Know the Link Between Sleep and Inflammation

Inflammation creates the “perfect storm” in autoimmune conditions, setting off a domino effect of disease activity, including demyelination for those with MS. One way to offset future inflammatory flareups is to prioritize sleep. Why?

The circadian connection

Our circadian rhythms regulate countless processes, sleep being one of the most important.

But the circadian system isn’t only in charge of managing sleep-wake cycles; it’s also a fundamental player in digestion and immune system function, as well as in the management of the inflammatory process.¹

Inflammation is meant to help our bodies heal, so it’s not normally a bad thing. But in cases like MS, inflammation tends to run amok at the cellular level, contributing to damage to the central nervous system.

Inflammatory behavior is also directly linked to the immune system. As people living with MS, we need to pay attention to circadian disruptions, as they influence both our disease course and immune system function.

Unfortunately, one of the biggest circadian disruptions that all humans endure is the struggle to get enough quality sleep. For this reason, sleep is critical for offsetting inflammation in those with MS.

The effect of losing just one night's sleep

It’s been well established that losing just one night of sleep, even among healthy people, can trigger inflammation.² From research published in Science Daily in 2008: “Loss of sleep, even for a few short hours during the night, can prompt one’s immune system to turn against healthy tissue and organs.”

Recent research further shows that sleep disturbance, as a measure of sleep loss—as opposed to entire nights of lost sleep—is just as problematic in raising the risk for systemic inflammation.

The presence of two markers of systemic inflammation as products of poor sleep—CRP (C-reactive protein) and IL-6 (interleukin-6)—were confirmed in a 2016 study (Biological Psychiatry).³

Insomnia, then, or disrupted sleep by any cause (for people with MS, this could include other sleep disorders, pain, medication side effects, or symptoms from comorbid conditions) are poised to set off new chains of inflammation if we don’t make concerted efforts to get adequate nightly sleep

The microbiome

The gut-brain connection continues to make MS news these days because researchers believe that the microbiome houses anti-inflammatory antibodies in the intestines which could travel to the brain and fight against immune system attacks.⁴

“The cells in question are plasma cells—white blood cells that originate as B cells in the bone marrow but change their behavior when triggered by microbes in the gut,” writs Weiler and Oldfield for UCSF News Center in January 2019. They reported on research which found that gut-based plasma cells produced immunoglobulin A (IgA) antibodies which “appear to migrate to the central nervous system and produce an anti-inflammatory effect during MS flare-ups.”⁵

Dr. Michael J. Breus, better known as The Sleep Doctor, points out that the microbiome is called our “second brain” because it is home to more than 100 million neurons in its own dedicated nervous system.⁶

“The intestinal microbiome produces and releases many of the same sleep-influencing neurotransmitters—dopamine, serotonin, and GABA among them—that are also produced by the brain,” Breus writes. But, he warns, “emerging research indicates that when circadian rhythms are disrupted, the health and functioning of the microbiome suffers.”

Circadian disruptions we can all relate to include stress, medication usage, poor diet, and—of course—disturbed sleep.

The Goldilocks rule for sleep

How much sleep is enough to fend off inflammation? The range for adults is between 7 and 9 hours of uninterrupted sleep.⁷

But will sleeping more than 9 hours mean better health?

Not necessarily. The Biological Psychiatry study from 2016 also linked long duration sleep (9 or more hours nightly) with elevated levels of inflammatory markers.

Sleeping away the inflammation

People with MS are frequently told to avoid stress, for good reason.

Dr. Breus makes it plain that “sleep offers us significant protection against stress, itself a major contributor to chronic inflammation—a now known pathway to disease.”⁸

It goes without saying that poor sleep and stress are unwanted bedfellows. How can we avoid letting stress steal our nightly ZZZ?

Dr. Breus supports fighting back by prioritizing sleep. "Sleeping well can work directly to keep inflammation in check by avoiding the pro-inflammatory activity that occurs in the presence of poor, dysregulated sleep."

For better sleep

• Seek medical advice if you suffer from disrupted sleep
• Practice good sleep hygiene. This includes keeping to a consistent sleep schedule, putting away your cell phone at night, watching caffeine and alcohol consumption (and their timing), making your sleep space “sleep friendly,” and looking carefully at drug side effects as they pertain to sleep.
• Turn to relaxation techniques to help you fall asleep and return to sleep, should you awaken in the middle of the night.
• Learn cognitive behavioral therapy techniques to banish racing thoughts at bedtime.