The links between autoimmune diseases and sleep disturbances have been well established for a long time but little understood until recently.  A primary symptom of autoimmune diseases, in general, is extreme fatigue.

 The National Cancer Institute (NCI), a branch of the National Institute of Health (NIH), defines an autoimmune disease as “A condition in which the body’s immune system mistakes its own healthy tissues as foreign and attacks them.” The majority of autoimmune diseases cause inflammation in different areas of the body.  The location of the body that is affected depends on which autoimmune disease the patient has. 

What Are Autoimmune Diseases

A patient’s symptoms can appear, disappear, and then reappear.  Their symptoms may be mild or severe or fluctuate. Some common symptoms are:

• Fever
• Skin Rashes
• Fatigue
• Joint Pain
• Digestion Issues
• Swelling
• Swollen Glands
• Muscle Aches
• Abdominal Pain

“People who don’t see you every day have a hard time understanding how on some days–good days–you can run three miles, but can barely walk across the parking lot on other days,’ [my mom] said quietly.”

― Jennifer Starzec

There are over 80 diagnosed autoimmune diseases that are often genetic and run in families.  Women are three times more likely to be diagnosed with autoimmune diseases.  There are approximately 23 million Americans diagnosed with these diseases (7% of the US population), and these diseases’ incidents are growing.

Women are most likely to develop autoimmune during their child-bearing years (between 15-65).  A few reasons women are diagnosed more frequently can be genetics, hormones, and women’s predisposition to inflammation. For example, the hormone estrogen plays a significant role in autoimmune diseases in women.  Researchers have also found a gene on the X chromosome that they believe is linked to these diseases, but research is still ongoing. 

Autoimmune diseases are the fourth leading cause of disability and the eighth leading cause of death in women among this age group. 

Testosterone reduces inflammation which could be why men are less likely to receive these diagnoses. However, men are not immune to autoimmune diseases. 

“For patients with autoimmune diseases, their body is both the aggressor and the victim.  Their own body is causing their pain.” Dr. Tomkinson

Common Autoimmune Diseases 

The most commonly diagnosed autoimmune diseases are:

• Type 1 Diabetes: Your pancreas makes insulin, a hormone that regulates your levels of blood sugar. In patients with Type 1 diabetes, their immune systems attack their pancreas, destroying its ability to create insulin. As a result, high blood sugar can damage a patient’s organs and blood vessels.
• Rheumatoid Arthritis: RA causes your immune system to attack your joints.  This causes you to experience pain, heat, soreness, and joint stiffness. RA is unlike osteoarthritis in that it can be diagnosed in people thirty years and under.  Osteoarthritis is caused by over usage or injury of the joint.  Rheumatoid is caused by a patient’s immune system attacking their joints.
• Psoriasis/ Psoriatic Arthritis: The immune system attacks patients’ skin when they have psoriasis or psoriatic arthritis.  When functioning normally, skin cells grow and then shed when they die.  In a patient with these diseases, the skin cells multiply too quickly.  The extra cells create swollen red patches with white scales of plaque on the patient. In addition, 30% of patients also develop arthritis in the joints.  This is known as psoriatic arthritis.
• Multiple Sclerosis: MS is an autoimmune disease that attacks a patient’s nerves.  It attacks the myelin sheath around the nerves.  This protective coating surrounds the nerves and helps the nerves communicate with the brain and spinal cord.  Patients with MS experience weakness, numbness, balance problems, and trouble walking.  Within 15 years of diagnosis, 50% of MS patients need help walking.                                                                                                                                                       
• Systemic Lupus Erythematosus: Lupus is an autoimmune disease that attacks a patient’s entire system.  The organs most commonly affected are the kidneys, brain, joints, and heart.  The most prevalent symptoms are skin rash, joint pain, and fatigue.
• Inflammatory Bowel Disease:  IBD is an autoimmune disease that attacks the intestinal lining. Each condition affects a different part of the GI tract. For example, Crohn’s disease can attack any part of the digestive tract from the mouth to the anus. On the other hand, ulcerative colitis only affects the lining of the colon and the rectum.
• Addison’s Disease: Addison’s disease is an autoimmune disease that attacks the adrenal glands.  These glands generate the hormones cortisol and aldosterone.  Not having enough cortisol affects the way your body uses and stores carbohydrates and glucose.  Too little aldosterone causes too little sodium and too much potassium in your blood.  Symptoms of Addison’s disease are weight loss, weakness, low blood sugar, and fatigue.
• Graves’ Disease:  This is an autoimmune disease that attacks the thyroid gland.  The thyroid produces hormones that control metabolism.  When a patient has Graves disease, their body produces too much of this hormone, causing their system to speed up.  This creates symptoms like nervousness, weight loss, over-heating, and a fast heartbeat.  The disease can also cause a patient’s eyes to protrude or “bulge’ (aka exophthalmos).
• Hashimoto’s Thyroiditis:  This autoimmune disease affects the thyroid by causing it to produce too little of the hormones it produces.  Symptoms of Hashimoto’s thyroiditis are cold intolerance, hair loss, fatigue, weight gain, and goiter.
• Myasthenia Gravis: Myasthenia Gravis is an autoimmune disease that attacks the nerve signals that your brain uses to control your muscles.  The most frequent symptom is muscle weakness.  Muscles that are most frequently affected are the muscles that control eye movement, swallowing, and facial movements.

Treatments for Autoimmune Diseases

There is not one single test to diagnose most autoimmune diseases. Instead, doctors use a combination of tests, symptoms, and exams to determine your diagnosis.  One of the tests used is an antinuclear antibody test (ANA).  If this test is positive, you have an autoimmune disease, but the doctor will still have to determine which autoimmune disease you have.  A negative ANA test does not necessarily mean that you do not have an autoimmune disease.  Sometimes you have to be in a flare-up for the ANA test to come back positive.

Autoimmune diseases have no cure, and most are progressive.  However, there are treatments available to slow or halt the progression of the disease.  They are treated by a combination of immunosuppressants, nonsteroidal anti-inflammatory drugs (NSAIDs), and biologics.

“It is imperative that patients with autoimmune disease are consistent in their medication regiment.  Every time they go off their medicine, more damage is one that we may not be able to repair.” Dr. Tomkinson

Sleep and Autoimmune Diseases

When it comes to autoimmune diseases and sleep, it can sometimes be hard to tell which came first.  Often sleep dysregulation is an early symptom of an autoimmune disease.  Commonly, the first symptom that patients share with their doctors is their extreme tiredness.  Chronic fatigue is quite normal for patients with autoimmune diseases.  Unfortunately, when this is the only symptom the patient is presenting with, it can take doctors some time to figure out what is going on.

 However, studies are showing that chronic sleep deprivation can cause autoimmune diseases.  These findings are still being researched, but initial results suggest that sleep dysregulation can be the cause of autoimmune disease because of the effects of sleep on the immune system.  

“Sleep is arguably the most important process that our body does.  Healthy sleep is the foundation of a healthy body.” Dr. Tomkinson 

How Sleep is Dysregulated

Researchers do not fully understand precisely how autoimmune diseases and sleep affect each other, but they do know some of how they do.   Here are a few examples.

• A patient’s immune system attacks the cells that regulate sleep.  Narcolepsy is the result of a person’s immune system attacking the cells that regulate their sleep cycle.  Narcolepsy is an autoimmune system where a patient will suddenly fall asleep with no warning. As a result, the patient is unable to control when or how they fall asleep.  Narcolepsy destroys a patient’s hypothalamus cells. These cells create the neurotransmitters that regulate the sleep cycle. Patients with narcolepsy generate a protein that blocks the creation of these neurotransmitters.  Their patient’s immune system does all this by attacking their brain tissue.
• Pain can interfere with a patient’s quality of sleep.  Several autoimmune diseases cause joint and muscle pain.  This pain can be so severe that the patient cannot find a comfortable position in which to sleep.  This is often the case for patients with rheumatoid arthritis and Lupus.
• Depression, stress, and anxiety are well-known causes of sleep dysregulation.  Sleep disorders and mental health issues like depression can exacerbate and worsen each other.  A patient should seek medical help to treat both conditions simultaneously, as treating the only one can exacerbate the other and have dire consequences, including an increased risk of suicide.
• Insomnia without pain is a common complaint of patients with autoimmune diseases. However, even when a patient’s pain is controlled, their autoimmune disease can still negatively affect falling or staying asleep.

Conclusion

Sleep and autoimmune diseases are intricately connected.  The research is ongoing, but researchers now know that sleep dysregulation can be caused by autoimmune diseases and cause them.  Patients with autoimmune diseases should seek treatment for their sleep problems from a doctor because lack of sleep can worsen their other conditions. 

“We are just beginning to understand how closely autoimmune diseases and sleep are connected.  As research continues, the hope is that we can develop better treatments for both disorders.” Dr. Tomkinson

The information in this article is not meant for diagnostic purposes, and we are not doctors. Please consult your doctor before making any decisions concerning your healthcare.

Resources

21, K. A. | M., Anderson, K., & Anderson, K. (2020, September 15). Are autoimmune disorders more common for women? The Checkup. https://www.singlecare.com/blog/autoimmune-diseases-in-women/. 

Allied Academies. (2018, September 12). The World Incidence and Prevalence of Autoimmune Diseases is Increasing. Allied Academies. https://www.alliedacademies.org/proceedings/the-world-incidence-and-prevalence-of-autoimmune-diseases-is-increasing-2449.html. 

Autoimmune Disease. National Stem Cell Foundation. (n.d.). https://nationalstemcellfoundation.org/glossary/autoimmune-disease/. 

Genentech. (2017, November 1). Autoimmune Disease 101. Genentech: Breakthrough science. One moment, one day, one person at a time. https://www.gene.com/stories/autoimmune-disease-101. 

Goodreads. (n.d.). Chronic Illness Quotes (177 quotes). Goodreads. https://www.goodreads.com/quotes/tag/chronic-illness. 

MediLexicon International. (n.d.). Sleep apnea and autoimmune diseases: How are they connected? Medical News Today. https://www.medicalnewstoday.com/articles/sleep-apnea-and-autoimmune-diseases-how-are-they-connected. 

NCI Dictionary of Cancer Terms. National Cancer Institute. (n.d.). https://www.cancer.gov/publications/dictionaries/cancer-terms/def/autoimmune-disease. 

Person, Nelson, H., 1325, 1781, ImageObject, & Holly Daniels Nelson has a B.A. In Mass Communication, and is a communication specialist in Public Relations at Intermountain Riverton Hospital. (2019, November 19). Why women have more autoimmune diseases. intermountainhealthcare.org. https://intermountainhealthcare.org/blogs/topics/live-well/2019/11/why-women-have-more-autoimmune-diseases/. 

Vann, M. R., Levine, B., By, Glover, L., & Gupta, D. S. (n.d.). Autoimmune Disorders and Sleep Problems – Autoimmune Disorders Center -Everyday Health. EverydayHealth.com. https://www.everydayhealth.com/autoimmune-disorders/getting-sleep-with-autoimmune-disease.aspx. 

WebMD. (n.d.). Autoimmune Diseases: What Are They? Who Gets Them? WebMD. https://www.webmd.com/a-to-z-guides/autoimmune-diseases. Zielinski, M. R., Systrom, D. M., & Rose, N. R. (2019, August 6). Fatigue, Sleep, and Autoimmune and Related Disorders. Frontiers in immunology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6691096/.