Sleep (yes) and Melatonin (maybe) to Balance the Immune System

[McCamy Taylor]

Since I am a physician who also has a Masters Public Health, I am going to try to keep up with the article showing up in journals and also try to analyze them in a way that folks without this training may find useful. I am not advocating any particular treatments (unless a prospective double blind trial shows good results and there will be no prospective double blind trials coming out in the next few weeks on COVID because it is just not possible to do them)

The article below is a discussion rather than the results of a clinical trial but it is worth reading especially if you consider the natural course of melatonin production in humans is a graph that looks like this:



Here is the article:

https://www.sciencedirect.com/science/article/pii/S0024320520303313

Here is the abstract:

This article summarizes the likely benefits of melatonin in the attenuation of COVID-19 based on its putative pathogenesis. The recent outbreak of COVID-19 has become a pandemic with tens of thousands of infected patients. Based on clinical features, pathology, the pathogenesis of acute respiratory disorder induced by either highly homogenous coronaviruses or other pathogens, the evidence suggests that excessive inflammation, oxidation, and an exaggerated immune response very likely contribute to COVID-19 pathology. This leads to a cytokine storm and subsequent progression to acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) and often death. Melatonin, a well-known anti-inflammatory and anti-oxidative molecule, is protective against ALI/ARDS caused by viral and other pathogens. Melatonin is effective in critical care patients by reducing vessel permeability, anxiety, sedation use, and improving sleeping quality, which might also be beneficial for better clinical outcomes for COVID-19 patients. Notably, melatonin has a high safety profile. There is significant data showing that melatonin limits virus-related diseases and would also likely be beneficial in COVID-19 patients. Additional experiments and clinical studies are required to confirm this speculation.

This is not a study result. However if you read through the text there are some interesting points made about how melatonin has been shown to reduce CNS and nerve damage in lab rats given certain viral infections. And COVID appears to be an RNA virus that affects the central nervous system via the olfactory nerve which is adjacent to the nose and therefore a site where viruses can easily enter the brain.

There are also human studies showing that melatonin may decrease the level of cytokines and inflammation in people with other disease.

Although there is obviously no report related to the use of melatonin in COVID-19 patients, in subjects with other diseases and an increased level of inflammation, the application of melatonin showed promising results regarding the attenuation of circulating cytokines levels. In a randomized controlled trial, 8-week oral intake of 6 mg/d melatonin caused a significant decrease in serum levels of IL-6, TNF-? and hs-C-reactive protein (hs-CRP) in patients with diabetes mellitus and periodontitis [56]. In another trial of patients suffering with severe multiple sclerosis, orally 25 mg/d of melatonin for 6 months also promoted a significant reduction in serum concentrations of TNF-?, IL-6, IL-1? and lipoperoxides [57]. In the acute phase of inflammation, including during surgical stress [58], brain reperfusion [59], and coronary artery reperfusion [60], melatonin intake of 10 mg/d, 6 mg/d and 5 mg/d of melatonin for less than 5 days induced a reduced level of pro-inflammatory cytokines. A recent meta-analysis of a total of 22 randomized controlled trials suggested that a supplementary use of melatonin is associated with a significant reduction of TNF-? and IL-6 level [61]. This clinical evidence suggests that the use of melatonin as a supplement may effectively reduce the levels of circulating cytokines, and may potentially also lower pro-inflammatory cytokine levels in COVID-19 patients.

This goes along with something I have been thinking. Youth does not necessarily protect us from new viruses. A disproportionate number of young people died from the 1918 flu pandemic.

https://www.sciencedirect.com/science/article/abs/pii/S0022519311003894

However something appears to be protecting younger people from COVID 19's worst effects. Could it be a hormone that is present in higher levels in young people? Might not be melatonin. There are many hormones that vary by age.

Note that the doses used in the human test above are not huge. 3 mg, 5 mg, 10 mg. These are the usual recommended doses for normal function. The goal is not to kill the virus with melatonin. The goal is to achieve a pattern of sleep (which affects on the immune system) as much like that as a young person as possible. You are looking for normal.

Along these same lines, sleep hygiene--getting enough rest at the same time every day while limiting things which can affect sleep architecture (like alcohol and stimulants before bedtime) limiting things that can cause you to reflux in your sleep (like eating before bedtime, lying down flat on your back after eating) and using your sleep apnea treatment might also bolster the immune system.

Had to search long and hard for a review of sleep and in the immune system that is not behind a pay for view wall. Thank you NCBI (National Center for Biotechnology Information) for sharing this one.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3645929/

Inflammation modulates sleep and the effects of sleep loss and conversely sleep or sleep loss alters inflammatory responses including the production of inflammation regulatory substances activated by neuronal/glial use and immunologic pathogen recognition

PS: For those that want advanced reading, this is a fascinating study about how RNA viruses (like COVID) work in the immune system. Notice that some of them have a biphasic pattern. They do one thing in the initial infection and then later act differently. Full PDF available thanks to ncbi

https://www.annualreviews.org/doi/abs/10.1146/annurev.mi.40.100186.001111

[Bernardo de La Paz]

1. Interesting! Thank you for posting the information from good sources. . . . nt

[Anon-C]

2. Awesome post with great info!

[Ferrets are Cool]

3. I read this a week ago and may be dumb,

but I ordered from Amazon and got it within 3 days. Hell, it can't hurt.

[McCamy Taylor]

5. Very rarely someone will say it gives bad dreams

But that is the worst I have ever heard a patient say.

[Turbineguy]

7. Right now there are

plenty of reasons for having bad dreams.

I try and limit my intake of trump too.

[a la izquierda]

8. Horrendous nightmares and night sweats...

And I don’t normally have either.

[ARPad95]

4. Thank you, McCamy Taylor! Very informative.

[lostnfound]

6. Melatonin is higher in women, too, isn't it? Sex differences in COVID outcomes.

[JudyM]

9. Thanks for this.

I had noticed the melatonin issue and it seems reasonable. Also consider vitamin D and ZN, both of which are at low levels in seniors... a situation that can be easily and inexpensively reversed.

[CTyankee]

10. I take 10 mg of Melatonin every night. I think it helps me sleep and feel refreshed in the morning.

I do not drink alcohol. I do drink "wine" that has been de"aocoholized." That way, I get the taste i like but not the alcohol and its effects.