Publication of the Association of Polysomnographic Technologists • Summer 2006 • www.aptweb.org
Sleep and the Immune System
BY EDWIN CINTRON, RPSGT AND KORNELIA DENEAU, RPSGT
t is often wondered how it is that some people are more at risk of catching colds, viruses, and other common illnesses while others do not. It is
obvious that this is directly affected by the body’s immune system, but
sleep may play a major part. The amount of restorative sleep one is able
to acquire plays a crucial role in strengthening the immune system.
Making sure you get plenty of rest is not just an old wives’ tale after all.
I
There are no proven medications available that help to strengthen the
immune system1. This makes it important to lead a healthy lifestyle, which
includes getting enough sleep. No one is really sure about the function of
sleep as far as its role in the healing process, but body temperature appears
to be important. Rats that are chronically deprived of sleep show increases
of 10° C, or more2. This suggests that sleep has cooling functions.
Conversely, rats deprived of sleep for two weeks or more show a significant
drop in body temperature suggesting that sleep may also have a role in heat
retention2. Studies of sleep deprivation done by Dr. Allen Rechtshaffen, et al,
have shown that this constant drop in body temperature leads to death after
11-22 days in rats3. It is estimated that it would take as long as 7 months
of complete sleep deprivation to result in death for humans3. A good, deep
sleep (delta sleep, in particular) allows the body to produce more growth hormones. This, in turn, helps the body to rebuild the immune system.
Loss of restorative sleep can lead to many different diagnoses including
the flu, colds, or other illnesses. One theory suggests that the tiredness
associated with the illness may be the body sending a message4. The message is simple. Sleep is needed. So why is sleep so important? To answer
this, one must consider that when asleep, the human body is using less energy for other things. It can devote more energy to attack invading bacteria
and/or viruses more effectively. In older adults, the ability to fight off infection is not as good as it is in younger adults5. In response to an infection, one
of the body’s defense mechanisms is to increase body temperature (fever) to
kill the cells causing the illness5. Since the amount of slow wave sleep is less
in older adults6, this could explain why the immune system is weaker in the
elderly. The amount of slow wave sleep in early adulthood (age 16-25 years)
is about 18.9%, and it drops to 3.4% during middle age (age 36-50 years)7.
Healthy sleep also plays a very important role from infancy through
adolescence. The impact of poor sleep becomes apparent with this population in a diverse manner. The lack of restorative sleep affects not only
the health of the child but also the physical stature. The need for sleep
and the repair of tissues is key for further growth. It is well known that in
normal subjects, growth hormone is released during sleep in a pulsatile
pattern with peaks during slow-wave sleep8. We also know that the percentage of slow-wave sleep is increased during the developmental years8.
In pre-pubertal children, secretion of the growth hormone is clearly coupled with sleep onset9. It peaks during the first third of the night, during
slow wave sleep, and is secreted exclusively during other stages of sleep9.
To better understand the consequences of poor sleep in the pediatric
population, one can take into consideration the health issues of those with
Down Syndrome (DS). Children with DS have been reported to have severe
growth arrest and Microcephaly10. Additionally, it should be considered that
many patients with DS have been reported to present with obstructive
sleep apnea11. Given the above sleep alterations, the relationship between
sleep structure and growth hormone production during sleep is strongly
suspected in this population12. Growth hormone release is known to be
16
reduced in children with sleep apnea,
probably due to the consequent sleep fragmentation12,13. Growth hormone production can become normalized if the sleep
apnea is effectively treated14.
Aside from the physical status, sleep
deprivation has an effect on a patient’s
mental status as well. When a person is Kornelia Deneau
severely sleep deprived, this has been
known to lead to irritability, hallucinations,
psychosis, etc... It has been shown that
sleep deprivation leads to delusional
thoughts and hallucinations as what was
seen when Peter Tripp stayed awake for
201 hours in 195915,16. What makes this
remarkable is some believe that recovery
of these symptoms comes after just one
night of sleep3. For clinical depression,
sleep deprivation has been used as a
treatment as well. 40-60% of cases
showed significant and rapid improvement of symptoms by utilizing sleep deprivation as a form of treatment for Edwin Cintron
depression17,18. The portion of sleep that
seems to offer the highest amount of restitution again appears to be slow
wave sleep, not only for immunity, but for the mental status as well19.
There are other medical conditions that have been attributed to a lack
of sleep. For example, if a person sleeps for too little or too long, it can lead
to symptoms of Diabetes Mellitus20. Sleeping less than 6 hours, or for more
than 9 hours, has been linked to this metabolic inability to stabilize glucose
levels20. One study showed that when subjects were only allowed to sleep
for only 4 hours per night, an 18 year old could not metabolize their glucose level any better than an 80 year old21. Hypertension, also, has been
linked to not getting an adequate amount of sleep22,23. 80% of the growth
hormone, which is important in healing and muscle regeneration, is
released during delta sleep24. Since Fibromyalgia patients show a decreased
level of delta sleep, this may contribute to the muscular pain involved in this
muscle disorder25. Fibromyalgia is a chronic musculoskeletal pain disorder,
which, to date, has no FDA approved treatment to help with symptoms26.
The fact that some people become ill more often than others may be
related to the fact that some people show more delta sleep than others.
There are no known medications that improve immunity. However, slow wave
sleep is most important in boosting the immune system, and exercise has
been shown to increase the amount of slow wave sleep3. It is estimated that
47 million adults in the United States do not get the required amount of
sleep27. This puts everyone at risk of health problems because the immune
system is not able to repair itself without an adequate amount of sleep. H
References
1. The Immune System. 9 July 2006. http://en.wikipedia.org/wiki/Immune_system
2. Rechtschaffen, A. and Siegel, J.M. Sleep and Dreaming. Principles of Neuroscience.
4th Ed. 936-947, New York, 2000.
http://www.npi.ucla.edu/sleepresearch/SleepDream/sleep_dreams.htm
continued on page 22
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Sleep and the Immune System
continued from page 16
3. Culebras, A. Clinical Handbook of Sleep Disorders. 1996 Butterworth-Heinemann.
Boston. (2) 46-48, (13) 405-406.
4. Brain Stories: Immune Responses to Sleep. University of Texas at Austin.
http://utopia.utexas.edu/project/brainwaves/stories/immune.html
5. Aging and Immune System. 2006 Anti Aging Research Lab. http://www.antiagingresearch.com/immune_system.shtml
6. How Sleep Changes. 2006 National Sleep Foundation.
http://www.sleepfoundation.org/hottopics/index.php?secid=12&id=183
7. Van Cauter, E., Leproult, R., Plat, L. Age-Related Changes in Slow Wave Sleep and REM
Sleep and Relationship with Growth Hormone and Cortisol Levels in Healthy Men. JAMA
2000. 284:861-868.
8. Feinberg, I. The ontogenesis of human sleep and the relationship of sleep variables to
intellectual function in the aged. Comp Psychiatry 1968; 9 : 138.
9. Parker DC, et al: Rhythmicities in human growth hormone concentration in plasma.
Kreiger ed. Endocrine Rhythms. 1979 Raven Press. New York. 143-173
10. Castells S, et al. Growth hormone deficiency in Down Syndrome Children. J Intellect
Disabil res. 1992 feb. vol 36 1 29-43.
11. Parker DC, Rossman LG. Physiology of human growth hormone release in sleep.
Endocrinology. 1973. Amsterdam. 655-660
12. Ferri, R, et al. Sleep Neurophysiopathology in Down Syndrome. Presented at 6th
World Congress on Down Syndrome, Oct 1997 in Madrid Spain. http://www.altonweb.com/cs/downsyndrome/index.htm?page=ferri.html
13. Grunstein, R., Stewart, D., Sullivan, C. Endocrine and metabolic disturbances in obstructive sleep apnea. Sleep, Hormones and Immunological System. 1992 111-122.
14. Parker DC, Rossman LG. Sleep-wake cycle and human growth hormone, prolactin and
luteinizing hormone. Advances in Human Growth Hormone Research. Washington, DC,
U.S. Government Printing Office, 1974, pp 294-312
15. Devillieres P, Opitz M, Clervoy P, Stephany J. Delusion and Sleep Deprivation.
Encephale. 1996 May-Jun;22(3):229-31.
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800.639.5432 phone
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804.378.0716 fax
16. Stanley Coren. Sleep Deprivation, Psychosis, and Other Mental Efficiency. 2006 CMP
Healthcare Media Group. http://www.psychiatrictimes.com/p980301b.html
17. Wirz-Justice, A Van den Hoofdakker, RH. Sleep Deprivation in Depression: What Do
We Know, Where Do We Go? Biol Psychiatry. 1999 Aug 15;46(4):445-53.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=
10459393&dopt=Abstract
18. Giedke H, Schwarzler F. Therapeutic use of sleep deprivation in depression. Sleep Med
Rev 2002 Oct;6(5):361-77 http://www.psycom.net/depression.central.sleepdep.html
19. Alexandros Vgontzas, et al. Sleep deprivation effects on the activity of the hypothalamic-pituitary-adrenal and growth axes: potential clinical implications. Clinical
Endocrinology, Volume 51 Issue 2 Page 205, August 1999)
20. Daniel J. Gottlieb, et al. Association of Sleep Time With Diabetes Mellitus and Impaired
Glucose Tolerance. Arch Intern Med. Vol. 165 No. 8 2005; 165: 863-867
21. Lambert, C. Deep Into Sleep. Jul-Aug 2005 Harvard Mag. http://www.harvardmagazine.com/on-line/070587.html
22. Sleep Deprivation: A Factor In Hypertension? Nature Clinical Practice Cardiovascular
Medicine (2006) 3, 352 http://www.nature.com/ncpcardio/journal/v3/n7/full/ncpcardio0571.html
23. JE Gangwisch, et al. Short sleep duration as a risk factor for hypertension: analyses of
the first National Health and Nutrition Examination Survey. Hypertension 2006 May;
47 (5) 833-9. Epub 2006 Apr 3.
24. Leon Chaitow. Chronic Fatigue Syndrome & Fibromyalgia: The Brain/Sleep Connection.
2006 ProHealth. http://www.fibromyalgiasupport.com/Fibromyalgia.cfm/id/5153
25. Dauvilliers Y, Touchon J. Sleep in Fibrmyalgia: Review of Clinical and Polysomnographic
Data. Neurophysiol Clin. 2001 Feb;31(1):18-33
26. Arnold LM. Biology and Therapy of Fibromyalgia. New Therapies in Fibromyalgia.
Arthritis Res Ther. 2006 Jun 1;8(4):212
27. Sleep Deprivation. 9 July 2006. http://en.wikipedia.org/wiki/Sleep_deprivation
About the Authors
Edwin Cintron, RPSGT is an instructor of Polysomnography at Erwin Technical Center in
Tampa, Florida and has been on the A2Zzz Magazine Editorial Board since 1998. Cintron
continued on page 34
SleepLand Calendar
Publication of the Association of Polysomnographic Technologists • Summer 2006 • www.aptweb.org
8TH WORLD CONGRESS - SLEEP APNEA 2006, September 27October 1, 2006, Montreal QC, Canada. www.wcsa2006.com.
MONTANA REGIONAL SLEEP SEMINAR 2006, October 12-14,
2006, at the Mansfield Health Education Center in Billings, Montana.
For more information contact Karen Allen at [email protected] or
call toll free 800-4 SNORES.
APT FALL REVIEW COURSE, October 21-22, 2006, at the Hilton
Indianapolis Hotel, Indianapolis, IN. For more information and registration visit www.aptweb.org.
INAUGURAL PATIENT SLEEP CONFERENCE, October 27-29,
2006, Minneapolis, MN. Hilton Minneapolis/St. Paul Airport Mall of
America. First-of-its-kind gathering of patients and their families and
sleep clinicians. Included are patient classes, and there will be clinical
break-out sessions for Sleep Technologists. Sleep and respiratory CEUs
will be awarded. Contact: [email protected] or call Tracy
Nasca at (952) 358-7070 or visit www.talkaboutsleep.com.
SPRING SLEEP SEMINAR, March 16-18, 2007, hosted by
Washington Regional Medical Center Sleep Disorders Center, Kansas
City Marriott Country Club Plaza, Kansas City, Missouri. For more information, contact Melinda Trimble at [email protected] or phone
(479) 527-0178.
WORLD FEDERATION OF SLEEP RESEARCH SOCIETIES WORLD
CONGRESS 2007, September 1-8, 2007, Carins - QLD - Austrailia.
www.wfsrsms.org.
19TH CONGRESS OF THE EUROPEAN SLEEP RESEARCH SOCIETY, 2008, Glasgow, Scotland. www.esrs.org.
from puzzle on page 36
“Slumber Tumbler” Answers
was the recipient of the of the 2005 APT Sharon Keenan Award and was the first ever
recipient of the APT Dr. Allen DeVilbiss Literary Award in 2002.
4. 0 (zero)
5. 5 (five)
6. 50 (fifty)
continued from page 22
1. physical stature
2. Bradycardia
3. light
Sleep and the Immune System
Kornelia Deneau, RPSGT has been working in the field of Polysomnography for seven
years. She has had experience working in a trauma pediatric hospital setting, and has
experience performing sleep studies on adults as well. She is currently the Clinical
Coordinator at Good Shepherd Medical Center for Sleep Disorders in East Texas.
They may be contacted through the APT National Office at [email protected].
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