, the immune response appears to be the same for both, study co-author Eric Prather, a psychiatrist at UCSF.

Sleep and related health outcomes are also associated with the type of social disparities that have kept the epidemic bare. In a separate study published in 2017, Prather and his colleagues looked at data from 732 people from three rhinovirus studies and found a similar relationship.

Only those who place themselves low based on measures of socioeconomic status (based on questions about income, education, and jobs) increase the likelihood of a cold after sleep deprivation. These disparities are reflected in infection rates for SARS-CoV-2 viruses. Part of the problem is that not everyone can get enough sleep, given that people in low-income brackets often do many chores or work shifts overnight. (Millennials and General Z are spreading coronaviruses – but not because of parties and bars.)

“It’s really a social justice issue around people’s ability to get sleep,” Prather says. “All of those things drive these sleep disorders and map to disparities in a set of outcomes, and possibly also on COID.”

Sleep and immune system

Studies that manipulate sleep – either deprive people or how much they get – begin to know why there is such a complex relationship between sleep and the immune system.

“We know you need sleep to fight infection,” says Haack of Harvard. “But exactly how it works, I think there’s still a lot of work to do.”

In a 2019 study, Hack and his colleagues listed more than three dozen ways that different immune system players vary based on sleep changes. For example, T cells are part of the immune system and often described as soldiers fighting infection. During sleep, according to studies conducted by German researchers, T cells usually exit the blood and are likely to be in the lymph nodes, where they are monitored to attack pathogens, Hack says. But one night of sleep deprivation, studies show, is enough to keep T cells from circulating in the blood, making them less able to know and react to the virus. When the body is deprived of sleep, T cells become less capable of interacting with virus-infected cells, reducing their power to fight infection.

Cytokines, a class of inflammatory molecules associated with epidemics, are also a major focus of research on sleep and immunity. Pro-inflammatory cytokines typically help organize an immune response to infection, triggering other cells to fight, says Sheldon Cohen, a psychiatrist at Carnegie Mellon University. But many of these molecules are also involved in cytokine storm production, which is associated with severe and fatal cases of COVID-19. In cold and influenza studies, people infected with poor sleep show worse symptoms, perhaps because elevated levels of pro-inflammatory cytokines interfere with T cells and other immune cells.

Cytokines do not function in isolation, but are instead part of creating an equilibrium in the immune system between factors that promote inflammation and combat. Learning how the process works to affect diseases like COVID-19 is still in progress.

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Sleep, Vaccines and COVID-19

Because researchers cannot ethically expose people to most diseases, including COVID-19, vaccine research has offered another way to investigate the relationship between sleep and the immune system. So far, this work makes a compelling case that gives sleep a real boost to the immune system. This is particularly true for antibodies, which are typically long-lasting proteins that the body makes in response to pathogens (and vaccines). Antibodies help the body remember those infections.

In the first such studies since 2002, a group of people slept for about eight hours for four nights before taking a flu shot, then slept the same amount for two nights after the shot. Ten days later, the researchers reported that participants’ influenza antibody levels were twice as high as those in the other group, who slept only four hours per night over the same period. Sleep deprivation may also decrease antibody responses to hepatitis A, hepatitis B, and H1N1 swine flu vaccines. In some studies, all this happens one night.

Those antibody benefits lead to long-term health outcomes, even in the long term. One study linked improved sleep before hepatitis B vaccination with a lower likelihood of developing the disease in the next six months.

Given the intense interest in developing a COVID-19 vaccine that would precipitate the epidemic, a simple behavior that could make vaccination more effective would be welcome news. At Walter Reed, researchers are developing a COVID-19 vaccine, and when its phase one clinical trial begins early this winter, says Colonel Capaldi, they will allow a group of participants for several nights before vaccinating We plan to sleep for 10 hours at night. . If snoozing results in a better vaccine response than those who are sleep deprived for long periods of time, future work may look to see if getting more sleep with help from medication may provide similar benefits.

Understanding the sleep connection can help direct vaccine delivery for frontline health-care workers, especially those working 80 hours a week during an epidemic. They may need to be relaxed beforehand to boost the effectiveness of the dose. “It may have such significant relevance to vaccination policy,” Prather says. “Anything that we can try to elicit a response seems really important.”

Researchers at Walter Reed, UCSF and other institutions are now going through mountains of data to link sleep with COVID-19 risk. Nothing has been published yet, but Hack says he has reviewed several upcoming studies on the subject, and the results appear promising.

Cohen of Carnegie Mellon said that sleep is far from the only factor that affects susceptibility to disease. According to an analysis Cohen published in 2020, exercise, social support, stress levels, smoking, alcohol intake and other factors also explain why a subset of people become ill only when exposed to a virus.

Nevertheless, experts recommend prioritizing sleep for those who have a choice, its effect on infection risk. Sticking to a consistent sleep schedule is an effective way to get high quality sleep, Prathar says. So it is relaxing to reduce the lights before bed, turn off the screen and take a break from the news. Cohen advised people to sleep at least seven hours a night to improve their chances of staying healthy during an epidemic.

“We say, we show that people who got insufficient amounts of sleep were more likely to get sick when we exposed them to a virus,” he says. “It clearly plays a role in health and wellbeing.”


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