One of the greatest medical achievements of modern civilization, vaccines protect against harmful diseases. Vaccines activate the immune system without making us sick and prepare the body to tackle the pathogen if we cross paths with it. How well vaccines work depends on several factors. Some, such as age, sex, and genetic make-up, are uncontrollable. However, there are a few that we can regulate, such as sleep.
Sleep is essential for the proper functioning of the body's physiological systems, including our immune system. Sleep duration at the time of vaccination against viral infections can affect the immune response and regulate how well we are protected. Research shows that poor sleep right before, during, and after becoming vaccinated might reduce vaccine efficacy and make you benefit less from it.
Sleep quality and the flu shot
The first human study exploring whether sleep has any impact on the immune response to vaccination used the flu shot. It examined 11 healthy young men with a mean age of 23 years who slept only 4 hours per night for 4 days pre-vaccination and 2 days post-vaccination. It compared this group to 14 other men who slept 7.5 to 8 hours. Ten days after the vaccination, researchers measured antibody levels, the immune system molecules important for protection against pathogens. The results showed that those who slept only 4 hours every night had less than half of the antibody amounts compared to those who slept 7.5 to 8 hours.
Additional research on the influenza vaccine found similar results. Eighty-three healthy young adults filled out sleep diaries for 13 days detailing how long they slept, quality of sleep, and how long they slept compared to how long they spent in the bed, known as sleep efficiency. On day 3, the participants received the influenza vaccine, and at months one and four, researchers measured the antibody levels. Researchers found that shorter sleep duration, mainly the two nights before vaccination, resulted in lower levels of antibodies 1 and 4 months later. In contrast, sleep efficiency and subjective sleep quality did not influence the antibody response.
A separate study, however, found no lasting effects of acute sleep deprivation on how well the vaccine against the swine flu worked. Thirteen healthy young participants with a mean age of 20 years slept a full night, while eleven others did not sleep at all the night after vaccination. Researchers found no difference in the swine flu-specific antibody levels between the groups 10 to 72 days after the vaccination. Nevertheless, five days post-vaccination sleep-deprived men, but not women, had reduced antibody responses compared to the group who slept the entire night.
Sleep duration and the hepatitis vaccine
Further emphasizing the importance of sleep for proper vaccine efficacy, research shows the impact night rest has with vaccines against hepatitis A and B.
Lange and colleagues (2003) showed that no sleep the night after vaccination against hepatitis A reduced antibody levels almost two-fold compared to a solid night's sleep. Additional research found that people who slept 7.5 hours after vaccination against hepatitis A had double the amount of T helper cells specific to the hepatitis A virus, compared to the group who stayed awake. Such pathogen-specific T helper cells are immune cells that are important in a protective immune response against a specific pathogen.
Similarly, shorter sleep duration is associated with a worse immune response to hepatitis B vaccination. Researchers tracked sleep duration, sleep efficiency, and subjective sleep quality in healthy midlife adults, 40 to 60 years, who received the hepatitis B vaccine. Study results showed that shorter sleep duration was associated with lower antibody response. Similar to influenza, sleep efficiency and subjective sleep quality did not influence the antibody response. Additionally, researchers found that sleeping less than 6 hours per night resulted in a significantly decreased likelihood of clinical protection following hepatitis B vaccination.
Sleep and COVID-19 vaccines
Sleep contributes to the ability of vaccines to protect you as well as possible. Unfortunately, this has been a significant problem during the COVID-19 pandemic. Sleep quality during the pandemic decreased, and people slept less. Consistent reports show poorer sleep during the pandemic than before and during lockdown compared to no lockdown.
Research about how sleep affects the efficacy of COVID-19 vaccines is not yet available, but scientists suggest that sleep duration and time of day the vaccine is administered could impact how well the vaccine protects against COVID-19. Research on vaccines against influenza and hepatitis suggests that extending sleep duration at the time of vaccination can boost immune responses.
What can you do?
Research shows that adequate sleep contributes to proper immune responses to vaccines against viral infections, such as flu and hepatitis. Therefore, before, during, and after vaccination, prioritize getting at least 7 hours of uninterrupted nightly sleep. This is particularly important for people with weak or compromised immune systems. Extending your time spent sleeping when receiving a vaccination will help ensure an adequate response to vaccines and potentially reduce the incidence of severe disease.
Benedict, C., Brytting, M., Markström, A., Broman, J. E., & Schiöth, H. B. (2012). Acute sleep deprivation has no lasting effects on the human antibody titer response following a novel influenza A H1N1 virus vaccination. BMC immunology.
Benedict, C., & Cedernaes, J. (2021). Could a good night's sleep improve COVID-19 vaccine efficacy? The Lancet Respiratory Medicine.
Jahrami, H. A., Alhaj, O. A., Humood, A. M., Alenezi, A. F., Fekih-Romdhane, F., AlRasheed, M. M., ... & Vitiello, M. V. (2022). Sleep disturbances during the COVID-19 pandemic: a systematic review, meta-analysis, and meta-regression. Sleep Medicine Reviews.
Lange, T., Dimitrov, S., Bollinger, T., Diekelmann, S., & Born, J. (2011). Sleep after vaccination boosts immunological memory. The Journal of Immunology.
Lange, T., Perras, B., Fehm, H. L., & Born, J. (2003). Sleep enhances the human antibody response to hepatitis A vaccination. Psychosomatic medicine.
Prather, A. A., Hall, M., Fury, J. M., Ross, D. C., Muldoon, M. F., Cohen, S., & Marsland, A. L. (2012). Sleep and antibody response to hepatitis B vaccination. Sleep.
Prather, A. A., Pressman, S. D., Miller, G. E., & Cohen, S. (2021). Temporal links between self-reported sleep and antibody responses to the influenza vaccine. International journal of behavioral medicine.
Spiegel, K., Sheridan, J. F., & Van Cauter, E. (2002). Effect of sleep deprivation on response to immunizaton. Jama.