Sleep and the workings of the immune system are inextricably intertwined: When you’re chronically sleep-deprived, your immune response is weaker, which can increase your likelihood of getting sick from whatever virus or bacteria is floating in your airspace. (Of course, sleep alone won't protect you from getting sick; with respect to COVID-19, specifically, the Food and Drug Administration (FDA) recommends all eligible people get vaccinated to preserve public and personal health.) But the connection between the sleep and the immune system doesn’t stop at illness susceptibility: When you start to actually feel sick, getting sufficient sleep becomes extra crucial for recovery. In fact, the reason you may need even more sleep than the recommended seven to eight hours a night when you’re sick reflects both the body’s physiological response to infection and the process required to heal from it.
Right around the time when you first get sick, a few changes in the body can prompt more sleepiness. “Any acute viral infection causes a release from the body of inflammatory mediators, which can make us very drowsy,” says UCHealth pulmonologist and sleep specialist Neale R. Lange, MD. “It’s an instruction set to our body to increase its temperature—which is why you’ll often get a fever in the first few days of being sick—because a higher temperature helps defend against the virus or bacterium.”
While that fever can make you feel sleepy, so can the pathogen itself. “As it circulates in the body, the toxin may be somnogenic, or sleep-inducing, due to the extra effort necessary by your body to start fighting it,” says Nancy Foldvary-Schafer, DO, MS, director of the Sleep Disorders Center at the Cleveland Clinic.
That drowsiness is essentially your body putting you to bed because it needs good-quality sleep even more when it’s fighting an illness. “All the stages of sleep, particularly the deeper non-REM and REM stages, have active functions, initiating a drop in heart rate and blood pressure, and also allowing for the immune response that clears away toxins,” says Dr. Foldvary-Schafer.
“All the stages of sleep have active functions, initiating a drop in heart rate and blood pressure, and also allowing for the immune response that clears away toxins.” —Nancy Foldvary-Schafer, DO, MS
As for those active functions? While you doze, your body can increase production of immune-supportive cytokine proteins and antibodies and also more effectively shuttle infection-fighting T-cells to lymph nodes, where they can do their job—all of which reflects why you need more sleep when you're sick, says Dr. Lange. (In fact, he adds, this is also why you need more sleep just before and after getting a vaccine, because doing so supports your body’s antibody-generating response, and, in turn, the vaccine’s efficacy.)
By contrast, not getting the increased sleep your body is signaling for can make getting over any sickness that much tougher. “The worse or more fragmented your sleep is, the higher your resting inflammatory condition will be,” says Dr. Lange. “And heightened inflammation just puts you more at risk for complications to arise from the illness.”
How much sleep to get when you’re sick
Every person’s drowsiness response to sickness will vary, meaning you should listen to your body to determine how much sleep you really need when you’re sick. “Do not try to override the sleepiness you feel,” says Dr. Lange, who stresses the importance of getting, at the very least, the recommended seven to eight hours of sleep while you’re sick, and allowing yourself to go up from there, depending on how you feel.
To get the best quality sleep when you’re sick, it’s essential to practice all the typical habits of healthy sleep hygiene, too: Steer clear of blue-light-emitting devices (aka try not to doom-scroll while in bed), be mindful of the temperature of your bedroom, and keep other activities (like work and eating) outside the bedroom, as much as you can.
As you begin to feel a bit better, you can continue extending your usual sleep by an hour or so each night for a few days, so long as you anchor your wake-up time, says Dr. Foldvary-Schafer. This helps re-regulate your circadian rhythm, while still allowing you to tend to your body’s temporary need for more shut-eye.
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