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Health Hack #60 - The Power of Sleep, Continued...

As we look back at our current pandemic years from now, it’s likely we’ll remember the certain phases of it pretty easily. A zero to sixty ramp-up, seemingly overnight, in March. Austerity measures and drastic changes to our daily routines and social interactions then coming to define the spring season of 2020.

With summer came spurts of good news, with various business restrictions lifting, and a sense that the social distancing practices in place had managed to place us on the right track, with feelings that the end could be in sight.

Come autumn, however, it suddenly felt that we’d taken a step backwards. Cases began to surge, the severity of restrictions on gatherings and business activities began to again reflect those first introduced in the spring, and collective morale really seemed to shift.

Now that winter is upon us, the newly released vaccines have quickly come to dominate the dialogue around the pandemic. Given the novel, all-consuming nature of this coming phase, and the fact that this particular aspect so severely impacted our traditional holiday plans, it’s almost certain to embed itself into our psyche for decades to come. Where were you when you first heard the news of Princess Diana? Or of the Twin Towers coming down? These, though, were individual moments. Uniquely, probably most similar to life during extreme wartime, we’ll be able to recollect months at a time, with isolated events like our altered winter religious holidays serving to quickly jog our memories, and epitomize the overall state of being during these strange times.

Where Sleep Has Fallen into each Phase of the Pandemic

Aside from the power of real food, we’ve probably banged the drums on the benefits of quality sleep more than any other subject related to our health. From a terse intro (Part 1) on the physiological benefits of sleep, to a follow-up (Part 2) ripe with a litany of sleep improvement tips, we laid a sound foundation for why sleep matters in the earliest stages of this weekly blog.

Beyond the baseline all purpose information, we’ve also spent time applying the concept of sleep to different phases of the pandemic. In the spring (here), we explained the link between circadian rhythm preservation and immune health, noting that hormonal dysregulation driven by poor sleep drastically reduces our resistance towards illness.

Come summer, we explored the subject of breathing (Am I Breathing Correctly?), highlighting the health benefits of learning to breathe through one’s nose. Nasal breathing, particularly during sleep, is known to amplify the production of red blood cells and thereby boost the armor of our respiratory system at large.

Most recently, the subject arose again (In Preparing for a Potential Return to Lockdown) very subtly, as a vital part of a toolkit for health preservation during periods of time when we find ourselves persistently indoors. Though not called out specifically, quality sleep is the ultimate culmination of a day well spent. When we check off the important waking boxes (nourishing meals, exercise, socialization, stress reducing routines/hobbies, etc.), we land in the sweetest spot for optimizing a night’s slumber.

How Sleep Can Impact this Next Phase

There is scientific evidence to suggest that sleep can significantly affect one’s immune response to a particular vaccine. This theme has appeared a number of times in the scientific literature over the years.

Back in 2002, the Journal of American Medical Association (a.k.a. JAMA) published a study revealing that poor sleep in the days leading up to receiving the Influenza Virus Vaccine (a.k.a. The “Flu Shot”) yielded far fewer antibodies than the control group that was better slept. On the 10th day following the vaccination, a group that had received fewer than 6 hours of sleep on each of the four night’s prior to being vaccinated possessed more than 50% fewer antibodies than the control group that was given no constraints on sleep duration. (Interestingly, for this particular study, the discrepancy between antibody populations seemed to reduce itself over time, suggesting that the adverse impact was short lived.) 

In 2012, a similar study was conducted, using the Hepatitis B vaccine. Hepatitis B vaccines are typically administered in 3 stages over the course of six months: the first shot, the second coming one month later, and the third coming five months after that. The trial measured levels of antibodies just prior to the second and third phase, and then six months after the final phase (to better measure lasting immunity). Individuals who’d steadily received lower end of the spectrum sleep quantities (6 hours or less, per night) were 11.5 times more likely to be unprotected by the vaccine than those receiving an average of 7 hours or more of sleep per night. In this study, 70% of the participants wore electronic sleep monitors, to hedge against faulty reporting which is often a concerning factor for lengthier studies such as this one.

A third study, from just this year, corroborated the findings from the 2002 JAMA study. Again, the lower the duration and quality of sleep in the days immediately preceding and following the vaccination (in this case, the Influenza Vaccine again, albeit a different strain from the 2002 study) predicted lower levels of antibodies, in this case four and sixteen weeks after the vaccination was administered, suggesting that the adverse effects of poor sleep on vaccine efficacy were far more long term than previously observed.

What does this say about sleep’s relationship to the COVID vaccines? Definitively speaking, we can’t say. Not only have there been no such studies (at least none that I’m aware of) to date, extrapolating predictions from former studies that scrutinized other vaccines may not be super relevant to what we’re up against here. Not only are the current COVID vaccines engineered towards tackling a completely different virus than the others, they function through a distinctly different mechanism. The Pfizer and Moderna products that are currently available carry the unique classification of being mRNA vaccines.

Traditionally, a vaccine injection will include a weakened or completely inactive viral particle, which is used to trigger an immune response. With an mRNA vaccine, recipients are essentially given an instruction manual that teaches one’s cells to create a harmless piece of a “spike protein”. This spike protein is the same one found on the surface of the virus being vaccinated against, in this case the COVID-19 virus. The innocuous piece of protein that is created by the mRNA vaccine elicits an immune response, creating the same antibodies to ward it off that would be created in the event of an actual COVID-19 infection. (For a very digestible explanation on mRNA vaccines, click here.)

Given sleep’s innate immune boosting properties, it seems plausible that it could prove beneficial in optimizing the efficacy of vaccines in general. Rhinoviruses are the most common culprit for what we know as "the common cold". A pretty astounding statistic: those sleeping fewer than 7 hours per evening (on average) are more than three times as likely to contract some form of rhinovirus, versus yielding more than 7 hours of sleep per night.  

Again - this is not sufficient evidence in proving that quality sleep will generate a more optimal antibody response from either of the available COVID vaccines. But given all of the peripheral evidence, it wouldn’t be remotely surprising if it did. And given the host of other benefits that come from sleeping well, now is always the wisest time to begin focusing on improving something as instrumental to our well being as our sleep.

Sleep Well.