International Journal of Nutrition, Pharmacology, Neurological Diseases

: 2020  |  Volume : 10  |  Issue : 2  |  Page : 65--68

Sleep and Body Fluids

Sai Priya1, A.M. Mahalakshmi1, Sunanda Tuladhar2, Bipul Ray2, B.S. Sushmitha1, S. Shivashree1, B. Saravanan1, Muhammed Bishir1, Abid Bhat2, Saravana Babu C.2,  
1 Department of Pharmacology, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Mysuru, Karnataka, India
2 Department of Pharmacology, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Mysuru, Karnataka; Centre for Experimental Pharmacology and Toxicology, JSS Academy of Higher Education & Research, Mysuru, Karnataka, India

Correspondence Address:
Lecturer A.M. Mahalakshmi
Department of Pharmacology, JSS College of Pharmacy, S. S. Nagar, Mysuru-570015
Associate Professor Saravana Babu C.
Department of Pharmacology, JSS College of Pharmacy, Coordinator Central Animal Facility JSS Academy of Higher Education & Research, Mysuru-570015,


Sleep plays a crucial role in metabolic homeostasis thereby influencing health and well-being. It is closely related to the balance of energy and metabolism. Physiological, metabolic and environmental factors affect the length and quality of sleep. As the problem of sleep disturbance is pervasive and the disturbances in sleep are linked to metabolic changes in body fluids. Disturbance in sleep affects composition and physiology of body fluids. This review summarized to provide evidences on sleep disturbances and alterations in major body fluids.

How to cite this article:
Priya S, Mahalakshmi A, Tuladhar S, Ray B, Sushmitha B, Shivashree S, Saravanan B, Bishir M, Bhat A, Babu C. S. Sleep and Body Fluids.Int J Nutr Pharmacol Neurol Dis 2020;10:65-68

How to cite this URL:
Priya S, Mahalakshmi A, Tuladhar S, Ray B, Sushmitha B, Shivashree S, Saravanan B, Bishir M, Bhat A, Babu C. S. Sleep and Body Fluids. Int J Nutr Pharmacol Neurol Dis [serial online] 2020 [cited 2020 Jul 14 ];10:65-68
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Full Text


Sleep plays an important role in several biological functions such as rejuvenation of the body, energy homeostasis, survival along with vital functions such as neuronal formation, learning, memory, emotional regulation, cardiovascular and metabolic function, and in autophagy.[1] Sleep is an actively regulated process which is significantly moderated by homeostatic effects that accumulate during on-going wakefulness.[2] There are two states of sleep, non-rapid eye movement sleep (NREM) and rapid eye movement sleep (REM). NREM is classified into stages of four and every stage has unique characteristics including variations in brain wave patterns, eye movements, and muscle tone.[3] For healthy individuals appropriate sleep duration for adults is 7 to 9 hours and 7 to 8 hours for older population.[4] The natural sleep-wake cycle is adversely affected by the shifts in work schedules.[5]

Adequate sleep is important for health and wellbeing of an individual and sleep disturbances lead to a number of physical changes. It is well-known that there exists an established connection between sleep and hydration. All the body fluids contribute to maintain hydration. Sleep dehydrates the body through fluid loss (from breathing). While this is a normal physiological process, researchers have shown that the relationship between sleep and hydration is much more complicated and potentially more serious than expected.[6] A study involving 32 students, placed on fluid restriction showed that dehydration was associated with worse sleep quality and abnormal sleep heart rates.[7]

Based on the above postulations of relation between hydration and sleep, this review is an attempt to correlate to summarize the sleep disturbances with changes in metabolic as well as physiological body fluids. Information is drawn out of the review; we believe will pave the way to further experimental studies that can be directed towards establishing a concrete relationship.

Sleep and Hydration

A cross-sectional study has reported shorter sleep duration of 6 hrs per night associated decrease in hydration in USA and Chinese adult population, which was evident by concentrated urine measured as urine specific gravity and urine osmolality.[6] Another cross-sectional study has reported less consumption of fruits and vegetables in relatively short duration of sleep as shown with lower biomarkers such as total carotinoids, beta-carotene and lycopene. As fruits and vegetables are also prominent sources of hydration, decrease intake of these constituents would also decrease the hydration levels with shorter sleep duration.[8]


Twenty-four hours of SD in healthy subjects showed significant increase in white blood cell and neutrophil count. The Activated partial thromboplastin time, prothrombin time and thrombin time were reduced after SD.[9] Sleep restriction for 4 h on three consecutive nights increased WBC and neutrophil count in eight healthy volunteers, while no much deviation was observed in other blood parameters.[10] Increased WBC, monocytes, neutrophils, total cholesterol and low-density lipoprotein cholesterol (LDL-c) were seen in post-menopausal women with 4h of sleep restriction for three consecutive nights.[11] Long-term sleep restriction (4h for five nights) followed by recovery sleep for 7 days has resulted in significant increase in the circulating WBC subpopulation (Total WBCs, monocytes, neutrophils and lymphocytes) along with the disturbances in the diurnal rhythms. On recovery sleep monocytes and lymphocytes count was decreased but neutrophil level was elevated. These effects were attributed to altered diurnal rhythms of total WBC and neutrophils, which was found to be high during sleep and falls flattened during awakening.[12] A study reported beneficial effects of both small duration of sleep and a longer duration of recovery sleep after sleep restriction in terms of recovering the increased neutrophil count.[13] Immunoglobulins like IgG, IgA, IgM and complement C3 and C4 levels were found to be high in SD group thereby altering the serum humoral immunity.[14] A study on SD induced fatigue reported decreased serum albumin levels in the rats.[15] Reduced serum albumin was found in non-obese obstructive sleep apnoea patients thereby increasing the oxidative stress.[16] No significant difference in blood electrolytes and albumin levels between Soyang and Taeeum Korean population after 3 days of sleep restriction for 4h.[17] Shorter sleep duration of less than 7 hrs per day exhibits insufficient micronutrients specifically vitamin D and calcium in a cross-sectional study of National Health and Nutritional Examination Survey (NHANES) 2005-2016.[18]


SD in Trichinella spiralis a helminth parasite resulted in reduced immune response through decrease in Natural killer cells in mesenteric lymph nodes.[19] During challenges like infection, sleep promotes host defences, in the absence of such challenges sleep encourages inflammatory homeostasis like cytokines. Also decrease in the duration of sleep leads to chronic, systemic low-grade inflammation.[20] Chronic SD abnormally regulates MHC class II expression subsequently activating aberrant T cells further causing allergies, autoimmunity and other immune-related diseases.[21] Decreased number of dendritic cells in lymph nodes contributed to improper activation of tumor-specific T cells in sleep-restricted mice, along with decrease in the number of peripheral CD4+ and CD8+ T cells (De Lorenzo et al. 2018). Another study revealed that paradoxical SD for 72 h not only resulted in decreased T and B in circulation but also in the immune tissues like spleen.[22] Sleep restriction for 21 days decreased spleen weight, total leukocytes and lymphocytes in comparison to paradoxical SD for 96 h.[23]

Cerebrospinal fluid (CSF)

A randomized cross over study of paradoxical SD for 5 days with 4h of sleep per night resulted in 27% increase in CSF orexin concentrations.[24] Reports of Chen et al.[25] reported dysregulation in chronic insomnia induced CSF-A beta metabolism. Melanin-concentrating hormone was found to upregulate in CSF followed 96h of paradoxical SD.[26] A randomized clinical trial at Radboud Alzheimer Center, of total SD for 1 night resulted in elevated A-beta 42 levels in CSF indicating higher risks for Alzheimer’s disease.[27]

Lacrimal fluid

Sleep deprivation for 10 days induced decrease in aqueous tear secretion leading to dry eye in rats.[28] Dye eye with disturbed superficial corneal epithelial cells (SCEC) microvilli morphology was observed following sleep deprivation. The study also resulted with downregulation of PPAR-α, TRP6 and Ezrin phosphorylation in mice.[29] Increased tear osmolarity, reduced tear secretion and tear film break-up time (TBUT) was seen in healthy volunteers subjected to sleep deprivation.[30] Korean National Health and Nutrition Examination Survey (KNHANES) revealed increased dry eye syndrome with shorter sleep durations of less than 4 hrs per day.[31]


In type 2 diabetic patients decrease and increase in sleep duration was found to significantly elevate the albuminuria irrespective of the subject’s age, sex, duration of diabetics and other major confounders.[32] Clinical study in Japan showed increased risk of proteinuria in population with less than 5 hours of sleep duration, eventually developing risk for chronic kidney disease.[33] 72 h of sleep deprivation in six young men reported significant increase in urinary urea levels, while glucose and electrolytes levels were decreased indicates the sleep deprivation-induced metabolic disturbances.[34] A cross-sectional survey has reported higher glomerular filtration rate and microalbuminuria in population with shorter sleep duration of less than 5 h, which was explained by glomerular hyperfiltration leading to renal and cardiovascular risks.[35] Sleep disturbances and sleep diseases were associated with higher risk for chronic kidney diseases which was evident from increased glomerular filteration rate and proteinuria in Chinese cross-sectional study.[36] Acute sleep deprivation resulted in increased renal sodium excretion and diuresis, whereas vasopressin and renin-angiotensin-aldosterone system levels were found unchanged during SD.[37]


One night of sleep deprivation resulted in reduction of mean rectal and esophageal temperatures but there was no indication in altered rate of sweating.[38] Sleep-deprived subjects showed delay in achieving core temperature required for onset of sweating.[39] SD induced differences in thermoregulation were found to be less while SD decreased rate of sweating and increased dry heat loss.[40]


Sleep disturbances like acute and chronic SD/restriction is characterized by alterations in the composition of major body fluids. Increased WBC count specifically neutrophil counts in SD triggers inflammatory responses in turn activating immunoglobulins like IgG, IgA, IgM and complement C3 and C4 which finally leads to altered serum humoral immunity. Paradoxical SD increases T and B lymphocytes and alters lymphatic tissues like spleen functions. SD significantly raises β-amyloid levels in the CSF, which could be a high alert to cognitive deficits and Alzheimer’s like conditions. Dry eye is observed in many clinical studies following SD by reducing the lacrimal fluid secretion and circulation. SD also leads to increased urea levels and decreased electrolytes in urine content indicating SD also affects the metabolic fluids like urine in the body. In this review we have pooled evidences from many studies revealing the correlation between changes in sleep duration and body fluids. In debt molecular studies in larger population from elderly to midlife to younger adults is required to explore more information between sleep depth and body fluids.

Financial support and sponsorship

JSS AHER provided the financial support for article processing fee.

Conflicts of interest

There are no conflicts of interest


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