There is a strong connection between a lack of sleep and autoimmune conditions. Autoimmune conditions such as lupus, multiple sclerosis, and rheumatoid arthritis often come with fatigue. Fatigue isn’t just feeling a little tired, it’s a profound sense of exhaustion that can get in the way of day-to-day activities. What causes this fatigue, and what does it have to do with sleep?
Sleep And Autoimmune Conditions – Inflammation
At the heart of autoimmune diseases is uncontrolled inflammation. Chronic inflammation affects various aspects of our body’s functioning, including metabolism, mood, and motivation. It also manipulates our sleep patterns and contributes to feelings of fatigue. Inflammatory cytokines, produced by immune cells, play a significant role in inducing fatigue.1
Inflammation And Fatigue
Inflammation impacts the central nervous system (CNS), causing what are known as ‘sickness behaviors’, which are linked to fatigue. Inflammation causes the activation of things called inflammasomes, which contribute to fatigue. These inflammasomes are activated by factors like ATP, ROS, and mitochondrial DNA, all of which relate to metabolism and cellular stress.2
Sleep And Autoimmune Conditions
Sleep disturbances are a frequent complaint from those with autoimmune conditions. This isn’t a one-way street, however, as stress and sleep issues increase the likelihood of developing an autoimmune disease. Conditions like chronic insomnia, sleep apnea, and restless legs syndrome are more commonly found amongst those suffering from autoimmune diseases. The inflammatory cytokines along with the disruption of our body’s internal clock contribute to sleep disturbances in autoimmune diseases.3
Stress, Sleep, And Autoimmune Conditions
Stress plays its own part in inducing fatigue in individuals with autoimmune diseases. Stress triggers inflammation in the brain and releases two substances, norepinephrine and cortisol, that influence immune responses and further contribute to fatigue. While stress is often necessary in short bursts, chronic stress leads to an overproduction of these hormones, causing fatigue, and exhaustion in our cells.4
Hormone Dysregulation
Hormones produced in response to stress called glucocorticoids can both inhibit and enhance inflammation in the immune system. Sleep loss and constant stress increase glucocorticoid levels, thereby enhancing inflammation. There is another hormone, Dehydroepiandrosterone (DHEA), that counters inflammation and reduces the production of pro-inflammatory cytokines. Individuals with autoimmune conditions often have low levels of DHEA.5 6
Neurotransmitters
Certain neurotransmitters such as serotonin, dopamine, norepinephrine, histamine, and glutamate play a role in regulating arousal, wakefulness, and fatigue. Inflammatory molecules are influenced by these neurotransmitters, leading to changes in behavior and fatigue. The vagus nerve, part of our autonomic nervous system, also has a role in modulating inflammation and fatigue.7 8
Chronic fatigue linked to inflammation affects the brain, resulting in fatigue, sleep problems, and cognitive challenges. Autoimmune conditions often affect blood flow to the brain, resulting in fatigue. The brain’s waste clearance system, known as the glymphatic system, is also impacted by inflammation, contributing to fatigue.9
Sleep Disorders
Autoimmune conditions that affect the nervous system create havoc in sleep patterns. Two of the most common autoimmune conditions that affect sleep patterns are Multiple Sclerosis and Guillain-Barré syndrome.
Multiple sclerosis is a condition where the immune system attacks the central nervous system. Sleep disorders in multiple sclerosis can range from insomnia and restless legs syndrome to REM sleep behavior disorder. The reasons range from inflammation and medication side effects to the specific location of brain lesions.10
Guillain-Barré syndrome (GBS), an acute autoimmune disease, can cause a significant drop in sleep quality, induce insomnia, and reduce REM sleep time, particularly during the acute phase of the disease.11
Anti-IgLON5 disease is a newly found neurological disorder with distinctive irregular sleep patterns and abnormal motor behaviors during sleep. It impacts various brain regions that regulate sleep. The cause isn’t completely clear yet, but it appears to have both autoimmune and neurodegenerative components.12
Genetics
Genetic factors also play a role in autoimmune diseases and fatigue. Certain genetic modifications related to inflammation have been implicated in fatigue. Understanding the mechanisms behind fatigue in autoimmune diseases can allow us to improve the quality of life for those with autoimmune conditions.13
Getting To The Root Cause Of Autoimmune Conditions
There are a multitude of factors that contribute to the development of autoimmune conditions and one of the major culprits is toxins. Toxins refer to any substance that is harmful to the body and can disrupt its normal functioning. These toxins come from various sources, including heavy metals, mold exposure, hidden infections, and chemicals.
Heavy Metal Toxicity
Heavy metals such as lead, mercury, and arsenic are commonly found in our environment, and prolonged exposure to them can cause serious health issues. These metals can accumulate in the body over time and trigger an immune response, leading to autoimmune conditions.14
Heavy metals cause oxidative stress in the body, which is linked to difficulty falling or staying asleep. Heavy metals are neurotoxins, substances that damage nerve cells and affect neurological functions.15
Studies have shown that heavy metal exposure can lead to various sleep disorders such as insomnia and disturbed sleep. This is because these metals, specifically lead, have the ability to disrupt the body’s natural production of melatonin, a hormone responsible for regulating sleep-wake cycles.16
Read more about how heavy metals affect health.
Toxins From Mold
Mold exposure is another common source of toxins that can contribute to autoimmune diseases. Mold can be found in buildings with water damage or high humidity levels, and breathing in mold spores can cause an inflammatory response in the body, leading to a range of health problems.17
Read more about the health-damaging effects of mold.
Hidden Infection In The Body
Hidden infections, such as cavitations, are known to play a role in autoimmune conditions. These infections can go undetected for years, but when left untreated, they weaken the immune system and increase the risk of developing autoimmune diseases.18
Chemical Toxicity
Chemicals found in everyday products, such as cleaning supplies, personal care products, and even food, are also toxic to the body. Many of these chemicals like BPA and phthalates have been linked to autoimmune conditions and other health problems.19 20
Read more about the common toxins we take for granted.
Sleep Hygiene Tips
Sleep hygiene routines are essential for improving sleep quality, even if autoimmune conditions are affecting your rest. Having a regular sleep routine is crucial as it trains your body to know when it’s time to sleep and when it’s time to wake up. This can help you fall asleep faster, stay asleep longer, and wake up feeling more refreshed.
Aside from having a consistent bedtime, it’s also important to wake up at the same time every day, even on weekends. This can help regulate your body’s internal clock, making it easier for you to fall asleep and wake up naturally.21
Additionally, avoiding caffeine, nicotine, and alcohol before bedtime improve your sleep quality. These substances disrupt your natural sleep patterns and make it difficult to fall and stay asleep.22 23 24
Light and darkness play a significant role in regulating our sleep-wake cycle. It’s important to adjust your lighting as needed, such as using dimmer lights or wearing an eye mask if you need complete darkness to sleep.25
Reducing screen time before bedtime and being physically active during the day can also help improve sleep quality. The blue light emitted from screens suppress the sleep hormone melatonin, making it harder to fall asleep.26 27
While napping may not affect your nighttime sleep, it’s best to limit naps to 20-30 minutes and avoid them late in the day as they can make you overly drowsy and disrupt your nightly sleep.28
Managing stress and worries before bed is also crucial for a good night’s sleep. This can include practicing relaxation techniques such as deep breathing or meditation, jotting down your thoughts in a journal, or talking to a trusted friend or family member about your concerns.29
Creating a quiet and comfortable sleep environment can also enhance the quality of your sleep. This includes controlling noise levels, keeping the room at a comfortable temperature, and using relaxing, natural scents such as lavender to aid in relaxation.30 31 32
Ultimately, the key to improved sleep quality lies in creating a personalized sleep hygiene routine that incorporates all of these elements. By incorporating regular bedtime, consistent sleep timings, avoiding stimulants before bed, managing stress, and creating a calm sleep environment, you can achieve better sleep and reduce the impact of autoimmune conditions.
Sleep Hygiene Tips
The relationship between sleep and autoimmune conditions is complex, with a myriad of factors at play. To restore normal sleep we need to both get to the root cause of autoimmune conditions and practice proper sleep hygiene techniques.
Read more about chronic fatigue syndrome.
References
1 Louati K, Berenbaum F. Fatigue in chronic inflammation – a link to pain pathways. Arthritis Res Ther. 2015 Oct 5;17:254. doi: 10.1186/s13075-015-0784-1. PMID: 26435495; PMCID: PMC4593220.
2 Latz E, Xiao TS, Stutz A. Activation and regulation of the inflammasomes. Nat Rev Immunol. 2013 Jun;13(6):397-411. doi: 10.1038/nri3452. PMID: 23702978; PMCID: PMC3807999.
3 Irwin MR, Olmstead R, Carroll JE. Sleep Disturbance, Sleep Duration, and Inflammation: A Systematic Review and Meta-Analysis of Cohort Studies and Experimental Sleep Deprivation. Biol Psychiatry. 2016 Jul 1;80(1):40-52. doi: 10.1016/j.biopsych.2015.05.014. Epub 2015 Jun 1. PMID: 26140821; PMCID: PMC4666828.
4 Noushad S, Ahmed S, Ansari B, Mustafa UH, Saleem Y, Hazrat H. Physiological biomarkers of chronic stress: A systematic review. Int J Health Sci (Qassim). 2021 Sep-Oct;15(5):46-59. PMID: 34548863; PMCID: PMC8434839.
5 Devine JK, Bertisch SM, Yang H, Scott-Sutherland J, Wilkins A, Molina V, Henrikson K, Haack M. Glucocorticoid and inflammatory reactivity to a repeated physiological stressor in insomnia disorder. Neurobiol Sleep Circadian Rhythms. 2018 Jun 20;6:77-84. doi: 10.1016/j.nbscr.2018.06.001. PMID: 31236523; PMCID: PMC6586925.
6 Blatkiewicz M, Sielatycka K, Piotrowska K, Kilańczyk E. DHEA and Its Metabolites Reduce the Cytokines Involved in the Inflammatory Response and Fibrosis in Primary Biliary Cholangitis. Int J Mol Sci. 2023 Mar 10;24(6):5301. doi: 10.3390/ijms24065301. PMID: 36982376; PMCID: PMC10049419.
7 Oshaghi M, Kourosh-Arami M, Roozbehkia M. Role of neurotransmitters in immune-mediated inflammatory disorders: a crosstalk between the nervous and immune systems. Neurol Sci. 2023 Jan;44(1):99-113. doi: 10.1007/s10072-022-06413-0. Epub 2022 Sep 28. PMID: 36169755.
8 Pavlov VA, Tracey KJ. The vagus nerve and the inflammatory reflex–linking immunity and metabolism. Nat Rev Endocrinol. 2012 Dec;8(12):743-54. doi: 10.1038/nrendo.2012.189. PMID: 23169440; PMCID: PMC4082307.
9 Mogensen FL, Delle C, Nedergaard M. The Glymphatic System (En)during Inflammation. Int J Mol Sci. 2021 Jul 13;22(14):7491. doi: 10.3390/ijms22147491. PMID: 34299111; PMCID: PMC8305763.
10 Čarnická Z, Kollár B, Šiarnik P, Krížová L, Klobučníková K, Turčáni P. Sleep disorders in patients with multiple sclerosis. J Clin Sleep Med. 2015 Apr 15;11(5):553-7. doi: 10.5664/jcsm.4702. PMID: 25700869; PMCID: PMC4410929.
11 Bahnasy WS, El-Heneedy YAE, El-Shamy AM, Badr MY, Amer RA, Ibrahim ISE. Sleep and psychiatric abnormalities in Gullian Barré Syndrome. Egypt J Neurol Psychiatr Neurosurg. 2018;54(1):5. doi: 10.1186/s41983-018-0007-1. Epub 2018 Apr 25. PMID: 29780225; PMCID: PMC5954782.
12 Gaig C, Iranzo A, Santamaria J, Graus F. The Sleep Disorder in Anti-lgLON5 Disease. Curr Neurol Neurosci Rep. 2018 May 23;18(7):41. doi: 10.1007/s11910-018-0848-0. PMID: 29796717.
13 Wang T, Yin J, Miller AH, Xiao C. A systematic review of the association between fatigue and genetic polymorphisms. Brain Behav Immun. 2017 May;62:230-244. doi: 10.1016/j.bbi.2017.01.007. Epub 2017 Jan 12. PMID: 28089639; PMCID: PMC5947855.
14 Cojocaru M, Chicoş B. The role of heavy metals in autoimmunity. Rom J Intern Med. 2014;52(3):189-91. PMID: 25509564.
15 Carmona A, Roudeau S, Ortega R. Molecular Mechanisms of Environmental Metal Neurotoxicity: A Focus on the Interactions of Metals with Synapse Structure and Function. Toxics. 2021 Aug 27;9(9):198. doi: 10.3390/toxics9090198. PMID: 34564349; PMCID: PMC8471991.
16 Liu J, Ghastine L, Um P, Rovit E, Wu T. Environmental exposures and sleep outcomes: A review of evidence, potential mechanisms, and implications. Environ Res. 2021 May;196:110406. doi: 10.1016/j.envres.2020.110406. Epub 2020 Oct 29. PMID: 33130170; PMCID: PMC8081760.
17 Harding CF, Pytte CL, Page KG, Ryberg KJ, Normand E, Remigio GJ, DeStefano RA, Morris DB, Voronina J, Lopez A, Stalbow LA, Williams EP, Abreu N. Mold inhalation causes innate immune activation, neural, cognitive and emotional dysfunction. Brain Behav Immun. 2020 Jul;87:218-228. doi: 10.1016/j.bbi.2019.11.006. Epub 2019 Nov 18. PMID: 31751617; PMCID: PMC7231651.
18 Vasconcelos E Cruz J, Notter F, Schick F, Lechner J. Comparison of Cytokine RANTES/CCL5 Inflammation in Apical Periodontitis and in Jawbone Cavitations – Retrospective Clinical Study. J Inflamm Res. 2024 Jan 5;17:67-80. doi: 10.2147/JIR.S442693. PMID: 38197033; PMCID: PMC10775705.
19 Sharif K, Kurnick A, Coplan L, Alexander M, Watad A, Amital H, Shoenfeld Y. The Putative Adverse Effects of Bisphenol A on Autoimmune Diseases. Endocr Metab Immune Disord Drug Targets. 2022 Aug 15;22(7):665-676. doi: 10.2174/1871530321666210210154309. PMID: 33568039.
20 Zhang Y, Lyu L, Tao Y, Ju H, Chen J. Health risks of phthalates: A review of immunotoxicity. Environ Pollut. 2022 Nov 15;313:120173. doi: 10.1016/j.envpol.2022.120173. Epub 2022 Sep 13. PMID: 36113640.
21 Crowley SJ, Carskadon MA. Modifications to weekend recovery sleep delay circadian phase in older adolescents. Chronobiol Int. 2010 Aug;27(7):1469-92. doi: 10.3109/07420528.2010.503293. PMID: 20795887; PMCID: PMC3415304.
22 Drake C, Roehrs T, Shambroom J, Roth T. Caffeine effects on sleep taken 0, 3, or 6 hours before going to bed. J Clin Sleep Med. 2013 Nov 15;9(11):1195-200. doi: 10.5664/jcsm.3170. PMID: 24235903; PMCID: PMC3805807.
23 Jaehne A, Loessl B, Bárkai Z, Riemann D, Hornyak M. Effects of nicotine on sleep during consumption, withdrawal and replacement therapy. Sleep Med Rev. 2009 Oct;13(5):363-77. doi: 10.1016/j.smrv.2008.12.003. Epub 2009 Apr 2. PMID: 19345124.
24 Landolt HP, Roth C, Dijk DJ, Borbély AA. Late-afternoon ethanol intake affects nocturnal sleep and the sleep EEG in middle-aged men. J Clin Psychopharmacol. 1996 Dec;16(6):428-36. doi: 10.1097/00004714-199612000-00004. PMID: 8959467.
25 Tähkämö L, Partonen T, Pesonen AK. Systematic review of light exposure impact on human circadian rhythm. Chronobiol Int. 2019 Feb;36(2):151-170. doi: 10.1080/07420528.2018.1527773. Epub 2018 Oct 12. PMID: 30311830.
26 Rafique N, Al-Asoom LI, Alsunni AA, Saudagar FN, Almulhim L, Alkaltham G. Effects of Mobile Use on Subjective Sleep Quality. Nat Sci Sleep. 2020 Jun 23;12:357-364. doi: 10.2147/NSS.S253375. PMID: 32607035; PMCID: PMC7320888.
27 D’Aurea CVR, Poyares D, Passos GS, Santana MG, Youngstedt SD, Souza AA, Bicudo J, Tufik S, de Mello MT. Effects of resistance exercise training and stretching on chronic insomnia. Braz J Psychiatry. 2019 Jan-Feb;41(1):51-57. doi: 10.1590/1516-4446-2018-0030. Epub 2018 Oct 11. PMID: 30328967; PMCID: PMC6781703.
28 Foley DJ, Vitiello MV, Bliwise DL, Ancoli-Israel S, Monjan AA, Walsh JK. Frequent napping is associated with excessive daytime sleepiness, depression, pain, and nocturia in older adults: findings from the National Sleep Foundation ‘2003 Sleep in America’ Poll. Am J Geriatr Psychiatry. 2007 Apr;15(4):344-50. doi: 10.1097/01.JGP.0000249385.50101.67. PMID: 17384317.
29 Lichstein KL, Riedel BW, Wilson NM, Lester KW, Aguillard RN. Relaxation and sleep compression for late-life insomnia: a placebo-controlled trial. J Consult Clin Psychol. 2001 Apr;69(2):227-39. doi: 10.1037//0022-006x.69.2.227. PMID: 11393600.
30 Hume KI, Brink M, Basner M. Effects of environmental noise on sleep. Noise Health. 2012 Nov-Dec;14(61):297-302. doi: 10.4103/1463-1741.104897. PMID: 23257581.
31 Kräuchi K, Cajochen C, Werth E, Wirz-Justice A. Functional link between distal vasodilation and sleep-onset latency? Am J Physiol Regul Integr Comp Physiol. 2000 Mar;278(3):R741-8. doi: 10.1152/ajpregu.2000.278.3.R741. PMID: 10712296.
32 Koulivand PH, Khaleghi Ghadiri M, Gorji A. Lavender and the nervous system. Evid Based Complement Alternat Med. 2013;2013:681304. doi: 10.1155/2013/681304. Epub 2013 Mar 14. PMID: 23573142; PMCID: PMC3612440.
