Sleep, Melatonin, Musculoskeletal Health and COVID-19…..What’s the Link?

New Studies Reveal Impact of Sleep and Melatonin on Physical Health and Disease Prevention in Adults and Adolescents

We all know how sleep deprivation can negatively affect health – impacting everything from our cognitive ability and immune response to heart function and disease prevention.

Now additional research underscores the important role that sleep plays in musculoskeletal health and the surprising link between melatonin, a key component in inducing sleep, and COVID-19.

The studies, which recognized that the pandemic has fueled anxiety related insomnia weakening the immune system vital in combating a host of diseases, including COVID-19, revealed that not only has melatonin (a hormone released primarily by the pineal gland at night) shown to improve restorative sleep but also immune response – potentially providing added protection against COVID-19.

According to a Cleveland Clinic study, researchers found that “melatonin reduced the likelihood of study participants getting COVID-19 by 28%.”  Among black participants, a population disproportionately affected by the disease, “infection likelihood was reduced by 52%.”1

The study further indicated that aside from potentially preventative benefits, melatonin may also help aid in the treatment of COVID-19 “due to its antioxidant and anti-inflammatory effects.”

Another study found that taking melatonin to improve sleep in the two weeks prior to a COVID-19 vaccination could help ensure that the vaccine is taken amid optimal sleep conditions, when the immune system is at its best.  And using melatonin for at least two to four weeks following receipt of the vaccine may enhance the body’s immune response to the vaccine and possibly increase length of time a person has immunity.2

If this information isn’t compelling enough, as COVID begins to increasingly affect younger population groups, data from the Centers for Disease Control and Prevention (CDC) show that insufficient sleep – common among high school students – is associated with an “increased risk for unintentional injury from drowsy driving crashes, sports injuries and occupational injuries.”3

The data showed that students reporting less than seven hours of sleep per night were more likely to report several injury-related risk behaviors than those sleeping nine hours or more.

The lack of sleep in both adult and adolescent population groups can be attributed to a number of factors, including anxiety, nutritional deficiencies impacting melatonin production, and over exposure to “blue light” affecting the body’s natural circadian rhythm (24-hour cycles that regulate sleep patterns and essential function based on sunrise and sunset).

Synthesized from tryptophan, an essential dietary amino acid, melatonin production can be impacted by nutritional factors such as the intake of vegetables, caffeine and some vitamins and minerals – though with less intensity than light, which is “the most dominant synchronizer of melatonin production.”4

According to the Sleep Foundation, blue light is a portion of the visible light spectrum that can affect alertness, hormone production and sleep cycles. It is emitted by LED and fluorescent lights, as well as many electronic devices.  Blue light is the largest disrupter of natural circadian rhythm and melatonin production.5

It is important to monitor behavior and discuss changes in sleep and activity patterns with your physician to determine if inadequate melatonin levels and disrupted sleep cycles are compromising restorative sleep and protective immune system function. Melatonin supplements, dietary changes and behavior modifications may be recommended.

 References

  1. Zhou Y, Hou Y, Shen J, Mehra R, et al. A network medicine approach to investigation and population-based validation of disease manifestations and drug repurposing for COVID-19. PLOS Biology. 2020. Doi.org/10.1371/ journal.pbio.3000970.
  2. Cardinali DP, Brown GM, and Pandi-Perumal SR. An urgent proposal for the immediate use of melatonin as an adjuvant to anti SARS-COV-2 vaccination. Melatonin Res. melatonin-research.net .
  3. Wheaton AG, Olsen EO, Miller GF, and Croft JB. Sleep duration and injury-related risk behaviors among high school students – United States, 2007-2013. Centers for Disease Control and Prevention (CDC). 2016;65(13):337-341. https://www.cdc.gov/mmwr/volumes/65/wr/mm6513a1.htm
  4. Peuhkuri K, Sihvola N, and Korpela R. Dietary factors and fluctuating levels of melatonin. Food Nutr Res. 2012;56:10.3402/fnr.v56i0.17252.
  5. Newsom R. How blue light affects sleep. 2021 June 24. Sleep Foundation. https://www.sleepfoundation.org/bedroom-environment/blue-light

 

This information is provided for educational purposes only and does not replace a discussion with your healthcare provider.

Dr. Korsh Jafarnia is one of Houston’s leading board certified, fellowship trained hand and upper extremity specialists.  A member of Houston Methodist Orthopedics & Sports Medicine, Dr. Jafarnia also serves as an assistant professor in the Department of Orthopedic Surgery at Weill Cornell-affiliated Houston Methodist Hospital. Call 888.621.HAND (4263) for an appointment, or go to www.korshjafarniamd.com to learn more.

Vitamin D and a COVID Link?

Several years ago we featured a blog discussing the rise in Vitamin D deficiency and the corresponding rise in certain injuries and diseases, including an increase in the number of fracture cases in younger Vitamin D deficient patients.

Over the years scientific research has identified a visible link between Vitamin D deficiency and increased risk of fracture, diabetes, cardiovascular disease and cancer [1, 2].  Testing Vitamin D levels of our fracture patients is now common practice in our clinic.

While the widespread deficiency identified in adolescents, young and middle-aged adults and elderly alike has itself been called a “pandemic,” new studies are now also showing the important role that adequate Vitamin D levels may play in not only maintaining good health but also accelerating recovery when diagnosed with COVID-19 [3].

Though research is ongoing, according to one recently published report, adults with vitamin D deficiency are at greater risk for severe COVID-19 infection and death. The data presented at the American Society for Bone and Mineral Research virtual meeting showed that the hospitalized COVID-19 group had lower 25-(OH)D levels (mean, 18.2 ng/mL) than the group with mild symptoms (30.3 ng/mL), or the control group (25.4 ng/mL; p < .0001 for both) (Figure 1) [3].

The report indicated that intervention trials are needed to explore whether vitamin D supplementation could prevent respiratory failure in people with COVID-19 or other serious respiratory infections.

The data is among the new information learned almost daily on the novel coronavirus.  And while researchers admit that additional research is necessary to further explore this link and the COVID prevention and recovery implications, most agree that encouraging adequate Vitamin D intake and addressing deficiencies present no downside in the interim.

Figure 1. Mean Vitamin D Levels found in adults with or without COVID-19.

 

 

Causes of Vitamin D Deficiency

While studies continue to explore possible causes of the widespread Vitamin D deficiency, a number have already been identified.  Some are the result of societal changes such as increased use of sun blocks/sun screens for fear of skin cancer (limiting unprotected sun exposure) and changes in our diet (processed, nutrient-deficient foods versus nutrient and Vitamin D-rich foods). Both of which have gradually reduced the amount of Vitamin D intake we receive.

 Other possible causes of Vitamin D Deficiency include:

 1.) Obesity

Some studies suggest that a higher BMI leads to lower 25(OH) D. Greater amounts of subcutaneous fat sequesters more of the vitamin and alter its release into circulation.

2.) Naturally dark-skinned individuals

Greater amounts of the pigment melanin in the epidermal layer (resulting in darker skin) reduces the skin’s ability to produce Vitamin D from sunlight.

3.) Certain Medications

Corticosteroid medications such as prednisone (often prescribed to reduce inflammation) can reduce calcium absorption and hinder Vitamin D metabolism. Other weight-loss, cholesterol-lowering and epileptic seizure medications have also been implicated in reduced calcium absorption and Vitamin D levels.

4.)  Age

As we age, our skin cannot synthesize Vitamin D as efficiently. The elderly are also likely to spend more time indoors, leading to inadequate intakes of the vitamin [4,5].

References

  1. Holick MF. Vitamin D: importance in the preventioin of cancers, type 1 diabetes, heart disease, and osteoporosis.  Am J Clin Nutr. 2004;79(3):362-371.
  2. Holick MF. The vitamin D Deficiency pandemic and consequences for nonskeletal health: mechanisms of action. Mol Aspects Med. 2008;29(6):361-8.
  3. Monostra M. Low vitamin D levels independently associated with severe COVID-19 cases, death. EndocrinToday. Helio. 2020 Sept 11.
  4. Armas LA, Hollis BW, Heaney RP. Vitamin D2 is much less effective than vitamin D3 in humans. J Clin Endocrinol Metab. 2004;89(11):5387-5391.
  5. Institutes of Health, Office of Dietary Supplements – https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/ .
  6. Vimaleswaran KS, Berry DJ, Lu C et al. Causal relationship between obesity and Vitamin D status:  bi-directional Mendelian randomization analysis of multiple cohorts. 2013 – http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001383.

Dr. Korsh Jafarnia is one of Houston’s leading board certified, fellowship trained hand and upper extremity specialists.  A member of Houston Methodist Orthopedics & Sports Medicine, Dr. Jafarnia is affiliated with Houston Methodist Hospital at Memorial City/Spring Valley.  He also serves as an assistant professor, Weill Cornell Medical College. Call 888.621.4263 for an appointment, or go to www.korshjafarniamd.com to learn more. 

This information is made available for educational purposes only.  It does not serve as a diagnosis in the absence of a consult with a qualified healthcare provided.