SLEEPING WELL may help prevent Covid-19 infection as well as stave off its worst symptoms and outcomes—with similar advantages seen in people who take the hormone melatonin. While melatonin plays a role in many operations of the body—such as helping calibrate the immune system–current benefits may come more for its role as a sleep aid in the heightened stress and disruptions of the pandemic, as well as for those exposed to and suffering infection with Covid-19.
“It is highly probably that sleep is involved in the pathological process of Covid-19,” according to a recent report from China’s National Science Foundation.
The effects of melatonin first showed up in a review by Cleveland Clinic data analyst Feixiong Cheng: people taking the supplement had “significantly lower odds of developing Covid-19, much less dying of it,” writes James Hamblin, Atlantic columnist and lecturer at The Yale School of Public Health.
“Few other treatments [for Covid-19] are receiving so much research attention,” according to Hamblin, who cites eight ongoing trials. In a Columbia University study of intubated patients, those taking melatonin had a lower risk of dying; and melatonin was on President Trump’s medication list at Walter Reed.
But melatonin may not deserve as much credit as “the function it most famously controls: sleep,” Cheng warns. Inadequate sleep may not only worsen symptoms during active Covid-19 infection but is often a lasting problem following recovery from the infection and notable in so-called “long-haulers.”
More evidence for the sleep-infection connection comes from studies of those receiving vaccines for seasonal flu —who appear to have a stronger, more effective reactions if they have slept well in the previous several days.
What links the two may be inflammation—associated with increased risk of “everything from diabetes to heart disease to Alzheimer’s disease (AD),” according to the EarlyBird blog. Among other health benefits, sleep helps clear the brain of toxins, including the amyloid-beta proteins that are linked to Alzheimer’s disease.
The best measure of inflammation in the body is the cytokines—also called C-reactive proteins. In the Chinese research, “sleep exerted roles in modulation of…numerous cytokines, including detrimental interleukin-6 and tumor necrosis factor, both of which were closely related with cytokine storm.”
Although cytokines signal the body’s immune system to send “repairing blood” to infected cells, overactive cytokines can drown the lungs, blocking transportation of oxygen into the body. Cytokines also make blood vessels more permeable to facilitate passage of immune cells from the blood to attack the virus, but too much permeability stimulates the clotting system, which can cause stroke as well as heart or kidney failure.
Determining optimal amounts of sleep as well as dosages for sleep aids like melatonin can be tricky. Besides age, individual sleep requirements depend on genetics—which can affect needed sleep time as well as individual proclivities for waking early or staying up late: “larks” vs. “owls.”
While the average adult sleeps anywhere from seven to nine hours, the advice for assessing individual need is to go to bed without setting an alarm clock around the same time every night for a period of several days when schedules can be relaxed enough to allow for catching-up and rebalancing.
Getting too much sleep can be just as unhealthy as getting too little. Arizona State University professor Shawn Youngstedt told the Wall Street Journal: “The lowest mortality and morbidity is with seven hours [of sleep].” In the Nurses’ Health Study of more than 70,000 women—which started in 1976 and, by 2011, all participants were age 65 and older—those who slept more than nine hours a night were 38% more likely to have heart disease; while other studies have linked excessive sleep to stroke. Those who slept more than nine hours a night were 38% more likely to have heart disease; while other studies have linked excessive sleep to stroke.
“If you regularly need more than eight or nine hours of sleep per night to feel rested, it might be a sign of an underlying problem,” says Johns Hopkins sleep expert Vsevolod Polotsky. That problem could be poor-quality sleep due to sleep apnea, bruxism (teeth grinding or clenching) or other causes.
Or it could be insufficient sleep due to conditions such as “delayed sleep phase syndrome,” in which an individual’s circadian rhythm keeps them up at night. For those with DSPS—and for many other people—sleeping into the morning hours allows for the completion of final sleep cycle of the night to provide the best, deepest sleep.
For melatonin dosages, University of Texas at San Antonio Cell Biology Professor Russell Reiter, who has studied the hormone’s potential health benefits since the 1960s, takes 70 milligrams each evening, while typical recommended doses range from 1 to 10 mg.
But according to the “majority of sleep scientists,” healthy habits should be the main focus for optimal sleep, writes Hamblin. Baylor College of Medicine Psychiatry and Behavioral Sciences Professor Asim Shah believes the “key to healthy pandemic sleep is to deliberately build routines,” including spending time in sunlight early in the day, reducing blue light for an hour before bed, waking and sleeping at the same time every day and taking scheduled walks.
The amino acid tryptophan, a building block of melatonin, is present in higher quantities in some food (notably dairy products and turkey) but has the best chance of enhancing sleep when consumed in combination with complex carbohydrates. For optimal sleep, the Mediterranean diet is high in such carbohydrates as whole grains, legumes and nuts.
For those affected by the heightened stress of the pandemic, with disrupted daily and nightly schedules and changes in diet and exercise, online videos offer training in meditation and self-hypnosis, which can help slow the rapid firing of nerves and eventually train the brain to fall asleep.
None of the above, however, applies to people who seem able to sleep anywhere for endless amounts of time for whom the no-alarm-clock test merely wreaks havoc with daily schedules. And for those suffering Covid-19 symptoms, the advice for sleeping is to stay off your back—better to lie on your stomach, or at least your side —and every two hours or so, get up and walk around.
Well-Being Editor Mary Carpenter keeps us updated on the effects of Covid-19. To read more of her posts, click here