Sleep disturbance bound to inflammation, immune response in 'feed forward loop'
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Poor sleep quality and duration can drive inflammatory and antiviral immune responses, which, in turn, often exacerbate sleep disturbances, according to a speaker at the Basic and Clinical Immunology for the Busy Clinician symposium.
“Sleep and immunity are partners in sickness and health,” Michael R. Irwin, MD, Cousins Distinguished Professor of Psychiatry at the Cousins Center for Psychoneuroimmunology, and director of the Mindful Awareness Research Center at UCLA, said in his presentation.
Irwin suggested that it is not just sleep, but “circadian dependent processes” that “prime” inflammatory responses and are an essential component to antiviral immune responses.
Inadequate sleep may have impacts on TNF, interleukin (IL)-6 and C-reactive protein levels, according to Irwin. It is because of these impacts that sleep disturbance is not only a consequence of inflammation, but a driver of inflammation in what he called “a feed forward loop.”
“Both sleep disturbance — that is, the quality of one’s sleep — and duration, are both associated with mortality risk and increases in the incidence and severity of immune-mediated inflammatory diseases,” Irwin said.
It was with all of this in mind that Irwin looked at non-pharmacotherapeutic methods of improving sleep. He described cognitive behavioral therapy as the “gold standard” intervention for chronic insomnia as dictated by both the American Academy of Sleep Medicine and the American College of Physicians.
However, despite its efficacy and durability, access issues inhibit widespread use and acceptance of cognitive behavioral therapy. “Few mental health professionals are trained in the delivery of [cognitive behavioral therapy],” he said. “Also, it is rather expensive.”
Another non-pharmacotherapeutic approach to managing chronic insomnia is mindfulness meditation, according to Irwin. The approach involves systematically attending to moment-by-moment experiences, thoughts and emotions from a nonjudgmental perspective. A growing body of data support the effectiveness of mindfulness meditation on sleep.
Irwin also addressed tai chi as a physical embodiment of mindfulness meditation approaches. A study in breast cancer patients showed that tai chi was comparable to cognitive behavioral therapy in improving sleep parameters. “This is important because tai chi can be delivered in community settings at very low cost,” he said.
Irwin concluded by stressing that sleep disturbance can have comparable adverse impacts on inflammation and antiviral immunity as poor diet, sedentary activity and obesity. “Treatments that target sleep behaviors reduce inflammation and improve antiviral immunity could possibly mitigate risk of inflammatory disorders and infectious disease risk,” he said.
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Irwin MR. Sleep and Immunity: Partners in Sickness and Health. Presented at Basic and Clinical Immunology for the Busy Clinician; Feb. 5-6, 2021. (virtual meeting).
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