How Much Sleep Do You Need When You Are Sick? A Lot More Than You Think

When we’re sick, all we want to do is sleep. But it is far easier said than done.

Young adult black man lying down at home with a flu and runny nose
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A few days ago, I came down with what felt like the mother of all colds. My nose was a drippy, congested mess, my throat scratched something fierce, and my body felt heavy and listless. My best recourse — the only reasonable thing I was capable of doing in my miserable state — was to rest.

But my toxic trait is that I don’t rest easy, even when I’m sick. Call it an occupational hazard for someone who likes to keep busy. When I did manage to coax my body into some relaxation and eventually nod off to dreamland, my stuffy nose and itchy throat rendered restful sleep almost impossible. My first few nights were fitful tossing and turnings that had me waking up almost every hour, which was absolutely irritating, but my attention-seeking night prowler of a cat loved it.

Unsurprisingly, when we’re sick, all we want to do is sleep. The out-of-hours visitation from the Sandman is touted as one of nature’s best medicines. But sleeping well when you’re sick, as I discovered, is easier said than done. Moreover, if you’re feeling sick but not entirely sleepy, where does that leave you? Do you force some shut-eye at the risk of messing up your sleep schedule? Is there any optimal amount of sleep to be had when you’re sick?

As a sick person in a rocky relationship with sleep, these were the questions rattling in my head (instead of sheep). As it turns out, the adage of “listening to your body” applies pretty much across the board. There are ways, however, to optimize your sleep when you’re sick, and also signs you should watch for in case your common cold-induced sleep habits become more of an ongoing concern long after you’ve gotten better.

Why do we feel sleepy when we’re sick?

From the outside, sleep seems pretty simple and straightforward. But under the hood, it’s a complicated physiological process that’s more than simply closing your eyelids. While scientists still don’t know the exact purpose of sleep, we know that it’s crucial for brain health, such as for organizing and consolidating memories. Additionally, getting an adequate nightly snooze keeps the old ticker going, regulates appetite, and safeguards your lifespan. (Weirdly enough, all-nighters may act as counterintuitive antidepressants, at least in mice.)

Sleepiness during sickness is equally not well understood. But we know when there’s a stressor — aka a gnarly bacteria or virus causing infection — our bodies mount a chemical response of which sleepiness is a byproduct, Kimberly Hutchison, a professor of neurology and a sleep medicine specialist at Oregon Health and Science University, tells Inverse.

“When our body is under stress because we’re fighting off an infection, we have inflammatory reactions going on and different inflammatory markers released that are oftentimes associated with a feeling of sleepiness,” says Hutchison.

Specifically, some of these inflammatory markers are called cytokines. These small proteins are like chemical walkie-talkies that immune cells use to communicate with each other, coordinating what needs to be done to clear the infection. Cytokines are produced not only during an infection but in any instance when there’s inflammation, like a cut or an allergic reaction.

One class of cytokines released by immune cells during infection are interleukins, which convey more specific or urgent messages, says Rajkumar Dasgupta, a pulmonary critical care sleep medicine specialist at the University of Southern California Keck School of Medicine.

“If you break down that word interleukins, it means to interact with ‘leukins’ [which are] white blood cells,” Dasgupta tells Inverse. “Some of these interleukins — there are a lot of [them] — are associated with making you sleepy.”

It’s thought interleukins influence sleep in conjunction with neurotransmitters, sleep-related genes, and our circadian rhythms. There’s some research to suggest that there may be special types of neurons, at least in roundworms, that encourage sleep under stressors like sickness. Studies in fruit flies have found a special gene, dubbed nemuri, that activates during infection to beckon sleep.

Sleeping versus “quiet wakefulness”

When we succumb to the immune system’s siren call to slumber, our body works to repair itself. There’s evidence, says Hutchison, suggesting that the deepest stages of sleep — namely, stages three and four — are helpful for overall immunity. However, when you’re sick, you’re more likely to experience disrupted sleep as I did, and you might miss out more on those deeper stages, which is when rapid eye movement (or REM) sleep occurs.

This isn’t so much a cause of concern, especially if you’re getting adequate rest throughout your recovery, says Hutchison and Dasgupta. The typical amount of sleep recommended for adults is between seven and nine hours a night, but this will understandably fluctuate when you’re sick depending on your body’s needs and tends to bounce back once you’re feeling better. If you feel your poor sleep is persisting even after you’ve recovered, whether due to a change of sleep habits or some other underlying disruptive reason, Hutchison and Dasgupta recommend getting checked out by a healthcare professional.

What if you’re sick and not feeling particularly sleepy? Laying in bed can feel like a chore and a bit stifling (I know I might be in the minority here). If there’s no immunological benefit of sleep to be had, what’s the point of bed rest?

The common sense answer is that you don’t want to overstress your body while you’re immunologically vulnerable. Ultimately, more stress will only put you at a disadvantage, prolonging and even worsening your illness.

I learned this the hard way. On days one and two of my cold, I wasn’t very sleepy during the day despite my nasal discomfort, and I thought I could just power through. On day three, I felt like a large frog somehow crawled down my throat, which no amount of coughing could dislodge. Waving a white flag, I finally gave into my bed and took the opportunity to practice what sleep specialists call quiet wakefulness.

“If I had to put my definition to it, quiet wakefulness is a restful activity of lying with your eyes closed,” says Dasgupta. “Of course, it’s no substitute for sleeping… but I feel sleep is very individualized. What we want to do is really try to activate the parasympathetic part of your body, the part of the autonomic nervous system that’s about the words ‘rest and digest.’ If you could just relax and get the parasympathetic nervous system kicking in, you might just doze on and off. Sometimes, you don’t even realize you fall asleep because you’re so peaceful.”

Optimizing sleep

Hopefully, I’ve convinced you to take sleep seriously and not to learn the hard way like I did. Hutchison and Dasgupta also have recommendations on how to get enough and quality sleep if you come down with a cold or any other persnickety respiratory bug.

  • Sleep in a dark, quiet room, preferably by yourself, if you have a partner.
  • If you’re running the heat, know the dry heat can dry up and aggravate your sinuses and, in turn, make it difficult to sleep. Keep a humidifier handy.
  • Use nasal strips to help you breathe easier when you’re congested.
  • Stay hydrated and drink hot fluids to help open your airways.
  • Avoid taking any cold medications at night, especially those with ingredients that might keep you awake. Avoid any that contain antihistamines, which cause drowsiness, during the day.
  • Do take naps during the day as needed, but avoid taking any long naps that may disrupt your nighttime sleep routine.

Finally, just listen to your body because it knows what it needs.

“If you’re feeling really sleepy, then take a rest or a break. That doesn’t necessarily mean that you have to be falling asleep,” says Hutchison. “You’re just giving yourself the grace that you need to recover. It’s better to give yourself a chance to overcome the infection by listening to your body and getting adequate sleep than it is to sort of push through it.”

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