Q&A: A good night’s sleep may improve immune response to COVID-19 vaccine

Getting good sleep before and after receiving the COVID-19 vaccine may boost immune response, according to the American Academy of Sleep Medicine.

The society noted that previous research on other vaccinations have demonstrated the benefits of achieving good quality and quantity of sleep before and after vaccination.

Healio Primary Care spoke with AASM President Kannan Ramar, MBBS, MD, to learn more about the evidence on how sleep may improve the immune response to COVID-19 vaccines and tips that primary care physicians can offer patients to achieve good sleep.

Q: How does sleep loss impact immunity?

A: In July 2020, the AASM conducted a survey and found that approximately one in five Americans, or about 19%, said they get less nightly sleep during the current pandemic, and 22% said that their sleep quality is actually worse than before the pandemic. As COVID-19 vaccines are being distributed for administration, it is important that people continue to get sufficient sleep to be able to generate an optimal immune response. The AASM recommends that adults, on average, should get 7 or more hours of sleep on a regular basis to promote optimal health. This helps with building a strong immune system, along with other benefits that come along with getting adequate sleep.

In terms of sleep loss and immunity, there are several studies that have found an association between sleep duration and vaccination response. There’s a study from 2020, published in the International Journal of Behavioral Medicine that found that the flu vaccine seemed to be more effective in people who got sufficient duration of sleep for the 2 nights prior to receiving the vaccine compared to those who did not get enough sleep. And similarly, in an older study that looked at patients’ response to hepatitis A and hepatitis B vaccines, they found that shorter sleep duration before and after vaccination is associated with a lower antibody response and a decreased likelihood of protection from hepatitis A and B. These research findings clearly suggest that sleep has a role in boosting innate and acquired immune response.

Q: What evidence suggests that healthy sleep can improve immune response to COVID-19 vaccines?

A: We don’t, unfortunately, have direct evidence at this point to say that getting sleep boosts immune response to COVID-19 vaccinations. Since we have data to support that good sleep — both from a quantity and quality perspective — builds and enhances the immune system, both innate and acquired, I think one can easily extrapolate it to the COVID-19 vaccinations as well. Though, as I pointed out, we do not have direct evidence yet, and hopefully studies in this regard might be happening and provide direct evidence down the road. Previous studies have clearly illustrated the association between sleep and the immune system, so I think it’s important to follow through on that, at this stage.

Q: Should PCPs recommend that patients try to achieve healthy sleep before and after receiving the COVID-19 vaccine?

A: It’s an emphatic yes to that question. I think it’s always important for patients to practice healthy sleep hygiene and achieve their best sleep in terms of both quality and quantity of sleep.

Q: What tips can physicians offer patients to help them achieve healthy sleep?

A: People with sleep disorders, I believe, should be cognizant of their immune health. I would recommend that they look at CDC guidelines and prioritize getting their recommended amount of sleep each night. And as we touched upon earlier, AASM recommends that, on average, adults should aim for 7 or more hours of sleep on a regular basis. How do we best do that? First, it’s important to establish a bedtime and a morning routine. Having that nightly routine usually brings about calm and relaxation, and this could be facilitated by either reading, journaling or even meditating for a few minutes. It’s important to have the bedroom environment to be a little cooler and dark. Second is ensuring that the bedroom is a space for sleep, and that includes limiting noise and distractions and using the bed only for sleeping. So, not to watch TV or read a book. I think that would be better off done outside the bedroom and when you get sleepy, or close to your bedtime, close the book, finish watching TV and then go into the bedroom. Third is setting boundaries for blue light exposure. With technological advances, it’s important to have a self-induced curfew by turning off the TV and, more importantly, electronic devices at least 30 minutes to an hour before bedtime. This eliminates the blue light exposure that can otherwise delay one’s ability to fall asleep, and it actually ends up moving the body clock to a later bedtime and wakeup time. Fourth is limiting alcohol, caffeine and large meals before bedtime. Avoiding caffeine after 2 p.m. is ideal, even better, after lunch. Avoiding alcohol close to bedtime is important. If one is having alcohol in small to moderate amounts, it’s okay, but having it 1 to 3 hours before bed is ideal. Having it too close to bedtime can disrupt the quality of sleep. Similarly, having a big meal before bedtime is not ideal. You would want to have at least 2 to 3 hours after dinner to be able to go to bed because you don’t want to go to bed with a full stomach, as that can disrupt sleep, too.

Q: Is there anything else you’d like to add?

A: Trying to get good sleep on the night both before and after vaccination is going to be important. If people are interested in learning more about this, they can visit the website sleepeducation.org.

Unfortunately, during the pandemic, people are definitely suffering from stress, worries, financial distress and losing loved ones, which not surprisingly will affect both the quantity and quality of sleep. So, prioritizing sleep as one prioritizes exercise and diet is going to be important for optimal health, and to be able to combat the pandemic that we are in.

References:

• AASM. Healthy sleep and immune response to COVID-19 vaccination. https://aasm.org/healthy-sleep-and-immune-response-to-covid-19-vaccination/. Accessed February 3, 2021.
• AASM. Sleep prioritization survey: COVID-19 and the impact on sleep. https://j2vjt3dnbra3ps7ll1clb4q2-wpengine.netdna-ssl.com/wp-content/uploads/2020/10/sleep-prioritization-survey-2020-COVID-19-impact-sleep-results.pdf. Accessed February 3, 2021.
• Lange T, et al. Psychosom Med. 2003;doi:10.1097/01.psy.0000091382.61178.f1.
• Prather AA, et al. Int J Behav Med. 2020;doi:10.1007/s12529-020-09879-4.
• Prather AA, et al. Sleep. 2012;doi:10.5665/sleep.1990.