Dr. Robert Pastore, PhD, CNS


Poor Sleep Quality and Immunity

2020-12-106 min read

Article Image

There are three interesting facts about sleep deprivation and immunity that are based on scientific study.

  1. Lack of quality sleep is associated with a higher likelihood of getting sick after being exposed to a virus.
  2. Lack of quality sleep negatively impacts how fast you recover if you do get sick.
  3. Long-term poor-quality sleep increases the risk of specific diseases that in and of themselves are risk factors for an increased risk of infection and those are cardiovascular disease, diabetes and obesity.

The goal for adults should be to obtain 7 to 9 hours of uninterrupted sleep per night. For teens the ideal range is 8 to 10 hours per night. Raise your hand if you hit your target.

Why does sleep deprivation equate with truncated immune functioning?

The governing concept is that sleep is believed to support the initiation of an adaptive immune system response. So, a good night sleep on a regular basis supports the following: if exposed to an invading antigen the human immune system takes up that antigen with antigen presenting cells and presents fragments of the antigen to cells called T helper cells. The T helper cells release a cytokine called IL-12 and that calls in the squad known as a T helper cell 1 response which supports the work of antigen-specific T cells and starts the production of antibodies by another type of cell called B cells. It’s this antigen/antibody response that initiates long lasting immunity. Sleep helps foster this adaptive immune response in lymph nodes. Disrupting sleep, disrupts the adaptive immune system response [1].

Of course the first question you should ask if you are experiencing a major deviation from the recommending amount of sleep is are there any medical reasons behind your poor-quality sleep that need to be addressed?

The following can interfere with quality sleep.

• Arthritis and or chronic pain

• Asthma

• Gastrointestinal problems such as reflux

• Hyperthyroidism

• Low back pain

• Nasal/sinus allergies

• Neurological conditions such as Parkinson's disease

• Prescription medications – birth control, cold and flu medicines, drugs for asthma, hypertension medication, thyroid medication, etc. There are many prescription medications that can interfere with sleep. Please talk to your doctor about any concerns.

• Restless leg syndrome – a neurological condition causing discomfort and the need to move one’s legs, strongly linked to iron deficiency anemia.

• Sleep apnea – (main types are obstructive, central and complex).

Let’s hypothesize that’s all covered. What about prescription sleep medications?

As I mentioned on a previous podcast, “I’ve spoken with many sleep experts over the years and none of them believe these drugs are sleep saviors. On the contrary they do not believe a human obtains true restorative sleep on these medications.” I also stated, “All of these aforementioned prescription drugs and OTC medications have a risk of side effects including but not limited to drug tolerance, rebound insomnia, headaches, dizziness, nausea, difficulty swallowing or breathing, worsening depression, suicidal ideation and even a potential link to dementia and increased mortality.” Please listen to that episode for more info. While there are many physicians that recommend these medications, I’m certain none would recommend them for chronic use every single night for the rest of your life.

Lifestyle Components

  • Address stress in the best way that works for you – meditation, exercise, cognitive behavioral therapy, psychotherapy, etc.
  • Do not consume caffeine late in the day. Some people are so sensitive that any more than one cup in the morning disrupts their sleep and for others they are fine having more, including late in the day. Learn your tolerance and stick with it.
  • Napping too late in the day can disrupt sleep in the evening.
  • Exposure to artificial light late in the evening, or prior to sleep. It disrupts normal neurological signaling required for sleep from taking place, such as the formation and release of melatonin, and the upregulation of excitatory neurotransmitters.
  • Adjust room temperature – too warm of a temperature can have negative affect on sleep
  • Alcohol is a sedative. It can make you fall asleep initially but may disrupt your sleep later in the night.
  • Nicotine from vaping or smoking – it’s a stimulant and disrupts sleep. Nicotine is a neurotoxin. Seek help to stop if you use it.
  • Eating too close to bed is a problem as well, keeping you up digesting instead of sleeping.

Consider trying something natural. I’m always asked about melatonin. So, let me explain that for a moment before I tell you what I personally take every night before bed.

Melatonin elicits its effects on the suprachiasmatic nucleus (SCN), an area of the brain the controls our circadian timing system, via at least two high-affinity melatonin receptors, MT1/MT1a and MT2/MT1b. Two distinct functional roles for melatonin on SCN physiology have been identified. Firstly, melatonin acts to promote sleep through the acute inhibition of SCN neuronal firing, a mechanism mediated by MT1/MT1a receptors. Secondly, melatonin has a phase-shifting effect which entrains the circadian rhythms within the environment and is mediated in part by MT2/MT1b receptors. The impact of these efforts are initiating sleep.

Unfortunately, many people experience negative side effects from melatonin, even at the standard lowest over the counter dose. In my early days in practice I successfully found a dose that had 500mcg, which is exactly half of the standard 1mg dose. Currently, I see 3mg to 5mg as a starting dose and I couldn’t imagine taking those. The feeling I had was akin to others reporting side effects such as a groggy feeling the next day, something I called a “melatonin hangover.” While we all know melatonin plays a crucial role in sleep, I always desired the tiniest dose possible. I also believe in a multifactorial approach to assisting sleep. As a dad, I absolutely need something. I cannot just turn off my brain at night and sleep. Every night I take an over the counter supplement called Power Off, that contains nine ingredients to help foster sleep. I co-authored a paper on each of these ingredients with Dr. Jennifer Newson, a PhD in neuroscience from Oxford. I have found it to be a game changer.


  1. Besedovsky L, Lange T, Born J. Sleep and immune function. Pflugers Arch. 2012;463(1):121–137. doi:10.1007/s00424-011-1044-0).