What's "rest"?

[Luciana]

That's how I understand the concept of "rest": when you have had surgery, it's obvious that a certain organ or body part needs time to heal, and you can't apply force to it.

But what about "rest" in relation to virus infections? If I have a flu - aside from feeling tired - why do I need to rest in order to get better?

Two years ago we had an outbreak of dengue fever. Lacking an specific treatment, doctors simply recommended "plenty of water, Tylenol for pain and fever, rest".

So my doubt is - what are the mechanisms behind "rest", and why does it help your body to heal from virus infections and other illnesses?

[jayrev]

This is purely a guess. I am not a doctor. But I would imagine that rest is prescribed for infections because the body's immune system requires energy to fight off infection. Energy expended through other means is energy that isn't available to the immune system.

For all I know that is completely wrong, but it makes sense.

[Ziggurat]

I think it's because your immune system needs to use energy, and if you're physically active your immune system will not be able to work at full capacity. Plus, if you're feeling sick, physical exertion is probably going to make you very uncomfortable, so from a purely comfort perspective it's certainly the wise thing to do as well.

[Brown]

I am not a doctor, either. (Well, I am a doctor in that I have the word "doctor" in one of my degrees, but I'm not a medical doctor.) What I have to say is based upon experience rather than medical knowledge.

I've had a couple of pretty nasty infections in my life. One of them (not sure if it was a viral infection) caused me to be hospitalized when I was a child. The doctor prescribed "bed rest," which meant I wasn't allowed to get out of bed for two weeks. Part of the reason "bed rest" was prescribed was so the hospital personnel could keep an eye on me. I was a kid and had a lot of energy. I wasn't very restful, but I obeyed the doctor and stayed in bed.

When I had some viral infections as an adult, I rested because I didn't feel like doing anything else. I couldn't work, I couldn't concentrate, I couldn't read, I could barely follow the plot of a "Star Trek" episode. There was nothing to do but rest.

[Doubt]

No expert here either. From what I understand it is not just energy. Most of the bodies resources are best used to fend off the illness. All those antibodies and white blood cells are made from protein. If you are up moving around and using your body then you are doing some damage to its structure. (All physical effort damages the muscles. When you are healthy and exercise, the repaired muscle should come back stronger.) That means your body will also need to repair that damage as well as produce the things needed to fight off the flu. The end result is that you overwork your internal origins. Some process needed to fight the illness or repair a little muscle tissue is likely to be shorted on resources.

Also any physical effort will likely result in reduced hydration of the body. If you are already running a fever, the chances of dehydration go up a bit. If you have diarrhea, the chance of dehydration goes up a lot.

Best to take it easy.

(edited for sppeeling)

[Yahweh]

Consider:

Going to work/school for 8 hours with a flu...

Or...

Staying at home, watching soap operas and playing on the JREF boards all day with a flu...


Rest is good.

[Rolfe]

The stuff about the immune system needing "energy" to work sounds like so much woo-woo.

The physiological fact is that if you don't rest you will get significantly worse and delay the eventual recovery. This isn't logic talking, it's pure observation. Some people, however, need telling.

Thinks about it....

No, I don't know why not resting makes everything worse. But it isn't about the immune system needing "energy".

Rolfe.

[Ziggurat]

Quote:

Originally posted by Rolfe

No, I don't know why not resting makes everything worse. But it isn't about the immune system needing "energy".

Rolfe.

Why not? It takes energy to make white blood cells. It takes energy for those white blood cells to move around and attack pathogens. It takes energy to repair cells damaged by pathogens. That isn't any sort of mystical energy, that's straightup biological energy in the form of sugar, etc. Believing that the imune system could somehow run without expending energy is woo-woo. Your body needs energy for a lot more than just moving your muscles.

Edit to add: if you're running a fever, you're also spending more energy than usual just heating your body up.

[SteveGrenard]

In spite of the fact that some refer to rest as conventional wisdom with no basis in fact where recovery from disease processes is concerned, this is incorrect. There is considerable evidence of a strong relationship between immune responses and sleep (e.g. a form of rest). Here are a few more recent abstracts from The (U.S.) National Library of Medicine's database on this subject:

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Int Rev Neurobiol. 2002;52:93-131.

Brain-immune interactions in sleep.

Marshall L, Born J.

Department of Clinical Neuroendocrinology, Medical University of Lubeck, 23538 Lubeck, Germany.

This chapter discusses various levels of interactions between the brain and the immune system in sleep. Sleep-wake behavior and the architecture of sleep are influenced by microbial products and cytokines. On the other hand, sleep processes, and perhaps also specific sleep states, appear to promote the production and/or release of certain cytokines. The effects of immune factors such as endotoxin and cytokines on sleep reveal species specificity and usually strong dependence on parameters such as substance concentration, time relative to administration or infection with microbial products, and phase relation to sleep and/or the light-dark cycle. For instance, endotoxin increased SWS and EEG SWA in humans only at very low concentrations, whereas higher concentrations increased sleep stage 2 only, but not SWS. In animals, increases in NREM sleep and SWA were more consistent over a wide range of endotoxin doses. Also, administration of pro-inflammatory cytokines such as IL-6 and IFN-alpha in humans acutely disturbed sleep while in rats such cytokines enhanced SWS and sleep. Overall, the findings in humans indicate that strong nonspecific immune responses are acutely linked to an arousing effect. Although subjects feel subjectively tired, their sleep flattens. However, some observations indicate a delayed enhancing effect on sleep which could be related to the induction of secondary, perhaps T-cell-related factors. This would also fit with results in animals in which the T-cell-derived cytokine IL-2 enhanced sleep while cytokines with immunosuppressive functions like IL-4 and L-10 suppressed sleep. The most straightforward similarity in the cascade of events inducing sleep in both animals and humans is the enhancing effect of GHRH on SWS, and possibly the involvement of the pro-inflammatory cytokine systems of IL-1 beta and TNF-alpha. The precise mechanisms through which administered cytokines influence the central nervous system sleep processes are still unclear, although extensive research has identified the involvement of various molecular intermediates, neuropeptides, and neurotransmitters (cp. Fig. 5, Section III.B). Cytokines are not only released and found in peripheral blood mononuclear cells, but also in peripheral nerves and the brain (e.g., Hansen and Krueger, 1997; Marz et al., 1998). Cytokines are thereby able to influence the central nervous system sleep processes through different routes. In addition, neuronal and glial sources have been reported for various cytokines as well as for their soluble receptors (e.g., Kubota et al., 2001a). Links between the immune and endocrine systems represent a further important route through which cytokines influence sleep and, vice versa, sleep-associated processes, including variations in neurotransmitter and neuronal activity may influence cytokine levels. The ability of sleep to enhance the release and/or production of certain cytokines was also discussed. Most consistent results were found for IL-2, which may indicate a sleep-associated increase in activity of the specific immune system. Furthermore, in humans the primary response to antigens following viral challenge is enhanced by sleep. In animals results are less consistent and have focused on the secondary response. The sleep-associated modulation in cytokine levels may be mediated by endocrine parameters. Patterns of endocrine activity during sleep are probably essential for the enhancement of IL-2 and T-cell diurnal functions seen in humans: Whereas prolactin and GH release stimulate Th1-derived cytokines such as IL-2, cortisol which is decreased during the beginning of nocturnal sleep inhibits Th1-derived cytokines. The immunological function of neurotrophins, in particular NGF and BDNF, has received great interest. Effects of sleep and sleep deprivation on this cytokine family are particularly relevant in view of the effects these endogenous neurotrophins can have not only on specific immune functions and the development of immunological memories, but also on synaptic reorganization and neuronal memory formation.

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Ann N Y Acad Sci. 2003 May;992:9-20. R


Humoral links between sleep and the immune system: research issues.

Krueger JM, Majde JA.

Department of Veterinary and Comparative Anatomy, Pharmacology and Physiology, Washington State University, Pullman, Washington 99164-6520, USA. Krueger@vetmed.wsu.edu

In the last twenty years we have realized that the immune system synthesizes a class of peptides, termed cytokines, that play a central role in alerting the brain to ongoing inflammation in peripheral tissues. Among the brain's responses to proinflammatory cytokines, or agents that induce these cytokines, are certain alterations in sleep profiles. Characteristically there is an increase in non-rapid eye movement sleep (NREMS), and NREMS intensity is often accompanied by a decrease in rapid eye movement sleep (REMS). Cytokines appear to play a role in normal sleep regulation; during pathology, higher levels of cytokines amplify the physiological cytokine sleep mechanisms. In this review we summarize the extensive literature on the roles of interleukin-1 (IL-1) and tumor necrosis factor-alpha (TNF-alpha) in sleep regulation, and their interactions with the neuropeptides growth hormone-releasing hormone (GHRH) and corticotropin-releasing hormone (CRH). We reach the tentative conclusion that the sleep-promoting actions of IL-1 and GHRH are mediated via anterior hypothalamic neurons that are receptive to these substances. It also seems likely that TNF-alpha and CRH also influence these neurons. In addition, we discuss an array of research issues raised by these studies that remain to be resolved.

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Nocturnal catecholamines and immune function in insomniacs, depressed patients, and control subjects.

Irwin M, Clark C, Kennedy B, Christian Gillin J, Ziegler M.

Cousins Center for Psychoneuroimmunonology, UCLA Neuropsychiatric Institute, University of California, Los Angeles, CA 90095-7057, USA. mirwin@ucla.edu

Insomnia predicts cardiovascular and non-cardiovascular disease mortality. This study evaluated EEG sleep, nocturnal sympathetic activity, and daytime measures of immune function in subjects with primary insomnia (n = 17) and patients with current major depression (n = 14) as compared to controls (n = 31). Insomniacs showed disordered sleep continuity along with nocturnal increases of average levels of circulating norepinephrine and decreases of natural killer cell responses, whereas depressed patients showed declines of natural killer cell activity, but no differences of EEG sleep or nocturnal catecholamines as compared to controls. Impairments of sleep efficiency correlated with nocturnal elevations of norepinephrine in the insomniacs but not in the depressives or controls. These data indicate that insomnia is associated with nocturnal sympathetic arousal and declines of natural immunity, and further support the role of sleep in the regulation of sympathetic nervous and immune system functioning.


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Neural-immune interactions in the regulation of sleep.

Opp MR, Toth LA.

Department of Anesthesiology, University of Michigan School of Medicine, Ann Arbor 48109-0615, USA. mopp@med.umich.edu

Interactions between sleep and the immune system have been recognized for millennia. The lethargy and increased desire to sleep that accompany mild infections such as colds or "the flu" are common experiences. These experiences have fostered the belief that sleep promotes recovery from infectious challenge. Another common belief is that the lack of sleep increases susceptibility to infectious disease. However, despite these age-old and widespread beliefs, surprisingly little empirical evidence supports the hypotheses that increased sleep aids recovery from, and lack of sleep increases susceptibility to, infections. Although research conducted over the last 30 years has clearly demonstrated that sleep is altered during the course of infection, few experiments have directly tested the functional impact of sleep on responses to immune challenge. We will review relevant literature documenting that sleep patterns do indeed change during states of infectious disease, discuss potential mediators of these alterations in behavior, and finally address the issue of whether sleep or sleep loss impacts the ability of the host to mount an appropriate immune response.

[BTox]

Quote:

Originally posted by Luciana Nery
So my doubt is - what are the mechanisms behind "rest", and why does it help your body to heal from virus infections and other illnesses?

I would think a significant part of the reason for this reco is to keep the person at home and reduce the risk of infecting others in the local population.

[BillyJoe]

I agree with Rolfe.

When you feel tired, ache all over, feel sick, are vomiting, can't breathe, you also feel like.....resting.
It doesn't actually help you recover from the illness.
On the other hand, if you have pneumonia and attempt to run a marathon in defiance of how you feel, you will probably die.
But you are not actually taking anything away from your immune system which will continue to do its work regardless.
I mean, with your immune system going full speed ahead, you could die all the same by stabbing yourself in the neck.

BillyJoe
(Don't quote me )

[Rolfe]

The amount of actual measurable energy needed by the immune system to work is negligible in the context of walking upstairs or even getting out of the chair.

This doesn't negate anything Steve posted (though I can't say I've digested it all) - sleep and the need for it isn't a well-understood thing, and immunosuppression is one of the things you see happening in sleep deprivation (?related to increased cortisol? no?). However, it's not nearly as simple as the immune system needing "energy".

Rolfe.

[Doubt]

Quote:

Originally posted by BillyJoe



It doesn't actually help you recover from the illness.


BillyJoe
(Don't quote me )

Quoting you anyway.

Why do you think rest does not help?

[BillyJoe]

Doubt
(Yeah, do that )

Quote:

Originally posted by Doubt
Quoting you anyway.

I asked you not to do that.

Quote:

Originally posted by Doubt
Why do you think rest does not help?

Personal experience......Yeah, I know, anecdotal, which is why I said not to quote me.

When you have an infection, you are forced to rest to some extent. I mean you are not physically able to run a marathon in the middle of a flu. Or maybe, if you were really fit, you could run one but just take a bit longer. This is still relative rest. But, does complete rest reduce recovery time? My personal impression is that it doesn't. And there are two bonuses from keeping on going: You keep earning and you are distracted from your illness. There's nothing worse than staying at home in bed feeling sorry for yourself. Also, you retain more of your fitness by remaining active, so your convalescence - return to normal function - should be faster.

Have there been any studies done to support this view? I don't know. So, as I said, don't quote me.

BillyJoe

[SteveGrenard]

An assistant just handed me a tear sheet from Tuesday (10-14-03)'s NY POST with the headline: FORGET THIS!

Sub-headline: "Doing nothing: the new workout"

Its about yet another "self-help" book which is by Drs. Peter Axt and Michaela Axt-Gadermann. (Germany)

It's called:

"The Joy of Laziness: Why Life is Better Slower and how to Get There"

It is hyped as a best seller in Europe and now, obviously, is hitting the U.S.

Their thesis is that over-activity and lack of rest is wasting energy with a higher metabolism. Also that when you are stressed hormones like cortisol and epinephrine (adrenalin) shorten your lifespan. Presumably they base their findings on neuroimmunology research
such as some examples posted above.

Was this book, per chance, the reason Luciana Nery asked about this or was it just a coincidence?


(There were rebuttals in the article by other doctors and researchers saying exercise is good for you.... yet another controversy looming?)

[Yahweh]

"Take 2 of these pills with milk every 4 hours, stay away from alcoholic beverages, and run plenty of laps."

[SteveGrenard]

Quote:

Originally posted by Yahweh
"Take 2 of these pills with milk every 4 hours, stay away from alcoholic beverages, and run plenty of laps."

And after the laps, take plenty of naps.