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Introduction

This article focuses on how you can use sleep to maximize your immune function and protect yourself against COVID-19.

Why is this important? Because if SARS-CoV-2 continues to become more virulent, even fully vaccinated people risk succumbing to COVID-19. Thus, both the vaccinated and the unvaccinated need adequate sleep to avoid the long-term health consequences of severe COVID-19.

Sleep and Vaccine Response

The importance of sleep is evident when we consider the effect of sleep deprivation on vaccine response.

For example, reducing your sleep four days before an influenza vaccination can reduce your antibody production from the flu vaccine by over 50% (reviewed in (1)).

Furthermore, suppose you don’t sleep the night after receiving a hepatitis-A, hepatitis-B, or influenza vaccine. In that case, you also reduce your antibody response to the vaccine by about 50% (reviewed in (1)).

Thus, being sleep deprived either before or immediately after receiving your vaccine greatly reduces the vaccine’s protective effect.

Sleep and COVID-19 Vaccine Response

Does sleep quality impact your immune response to the SARS-CoV-2 vaccine?

Unfortunately, we currently don’t have a definitive answer to this question (2). However, given how sleep deprivation negatively impacts the efficacy of other vaccines, it is likely that disrupted sleep will also reduce the effectiveness of the COVID-19 vaccine (2).

Maximizing your immune response to the COVID-19 is important for three reasons.

First, for those of you who have a compromised immune system (for example, people over the age of 70), ensuring you are sleeping well before and after your vaccine may be necessary to provide a protective immune response post-vaccination (2).

Second, the emergence of Sars-CoV-2 variants that can now partially avoid the vaccine immune response means that everyone should maximize their immune response to the COVID-19 vaccine.

Finally, some researchers have found that antibody responses rapidly wane after COVID-19 vaccination (3).

Now, before you panic, it’s normal for antibody levels to decline after any virus infection. Remember, it’s the memory cells of your immune system that provide long-lasting protection, not your short-lived antibody response.

Nevertheless, a more robust antibody response after your vaccine produces more memory immune cells, which reduces your chance of infection (3).

Thus, the current recommendation is that you should focus on getting as much quality sleep as possible before and after your COVID-19 vaccination (3, 4).

Sleep and Virus Infection

It should come as no surprise that sleep is also crucial for protecting you from infection.

For example, people who report poor sleep are more likely to suffer from respiratory diseases and succumb to pneumonia than those who experience adequate sleep (reviewed in (1)).

In addition, those who experience disrupted sleep report experiencing more frequent cold, influenza, and gastro infections than those who sleep well (reviewed in (1)).

Finally, virus challenge experiments show that people who experienced impaired sleep had an increased chance of developing a cold after receiving cold virus nasal drops (reviewed in (1)).

Thus, disrupted sleep makes you vulnerable to virus infections.

Sleep and COVID-19 Disease

Unfortunately, the role between sleep and COVID-19 remains understudied. Currently, the only known connection between sleep and COVID-19 is the link between sleep apnea and severe COVID-19.

Obstructive sleep apnea (OSA) is a sleep breathing disorder caused by obstructions of the upper airway during sleep (5). Recently, researchers identified OSA as a risk factor for severe COVID-19 (6).

Given that chronic sleep disruption increases inflammation and reduces anti-viral immunity (3), it makes sense that the presence of OSA can tip patients towards the state of runaway inflammation that increases the severity of COVID-19 (1).

Thus, it’s likely that sleep disruption increases your risk of suffering severe COVID-19.

Melatonin

Melatonin is produced in the brain during periods of darkness and is an essential regulator of your sleep-wake cycle (a.k.a, your circadian rhythm) (7).

The sleep-related roles of melatonin are promoting sleep, maintaining sleep, resetting your circadian clock, and training your circadian rhythm over time (7). Unfortunately, your natural melatonin production declines as you age, which contributes to age-related insomnia.

In addition, melatonin has several non-sleep-related roles in maintaining your health. For example, melatonin is an antioxidant, has anti-inflammatory effects, and is neuro- and cardio-protective (7-9).

When taken as a drug, melatonin appears to be a safe and effective sleep aid (11). Furthermore, the additional biological effects of melatonin mean that it may offer additional protection against COVID-19 (10).

Before you rush to the chemist to stock up on melatonin, please check with your doctor. Because various melatonin formulations are available, matching the correct melatonin formulation to your specific sleep disruption is necessary for optimal sleep results (10).

Only your doctor can identify which melatonin formulation is suitable for you.

Take-Home Message

High-quality sleep is vital to maximize your vaccine response and protect you against virus infection.

In contrast, disrupted sleep increases chronic inflammation, makes you vulnerable to viral infection, and dampens your vaccine immune response.

For these reasons, getting consistent, high-quality sleep is an essential part of your COVID-19 defenses.

If you currently have sleep issues, consider melatonin as a sleep aid. Not only does melatonin help you sleep, but melatonin has additional biological effects that may help prevent severe COVID-19.

Sleep For Covid

References and Further Reading

1.            L. Besedovsky, T. Lange, M. Haack, The Sleep-Immune Crosstalk in Health and Disease. Physiol Rev 99, 1325-1380 (2019).

2.            C. Benedict, J. Cedernaes, Could a good night’s sleep improve COVID-19 vaccine efficacy? Lancet Respir Med 9, 447-448 (2021).

3.            A. Hamady, J. Lee, Z. A. Loboda, Waning antibody responses in COVID-19: what can we learn from the analysis of other coronaviruses? Infection, 1-15 (2021).

4.            C. S. Kow, S. S. Hasan, Do sleep quality and sleep duration before or after COVID-19 vaccination affect antibody response? Chronobiol Int 38, 941-943 (2021).

5.            M. T. Mello et al., Sleep and COVID-19: considerations about immunity, pathophysiology, and treatment. Sleep Sci 13, 199-209 (2020).

6.            B. E. Cade, H. S. Dashti, S. M. Hassan, S. Redline, E. W. Karlson, Sleep Apnea and COVID-19 Mortality and Hospitalization. Am J Respir Crit Care Med 202, 1462-1464 (2020).

7.            L. M. Melhuish Beaupre, G. M. Brown, V. F. Gonçalves, J. L. Kennedy, Melatonin’s neuroprotective role in mitochondria and its potential as a biomarker in aging, cognition and psychiatric disorders. Transl Psychiatry 11, 339 (2021).

8.            M. Ashrafizadeh et al., Anti-Inflammatory Activity of Melatonin: a Focus on the Role of NLRP3 Inflammasome. Inflammation 44, 1207-1222 (2021).

9.            A. Wichniak, A. Kania, M. Siemiński, W. J. Cubała, Melatonin as a Potential Adjuvant Treatment for COVID-19 beyond Sleep Disorders. Int J Mol Sci 22,  (2021).

10.          I. Moroni et al., Pharmacokinetics of exogenous melatonin in relation to formulation, and effects on sleep: A systematic review. Sleep Med Rev 57, 101431 (2021).

11.          G. Fatemeh et al., Effect of melatonin supplementation on sleep quality: a systematic review and meta-analysis of randomized controlled trials. J Neurol,  (2021).

Acknowledgements

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Woman Yoga Nidra

Yoga Nidra for Better Sleep

Disrupted sleep increases anxiety and depression. Yoga Nidra is an effective method that has helped many people overcome insomnia.

Beautiful Woman Running On Treadmill

Low-Intensity Cardio for Metabolic Health

Emerging research shows that low-intensity cardio is the best way to improve your metabolic and cardiovascular health.

Strong bones, strong brain.

Strong Bones, Strong Mind

Regular exercise releases osteocalcin from your bones. Once in circulation, osteocalcin enters your brain to support learning and memory.