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General practitioner
Sleep plays an important role in immune function. One perhaps surprising mechanism behind this connection has to do with the effects of sleep on gut flora. Two recent studies shed light on the link between sleep and gut health.
The first was published in the December 2018 issue of the journal "Frontiers in Psychiatry". The researchers focused on the role of gut flora in insomnia and depression. The study authors reported:
"Numerous studies have shown that the occurrence of insomnia and depressive disorders is linked to biorhythms, immune function and nutrient metabolism. The exact mechanism is still unknown.
There is considerable evidence to suggest that the intestinal flora not only influences the body's digestive, metabolic and immune functions, but also regulates sleep and mental state via the gut-brain axis.
Initial results suggest that microorganisms and genes that control biorhythms interact. The composition of the gastrointestinal flora and metabolism are linked to our sleep and biorhythm."
Previous studies have shown that gut flora can play an important role in depression and anxiety. We can also increase or decrease the risk of these mood disorders through our diet - which influences the bacterial composition of the gut.
As described in the journal "Frontiers in Psychiatry", more and more scientific research indicates that our gut flora not only regulates our mood, but also our sleep cycle via the so-called gut-brain axis. This is a bidirectional communication pathway that connects our central and enteric nervous systems. Bidirectional means that the signals are transmitted in both directions.
In 2017, three biologists were awarded the Nobel Prize in Medicine for the discovery of master genes that control the body's biorhythms. Our body not only has an internal clock, but a whole range of different "clocks" that control everything from metabolism to psychological functions.
Our "master clock" in the brain synchronizes our bodily functions with the 24-hour light-dark cycle. However, every organ, and even every cell, has its own biological clock.
Half of our genes are also under the control of our biorhythm and switch on and off in cyclical waves. As you can probably imagine by now, the intestinal flora is also under the control of our biorhythm. This means that sleep disorders can also affect the composition and health of the intestinal flora, as the "intestinal clock" is disturbed. The magazine "Frontiers in Psychiatry" states:
"Evidence suggests that Clostridiales, Lactobacillales and Bacteroidales, which make up around 60 percent of the gut flora, exhibit significant diurnal fluctuations that lead to diurnal taxonomic configurations.
Liang et al. found that the two primary components of mammalian gut flora, Bacteroidetes and Firmicutes, exhibit abundant cyclic changes from day to night that are related not only to rhythmic food intake and dietary structure, but also to the individual's biological clock and sex.
Recent studies show that disruption of the internal clock, sleep deprivation and shift work alter the expression of genes that underlie the biorhythm, as well as the structure of microbial communities.
The impairment of sleep behavior in mice led to changes in the structure and diversity of the intestinal flora. These results suggest that genes underlying the biorhythm could influence the gut flora."
The results, which were published in "Frontiers in Psychiatry", can be summarized as follows: There is a bidirectional link between gut flora, sleep and personal depression risk. Endocrine hormones and genes that underlie the biorhythm play an important role in these processes.
The second study looking at the interesting link between gut health and sleep was published in PLOS ONE in 2019. Here, the researchers investigated how bacteria in the gut affect the actual quality of sleep - which, as we already know, can have far-reaching effects on general health.
Poor sleep and/or lack of sleep are linked to a variety of diseases and health conditions, such as:
On the other hand, high-quality sleep goes hand in hand with the following:
Using modern sleep measuring devices, the researchers were able to measure the sleep quality of test subjects. The results were then compared with the composition of the intestinal flora. The study investigated whether a correlation could be established between the two factors. The authors of the study reported:
"We found that diversity of total gut flora was positively associated with increased sleep efficiency and total sleep time. Poor gut flora led to waking up at night after sleep onset. We found positive correlations between gut flora diversity and the cytokine interleukin-6. This cytokine was already known for its effects on sleep before we started our study.
Our analysis of the composition of the gut flora revealed that a high proportion of Bacteroidetes and Firmicutes is positively related to sleep efficiency, cytokine concentration and abstract thinking.
Finally, we found that several taxa (Lachnospiraceae, Corynebacterium and Blautia) were negative in our sleep measurements. Our results suggest links between gut flora composition, sleep physiology, the immune system and our cognitive abilities. Building on our research, mechanisms can be developed to improve sleep by altering gut flora."
As mentioned at the beginning, sleep is known to influence our immune function. Cytokines, which are produced in response to antigens, are multifunctional chemical messengers that support the regulation of the innate and adaptive immune system.
Interestingly, according to the scientists, cytokines also appear to act as a "critical interface between sleep physiology and the composition of the gut flora."
The authors of the study explain:
"The acute-phase cytokines IL-1β and IL-6 in particular are strongly linked to sleep physiology. IL-1β is an important somnogenic factor. Administration of IL-1β in humans and animals resulted in an increase in spontaneous sleep and sleepiness. The concentration of IL-1β increases with increasing sleep deprivation.
In contrast to IL-1β, IL-6 is not a direct somnogenic factor. However, sleep deprivation still leads to increased IL-6 levels. In the gut, stress and illness lead to inflammation due to the production of IL-6 and IL-1β to varying degrees.
Mucositis in the intestine of mice, for example, caused an increase in IL-6 and IL-1β in the small intestine and in the blood and intestinal tissue. In humans, chronic stress alone led to an increase in IL-6 and IL-1β.
Despite the close relationship between cytokine activity, gut flora activity and sleep, few studies have addressed this... Previous research has shown that partial sleep deprivation can change the composition of the intestinal flora within just 48 hours.
A recent study came to the conclusion that a high quality of sleep was associated with intestinal flora that had a high proportion of bacteria from the Verrucomicrobia and Lentisphaerae strains. This was also associated with improved cognitive performance."
In summary, this PLOS ONE study shows that the composition of the gut flora, the quality and quantity of our sleep, immune function and cognition are linked.
The finding that poor sleep and lack of sleep can affect gut health offers an explanation as to why too little sleep can have deadly consequences, especially for chronic health conditions. CNN Health reports:
"If you are a middle-aged adult with high blood pressure, type 2 diabetes or existing heart disease and typically sleep less than six hours a night, you are at high risk of developing cancer or dying prematurely from heart disease."
The study referred to by CNN was published in the October 2019 issue of the Journal of the American Heart Association (JAHA). The researchers sought to determine whether short sleep duration increases the risk of death associated with cardiometabolic risk factors and cardiovascular and cerebrovascular disease.
Data from 1,654 adults from the Penn State Cohort Study were analyzed. Using Cox proportional hazard models, the adjusted risk ratio for all-cause mortality was 2.14 times higher in people who slept less than six hours and had cardiometabolic risk factors (high blood pressure, elevated blood sugar or type 2 diabetes) than in people who regularly slept six hours or more.
They also had a 1.83-fold higher risk of dying from cardiovascular or cerebrovascular diseases. Among the test subjects who suffered from heart disease or had had a stroke and slept less than six hours a night, the risk of death even increased 3.17-fold. Interestingly, the risk of dying from cancer also increased 2.92-fold.
All of these associations were independent of age, gender, ethnicity, obesity, smoking and other health conditions, factors that could influence the results. Conversely, a shorter sleep duration (less than six hours) did not increase the risk of death in people who had no cardiometabolic risk factors or suffered from the aforementioned diseases.
The same applies to people who had the relevant risk factors or illnesses but slept more than six hours a night. The risk of death did not increase in this group either. It was precisely the combination of chronic health complaints and short sleep duration that increased the risk of death for those affected, including cancer mortality.
How long we sleep affects our risk of dying
The authors of the study reported:
"These new findings show that objectively short sleep duration increases the risk of death in middle-aged adults with cardiometabolic risk factors or already developed cardiovascular and cerebrovascular diseases.
Participants who had these risk factors and who slept less than six hours at the start of the study had an 83 percent higher risk of dying from cardiovascular and cerebrovascular diseases. In the group in which the test subjects had the same risk factors but slept long enough, the risk of death due to the diseases mentioned increased by only 35 percent and therefore not significantly...
In conclusion, objectively short sleep duration effectively increases the risk of death associated with cardiometabolic risk factors or cardiovascular and cerebrovascular diseases. More importantly, our data suggest that short sleep duration also affects the risk of cancer mortality through different mechanisms.
Sleep is extremely important and also helps to prevent two diseases that are among the most common causes of death in many countries:
Scientists analyzed more than 300 studies conducted between 2004 and 2014 and developed the following recommendations. Remember: If you are ill, injured or pregnant, you need more sleep than indicated here.
Age group
Sleep needed for optimal health
Newborns (0 to 3 months)
14 to 17 hours
Infants (4 to 11 months)
12 to 15 hours
Infants (1 to 2 years)
11 to 14 hours
Kindergarten children (3 to 5 years)
10 to 13 hours
School children (6 to 13 years)
9 to 11 hours
Teenagers (14 to 17 years)
8 to 10 hours
Adults (18 to 64 years)
7 to 9 hours
Senior citizens (aged 65 and over)
7 to 8 hours
There is absolutely no doubt that for a long and healthy life, sleep should be the top priority in our lives. For many people, this means rearranging their daily routine and no longer staying up late into the night. Instead, we should go to sleep at a reasonable time.
If you have to get up at 6.00 am, you should be in bed between 9.30 and 10.00 pm - depending on how quickly you normally fall asleep. If you find it difficult to go to sleep at a certain time, set an alarm clock to remind you to finish your day's work in good time. You can find more information and tips in our guide: "Why you shouldn't fall asleep in front of the TV"
Achieving and maintaining a healthy gut flora is not as difficult as you might think. It is likely that this adjustment will not only improve your sleep. However, you need to be proactive and adjust your lifestyle. This includes:
Have you been feeling sluggish or unproductive lately? Then it's time to improve your sleep habits. Good sleep is a key factor in improving mood and overall health. However, many people do not get enough and good quality sleep, increasing their risk of various ailments.
Sources (in English):
Li, Y., Hao, Y., Fan, F. & Zhang, B. (2018, December). The Role of Microbiome in Insomnia, Circadian Disturbance and Depression. Frontiers in Psychiatry, 9: 669, doi: 10.3389/fpsyt.2018.00669
Carabotti, M., Scirocco, A., Maselli, M. A. & Severi, C. (2015, April-June). The gut-brain axis: interactions between enteric microbiota, central and enteric nervous systems. Annals of Gastroenterology, 28(2): 203–209
Aich, P. (2019, October). Gut microbiome diversity is associated with sleep physiology in humans. PLoS One, 14(10): e0222394, doi: 10.1371/journal.pone.0222394
Nova Southeastern University. (2019, October). "New study points to another possible correlation between sleep and overall good health: Your gut microbiome and quality sleep are interconnected." ScienceDaily. Verfügbar unter: [https://www.sciencedaily.com/releases/2019/10/191028164311.htm]
Gottlieb, D., J., Punjabi, N. M. & Newman, A. B. (2005, April). Association of Sleep Time With Diabetes Mellitus and Impaired Glucose Tolerance. JAMA Internal Medicine, 165(8):863-867, doi: 10.1001/archinte.165.8.863
Ayas, N. T., White, D. P. & Manson, J. E. (2003, January). A Prospective Study of Sleep Duration and Coronary Heart Disease in Women. JAMA Internal Medicine, 163(2):205-209, doi: 10.1001/archinte.163.2.205
Blask, D. E. (2009, August). Melatonin, sleep disturbance and cancer risk. Sleep Medicine Reviews, Volume 13, Issue 4, doi: 10.1016/j.smrv.2008.07.007
Smith, R. P., Easson, C., Lyle, S. M., Kapoor, R., Donnelly, C. P., Davidson, E. J. et al. (2019, October). Gut microbiome diversity is associated with sleep physiology in humans. PLoS One, 14(10): e0222394, doi: 10.1371/journal.pone.0222394
Fernandez-Mendoza, J., He, F., Vgontzas, A. N., Liao, D. & Bixler, E. O. (2019, October). Interplay of Objective Sleep Duration and Cardiovascular and Cerebrovascular Diseases on Cause‐Specific Mortality. Journal of the American Heart Association, 8:e013043, Vol. 8, No. 20, doi: 10.1161/JAHA.119.013043
Kembel, S. W., Jones, E., Kline, J., Northcutt, D., Stenson, J., Womack, A. M. et al. (2012, August). Architectural design influences the diversity and structure of the built environment microbiome. The ISME Journal, 6(8):1469-79, doi: 10.1038/ismej.2011.211