Autoimmunity, inflammation, and sleep, oh my!

When it comes to autoimmunity (AI), getting the right amount is an even more important factor in the healing process. Yet for people with autoimmunity, the added stress and worry of illness can interrupt sleep, even as the illness itself can increase exhaustion.  Restorative sleep can be even more important – not to be confused with endless bed rest on the opposite side of the spectrum, which can indicate the need for professional help.  Some people simply require more rest than others — especially those with autoimmune concerns. So it’s important to be able to take intentional steps to get what you need.

How much sleep is the right amount?

So, what’s the right amount of sleep? Experts now say a minimum of 7 hours of actual sleep is necessary for the adult body to repair itself. The U.S.-based National Sleep Foundation recently updated these guidelines (1):

Note that these guidelines are for actual sleeping — not the time before or after sleep that you may be in bed, but not actually asleep.

The problem: sleep deprivation increases inflammation

Is missing sleep really that big a deal?

Inflammation is measured by markers in the blood, specifically C-Reactive Protein (CRP) and cytokines.  Inflammation is necessary for a short period when healing from an injury or when your body is protecting you from an intense stress.  The problem arises when inflammation continues for days, months, and years on end.  One night of lost sleep can be resolved over the next week or so.  Continuing to get too little sleep each night creates compounded inflammation that takes a lot more work to heal.  Even if you’re the kind of person who loses sleep during the week to catch up on the weekend, it takes more than those two days to bring all your inflammation markers back to a more normal baseline.  (4)

Someone who has an autoimmune condition already has elevated inflammation in the body.  A lack of restorative sleep causes this inflammation to be further aggravated.

When you’re in an active autoimmune flare, you know how powerful the drive to sleep can be.  The vast majority of illnesses will increase your drive to sleep, since you need more than normal.  The immune system and your sleeping habits are tightly linked.  This means that when your immune system is compromised, more sleep can help to restore it, and you’ll be driven to sleep as much as you’re able.  It also means that too little sleep can compromise your immune system, making you more prone to illnesses, especially with active, complex autoimmune conditions. (5)

What happens when you don’t get enough sleep?

You already know that you don’t feel great after a night of short sleep, or when you just didn’t sleep well.  Both physical and mental performance suffer more if you’re short on sleep when you have an autoimmune disease.  It’s not just about how you feel.  There are negative effects that impact your whole body when you don’t get enough sleep, and these effects can compound over time.  In one study, scientists found that going for 40 hours without sleep, which is missing one full night’s rest, increases inflammation in young individuals who are otherwise healthy. (2)  In someone who’s neither young nor particularly healthy, what can the effects be then?

Sleep deprivation studies like this are often repeated, and many have altered variables such as missing multiple nights of sleep in a row, and getting only short nights of sleep for multiple nights.  They reliably produce the same results, which involve increased inflammation and increased risk of disease, along with other side effects like increased appetite, decreased focus, and mood irregularities.  While these are all harmful, inflammation has the most dramatic and most lasting negative impact.

For those with autoimmune disease, it is especially important to understand the role that sleep has in inflammation, stimulating the immune system, and regulating hormones (which themselves modulate the immune system) (3).

Sleep cycles

Our sleep cycles aren’t just about getting roughly 8 hours in a 24-hour period.  We’re earth-based creatures, and as much as we might not want to admit it, we’re affected by the seasons and the daily light cycles.  The frequencies of light are different at each time of the day, from sunrise, to midday, to sunset, and the amount of each type of light varies with the seasons.  If you find you want to sleep more and move less in the winter, or sleep less and be more active in the summer, this is exactly why.  This is called the circadian rhythm, and it is one of the sleep triggers that can modulate immune function.  (6, 10)

There are genes that regulate how well we’re synced up with the bigger clocks of the earth and the sun, and can explain why some people have such a hard time adjusting to different time zones or long distance travel.  These genes also are part of why some people can manage overnight work while others quickly manifest physical and mental health challenges.  Some doctors believe that no one who has an autoimmune condition should work night shifts precisely for this disruption to their circadian rhythm.

Dr. Sarah Ballantyne, also known as The Paleo Mom, has worked extensively in the realm of autoimmunity and circadian rhythms. (11, 12)  She’s referenced three specific types of white blood cells that can become poorly regulated, which are called Th1, Th2, and Th17.  These are all typically hyperactive in those with autoimmune conditions.  Sleep deprivation — even just getting too little sleep for 3 nights in a row — can cause these cells to be elevated, on top of higher CRP and cytokine levels.  This is a recipe for persistent inflammation.  Th17 in particular is further stimulated by inflammatory cytokines, creating an inflammatory feedback loop that feeds into itself.  Th17 takes longer to drop back to baseline levels, which is one of the reasons the weekend isn’t enough time to heal from a week of poor sleep.

Connecting sleep deprivation to autoimmunity

Autoimmune conditions can present a range of symptoms and attack virtually any tissue in the body.  As you may suspect, the inflammation that accumulates over time with poor sleep can have a direct impact on the development of autoimmune diseases.

A recent study in Taiwan, which analyzed data from 1995 to 2010, has revealed that those who had non-apnea sleep disorders (such as insomnia) had nearly twice the increased risk of developing an autoimmune condition than those who did not have a sleep disorder.  This population study did not focus on just one autoimmune condition; instead it included any disease that was autoimmune in nature.  The same research noted that sleep deprivation could trigger earlier onset of autoimmune symptoms.  Lack of sleep is contributing to the exponential rise of autoimmunity, fueled by our disconnection from natural light sources, stress-filled lifestyles, and foods that impair gut health.  (13)

Ballantyne states,

“Inadequate sleep has also been investigated as a possible cause of autoimmune disease. In an animal model of psoriasis, sleep deprivation caused significant increases in proinflammatory cytokines, cortisol levels, and increases in specific proteins in the skin associated with symptoms of psoriasis (like the flaking, dry, scaly skin).  In an animal model of multiple sclerosis, mice subjected to sleep deprivation developed the disease earlier than mice that slept normally.  Once the mice developed multiple sclerosis, sleep deprivation caused increased disease activity and pain sensitivity.  Furthermore, sleep disturbances are commonly reported by people with chronic inflammatory conditions (such as rheumatoid arthritis, systemic lupus erythematosus, inflammatory bowel disease and asthma).  Whether the sleep disturbances cause the disease or the disease causes the sleep disturbances is not well understood.  However, such sleep disturbances are known to worsen the course of the disease, aggravate disease symptoms such as pain and fatigue, increase disease activity and lower quality of life.” (3)

Now that you understand how powerful a necessity sleep can be, let’s dive in to some ways you can get enough deep sleep each night.

The solution: 10 steps toward a better night’s sleep

1. Actively plan to go to bed

The first step to getting more sleep when you’re not getting enough is about planning for it.  It can be easy to say, “I’ll go to bed early tonight” without having a solid concept of what ‘early’ means to you, and even missing the time when you would get at least 8 hours.  If you wake up at 6 in the morning, you would have to fall asleep by 10 at night to meet the general guideline of 8 hours of sleep.  If you head to bed at 9:30, that gives you half an hour to relax and fall asleep.  If you function best on 9 or 10 hours, account for this amount of time instead.  It’s common in a healing phase to need more sleep.  This step can be implemented right away, and takes no more than a single decision.  What time are you getting to bed tonight?

2. Sleep best in total darkness

Next, consider your sleep environment.  Getting a good amount of deep sleep depends on your body’s reactions to the elements in your bedroom.  Bright nightlights, televisions being left on, and even electronics in the same room can be disruptive to your sleep cycles.  Think of your bedroom like a sleeping cave.  Make it as dark as possible, and if you must have a clock or nightlight, keep it a dim red. Televisions are bright and loud, and can impair sleep, so keep these off.  Take electronics to a separate room, since there is evidence that the signal can disrupt the electromagnetic brainwaves responsible for deep sleep. (7)  Set your cell phone to Do Not Disturb for your sleep hours so that only emergency callers that you set can get through, and you don’t hear continual dings all night (or put it in a different room so you’ll only hear alarms and calls, not text messages or notifications).  Finally, consider the curtains in your bedroom.  Choose a fabric that will block out light so that outside lights don’t disturb your sleep, especially if the sun rises before you need to get up.

3. Manage light and activity

Seeing the bright light of early morning can help you to wake up, and daylight naturally helps to keep you more energetic during the day.  As evening comes, the altered light signals your brain to produce more melatonin to help you feel sleepy.  If you can’t wake naturally to sunlight in the mornings, try a wake-up lamp that turns on as your alarm, using the same frequency of light as a sunrise.  Getting sufficient activity during the day can have a similar effect.  You can do a simple program of walking or yoga as early in the day as you can, which will also improve your sleep quality at night.

4. Dedicate your bedroom for sleep

Keeping your bedroom reserved for only sleep, sex, and getting dressed can help you to subconsciously equate that room with only those activities.  Often, doing work or other activities in the bedroom can keep your mind too active when it comes time for sleep.  Train your mind to know that the bedroom is a place for relaxation, and the body will follow.

5. Foods can help you sleep better

Eating according to an autoimmune plan can improve your sleep quality, and choosing foods that are in balance with your circadian rhythm can help you fall asleep more easily.  It might sound complex, but the principals are easy to break down and adopt.  Dr. Doni Wilson (8, 9) has done a great deal of research into this topic, and hers are some of the best suggestions.

• Eliminating gluten and other grains can make a world of difference, since they are pro-inflammatory and can negatively impact blood sugar. These are essential foods to eliminate on an autoimmune protocol regardless, though their elimination will have a clear impact on sleep quality.
• Avoiding any other food triggers is equally important, not only to reduce autoimmune symptoms but also for sleep improvement. Keeping foods like dairy, eggs, and nightshades out of your meals, as suggested in the Autoimmune Protocol diet, can help improve your sleep.
• Refined sugar and other processed carbohydrates tend to be disruptive to sleep, especially when eaten within 3 hours of bedtime. Sugar is naturally excluded from a Paleo or Paleo Autoimmune Protocol diet but, if you’re not following those or one of the autoimmune-friendly protocols, be aware of this when choosing food.
• Eat your larger meals earlier in the day, and have something smaller for dinner.
• Some people who’ve experienced sustained stress find that a small snack, such as a bit of clean protein and a small portion of high-quality fat such as 1 TB of coconut oil half an hour before bedtime can actually help improve sleep, by helping to regular blood sugar levels through the night. This can include a small amount of carbohydrate, such as fresh fruit. Note that it’s important that all three components be present in high quality and small quantity – this is not an invitation for a bowl of ice cream before bed, which can disrupt sleep. (15)

6. Reduce stimulants

Coffee is the most popular stimulant on the market, followed by various teas, sodas, and energy drinks.  Ideally, we wouldn’t need these to wake up in the morning, even if we do enjoy them.  If you do consume stimulants, keep them to the early morning in as small a dose as you can manage.  Avoid them as afternoon approaches to make sure they are metabolized fully before it’s time to head to bed.  See a separate article about the impact of caffeine on hormonal fatigue and the resulting impact on autoimmune function, or take a peak here.

7. Actively relax

If thoughts are spinning in your head and keeping you awake at night, take some time before bed for relaxation exercises. Then, gentle yoga in the evenings is a non-stimulating exercise that can help relax the body and calm the mind.  You can write all those thoughts down in a notebook to deal with later.  Or you can create journal pages on things you are grateful for.  It’s especially important to reduce, or ideally avoid screen time at least an hour, preferably two hours, before bed.  The blue light emitted from electronic screens is disruptive to the hormones responsible for getting us to sleep.  (14)  If you must use screens, use a physical blue light filter like specially designed glasses you can use with any device or a filter app that changes the light coming from your screen. To unwind, some people stretch and meditate; others listen to relaxing music or nature sounds.  If you can’t relax enough to fall asleep, pick an activity that allows your mind to slow down so you can later drift off to sleep, such as a warm bath in a dimly lit room, or a gentle massage from a partner.  Routine will help in training the body and mind to relax and become ready for sleep.  Regular meditation at any time of the day helps to quiet and calm the mind overall, and this helps sleep to come more easily at night.

8. Consider magnesium

While it’s best to get all of your nutrients from whole food sources, it’s difficult to get enough sometimes.  Magnesium is one of the minerals that’s a challenge to get enough. (16)  Magnesium helps muscles to relax, and can also help you to fall asleep and stay in a deeper, more restorative sleep.  There are a variety of magnesium supplements available, and they are not all the same; work with your functional medicine practitioner to choose the one that is right for your overall needs.  A magnesium powder mixed in to a drink an hour or so before bed, for example, can often help. As always, check with your provider before making a change to your supplement protocol.

9. Check in with your provider

If taking these steps together do not help you get the sleep you need, or you suspect something else is going on – or when just want or need professional guidance — always check with your functional medicine practitioner for help. They may be able to provide some additional ammunition for your specific needs that can help you get the sleep you need, reduce inflammation, and fend off AI.

10. Learn more

Here’s a relevant article:

• Mindfulness Meditation Helps Fight Insomnia, Improves Sleep by Julie Corliss, Executive Editor, Harvard Heart Letter

A couple of book options by noted experts:

• Doni Wilson: Insomnia: A Natural Guide to Better Sleep
• Sarah Ballantyne’s eBook and associated program: Go to Bed

A deeper dive:

• Autoimmune Wellness Podcast outlining Mickey and Angie’s journeys and what they did about it
• Autoimmune Wellness Podcast outlining sleep researcher Dan Pardi’s journey, with what Dan found to do about it.

References:

1. https://sleepfoundation.org/press-release/national-sleep-foundation-recommends-new-sleep-times
2. https://www.ncbi.nlm.nih.gov/pubmed/17524614
3. https://www.thepaleomom.com/teaser-excerpt-from-the-paleo-approach-the-importance-of-sleep/
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3548567/
5. http://ajpregu.physiology.org/content/291/5/R1527.long
6. http://science.sciencemag.org/content/342/6159/727.full
7. https://www.ncbi.nlm.nih.gov/pubmed/23051584
8. https://doctordoni.com/2015/09/leaky-gut-and-autoimmune-diseases/
9. https://doctordoni.com/2015/01/food-sensitivities-and-sleep/
10. http://www.npr.org/2017/10/02/555170222/3-americans-win-nobel-in-medicine-for-circadian-rhythm-research
11. https://www.thepaleomom.com/regulating-circadian-rhythm/
12. https://www.thepaleomom.com/teaser-excerpt-from-the-paleo-approach-the-importance-of-sleep/
13. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4355897/
14. http://www.haifa.ac.il/index.php/en/home-page3/2528-the-blue-light-emitted-by-screens-damages-our-sleep
15. https://autoimmunewellness.com/eight-key-lifestyle-habits-to-support-adrenal-healing/
16. https://ods.od.nih.gov/factsheets/Magnesium-HealthProfessional/