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Does sleep apnea reduce your immune system function?

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Do sleep disorders like sleep apnea and insomnia reduce your immune system response to viruses and keep you sick longer? Science says yes. Current peer-reviewed research has demonstrated that uninterrupted, full-night sleep is necessary for strong immunity.

Three Takeaways:

  1. Immunological function and response to viruses and vaccines is affected by sleep.

  2. Full night sleep with sufficient REM and NREM (SWS) sleep is required for optimal immune system function.

  3. Sleep disorders like sleep apnea can particularly disrupt specific sleep cycles like REM sleep due to their pathophysiology.

Research has already documented how poor, insufficient sleep is as destructive to your health as no sleep at all.

Our current understanding of the neurological and biological processes of sleep began in 1953 with the identification of REM sleep (rapid eye movement) [1]. Similarly, immunology is a relatively new discipline, so the interdependency between your sleep and your immune response is one modern scientists are just now beginning to study.

In the study of neuroimmunology, researchers have measured how "T cells and the production of pro-inflammatory cytokines exhibit peaks during early nocturnal sleep" and "studies revealed a selectively enhancing influence of sleep on cytokines promoting the interaction between antigen presenting cells and T helper cells, like interleukin-12" [2]. One study found that sleep following vaccination against hepatitis A increased antigen-specific Th cells and antibody titres after the full night of sleep, suggesting a link between sleep and immunological memory.

Your circadian rhythm is regulated by the suprachiasmatic nucleus, a pair of nuclei located in the brain's hypothalamus. The suprachiasmatic nucleus can be thought of as a "central pacemaker" of your body's sleep-wake cycle [3]. The sleep-wake cycle involves alternating stages of REM and NREM sleep, with NREM sleep features mixed-frequency and slow-wave (or SWS) sleep.

During controlled sleep study testing in research laboratory settings, scientists can now measure how the sleep cycle down-regulates your hypothalamus–pituitary–adrenal (HPA) axis and the sympathetic nervous system (SNS) [4], where cortisol, epinephrine and norepinephrine reduce. Concurrently, restoration occurs with cell growth, release of growth hormone, and regulation of prolactin, melatonin, and leptin -- all strong factors in immune cell activation [5]. Scientists can also measure that cytokines release are associated with specific sleep stages [6].

Sleep disorders like sleep apnea can notably disrupt the REM and NREM sleep cycle due to the pathophysiology of the disorder. In sleep apnea, muscle atonia relaxes the tongue and jaw muscles, leading to a narrowing or blockage of the airway. This obstruction occurs more significantly during REM sleep when muscle atonia is increased to prevent physical activity while dreaming. As a result, patients who snore, choke, or gasp when they fall asleep are more likely to experience significantly increased sleep apnea and oxygen loss later in the night during REM sleep.

Insomnia can also worsen sleep immunity dysfunction. Insomnia can profoundly delay your sleep latency (or the time to initiate or fall asleep), thus delaying your NREM to REM circadian cycle. Americans are increasingly falling asleep at later hours but still waking up at early hours for work or for their children to go to school. The result of this increasing insomnia is a nation of adults who are sleeping fewer hours and experiencing fewer REM and NREM (SWS) cycles necessary for immunological functioning, production, and memory.

The National Sleep Foundation recommends the following sleep hours for optimal restoration and health:

  • Newborns (0-3 months): 14-17 hours

  • Infants (4-11 months): 12-15 hours

  • Toddlers (1-2 years): 11-14 hours

  • Preschoolers (3-5 years): 10-13 hours

  • School-age children (6-13 years): 9-11 hours

  • Teenagers (14-17 years): 8-10 hours

  • Younger adults (18-25 years): 7-9 hours

  • Adults (26-64 years): 7-9 hours

  • Older adults (65years and above): 7-8 hours

If your sleep is disrupted by snoring, choking, or gasping, get evaluated for sleep apnea with safe, comprehensive home sleep study evaluation at an American Academy of Sleep Medicine accredited sleep disorders center like SleepSomatics in Austin, TX.

References:

  1. Imeri, L., & Opp, M. R. (2009). How (and why) the immune system makes us sleep. Nature reviews. Neuroscience, 10(3), 199–210. https://doi.org/10.1038/nrn2576

  2. Besedovsky, L., Lange, T. & Born, J. Sleep and immune function. Pflugers Arch - Eur J Physiol 463, 121–137 (2012). https://doi.org/10.1007/s00424-011-1044-0

  3. Hastings MH, Maywood ES, Brancaccio M. Generation of circadian rhythms in the suprachiasmatic nucleus. Nat Rev Neurosci. 2018 Aug;19(8):453-469. doi: 10.1038/s41583-018-0026-z. PMID: 29934559. https://pubmed.ncbi.nlm.nih.gov/29934559/

  4. Theresa M. Buckley, Alan F. Schatzberg, On the Interactions of the Hypothalamic-Pituitary-Adrenal (HPA) Axis and Sleep: Normal HPA Axis Activity and Circadian Rhythm, Exemplary Sleep Disorders, The Journal of Clinical Endocrinology & Metabolism, Volume 90, Issue 5, 1 May 2005, Pages 3106–3114, https://doi.org/10.1210/jc.2004-1056

  5. Haus E. Chronobiology in the endocrine system. Adv Drug Deliv Rev. 2007 Aug 31;59(9-10):985-1014. doi: 10.1016/j.addr.2007.01.001. Epub 2007 Jul 14. PMID: 17804113. https://pubmed.ncbi.nlm.nih.gov/17804113/

  6. Marshall L, Born J. Brain-immune interactions in sleep. Int Rev Neurobiol. 2002;52:93-131. doi: 10.1016/s0074-7742(02)52007-9. PMID: 12498102. https://pubmed.ncbi.nlm.nih.gov/12498102/

SleepSomatics

SleepSomatics Diagnostic Center is a credentialed and accredited sleep center serving Austin and Central Texas since 1999. We provide sleep diagnostic and therapy services including In-Lab Sleep Study, Take-Home Sleep Test, and Sleep Therapy.