To protect ourselves during the coronavirus outbreak, many of us are relying on handwashing and sanitizing during the day. But what about at night? Many people may not realize that we are also susceptible to infection during sleep. Below, we explain how this happens and what you can do to protect yourself.

Why Are You Vulnerable to Coronavirus Infection When Sleeping?

You can become exposed to viruses during sleep due to pulmonary aspiration, which occurs when you inhale a foreign substance and it accidentally enters the windpipe or lungs rather than the esophagus. When you cough because something “went down the wrong pipe,” you have experienced pulmonary aspiration.

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Aspiration on saliva during sleep is fairly common. Because the muscles of the throat are relaxed, you may choke or gag on your saliva while sleeping—causing you to wake up gasping for air or unable to breathe. For those who suffer from acid reflux, sleep apnea, allergies, respiratory issues, or are under the influence of a sedative, nighttime aspiration is even more prevalent.

In a recent op-ed for CNN, Dr. Bruce L. Davidson notes, “coronavirus infects cells below the voice box, in the airways and deep in the lungs, unlike flu viruses which start in your nose and throat.” He goes to point out that aspiration during sleep allows fluid in the nose containing coronavirus to get past your voice box and enter your windpipe or trachea.

For healthy individuals, their system will transport aspirated viruses to the esophagus, where it is digested and broken down with saliva. Additionally, healthy people house safe bacteria in the nose and throat that work to neutralize viruses when they enter the body. Healthy lungs also contain cells that kill viruses when they arrive. Therefore, healthy people who take in only a small amount of the virus are likely to experience little to no symptoms of infection.

However, damaged lungs will transfer more aspirated throat contents to the lungs than usual, increasing the number of viruses that can get through. Those with impaired lung function, chronic asthma, or a compromised immune system are more likely to experience symptoms even when a small number of viruses enter the body.

How Can You Protect Yourself During Sleep?

It’s important to eliminate any presence of the virus on the face before bed—this will reduce the likelihood of coronavirus entering the body during aspiration. Dr. Davidson suggests including the following steps in your nightly routine to ensure no viruses are present.

Wash Hands and Face Before Bed

Just like you would during the day, wash your hands with warm water and soap for at least 20 seconds before bed. To remove any trace of the virus that may be around the nose and throat—you should also wash your face with soap and warm water.

Clean Nostrils

While washing your face, wash just inside each nostril, about a quarter-inch inside. You can do this by using warm water and soap on the tip of your finger, then gently blowing your nose. However, Davidson advises against the use of irrigation devices, such as Neti pots. These devices can force the virus further into the nasal passage.

Brush Your Teeth and Tongue

Before bed, be sure to brush your teeth and tongue and also swish, gargle, and rinse with an antiseptic mouthwash. The mouthwash will ensure no germs remain in the mouth or throat.

Avoid Sedatives Before Bed

As we mentioned above, sedatives and depressants can promote aspiration and increase the likelihood of taking in the virus as you sleep.

Disinfect Sleep Apnea Machines and Other Sleep Aids

If you use a sleep apnea machine or other sleep aids that come into contact with your face, be sure to clean it regularly and ensure it’s protected from people who may cough, sneeze, or breathe on it.

Adjust Your Mattress and Bedding

In addition to Dr. Davidson’s suggestions, adjusting your mattress and bedding can also help protect you during sleep. If you suffer from allergies, acid reflux, sleep apnea, or respiratory issues, finding a healthier sleep position can decrease the occurrence of nighttime aspiration and the likelihood of taking in the virus. Additionally, sleep is a powerful immune booster. As we work to protect ourselves against the spread of the coronavirus, a robust immune system is vital. To ensure your immune system is benefiting from deep, restorative sleep, our tips below can help you find a comfortable, healthy sleep position.

Use an Adjustable Mattress Foundation

Adjustable foundations used to be exclusive to hospital rooms, as they provided relief from certain conditions and more comfortable sleep. Now, you can receive these same types of benefits at home. Although modern adjustable beds are more high-tech, they offer sleepers the same comfortable sleep position and health benefits as hospital beds

Most adjustable bases feature head and leg articulation—this is the slight raising and lowering of the upper and lower portion of the bed. Sleeping with an elevated head can open airways and make breathing easier—reducing snoring and symptoms of sleep apnea.

Resident sleep expert, April Mayer, notes, “when the angle of the head is raised by 20 to 30 degrees, it prevents the collapse of the trachea, so both air and saliva flow freely. This unique feature can help prevent aspiration due to snoring, sleep apnea, or other respiration problems.”

A slight elevation in the legs can promote blood flow. If you suffer from cardiovascular issues, the increase in blood flow can help improve function. The raising of the knees can also reduce pressure on the lumbar disc—reducing back pain, sciatic nerve pain, and allowing you to sleep more soundly.

Many adjustable beds include convenient features such as built-in massagers, under-bed lighting, wireless controls, anti-snore buttons, and pillow tilting. While the head articulation is excellent for opening airways when sleeping, pillow titling helps support your head and neck even when you are sitting up in bed.

Rest on a Supportive Pillow

If you don’t have an adjustable foundation, you can receive similar benefits by using a wedge pillow. As we mentioned above, an elevated head can encourage saliva to flow—reducing the occurrence of aspiration. These pillows come in a variety of sizes, but offer sleepers a slight lift that can aid in breathing, digestion, and blood circulation.

Sleep on Hypoallergenic Materials

If you’re prone to allergies, it is best to opt for a mattress made with hypoallergenic and eco-friendly materials. Traditional mattresses, such as innerspring beds, tend to collect dust mites and dirt between the spring coils. These particles can increase allergy symptoms and congestion. When there is a build-up of nasal congestion, you are more likely to aspirate during sleep—allowing for viruses to enter your windpipe.

Instead, opt for a hypoallergenic mattress. Since latex and memory foam mattresses are so dense, this is no space for dust and dirt to collect. Plant-based memory foam and latex foam also wick heat and moisture away from the body, reducing the chances of attracting bed bugs. Latex foam is also naturally antimicrobial and antibacterial, so it is difficult for mold or bacteria to form in these beds. Therefore, both memory and latex foam beds can help alleviate allergy symptoms.

Mattresses and bedding made without eco-friendly materials can also house toxins and harmful VOCs (Volatile Organic Compounds) that can interfere with breathing. It is best to sleep on a more natural mattress that features plant-based memory foam or organic latex foam. These foams are cleaner, non-toxic, and will have minimal VOC emissions.

For bedding, cotton and Tencel® sheets will help create a soft, breathable sleep surface so you can rest comfortably. Tencel® is a highly sustainable material grown without the use of pesticides. When purchasing cotton sheets, it is best to opt for organic since traditional cotton is sometimes sprayed with harmful pesticides.

Elevating the head to open up airways and opting for a safe, non-toxic bed will go a long way in preventing nighttime respiration issues and helping you find the deep sleep you need. It is essential to keep our immune systems healthy and get proper sleep as we protect ourselves against this virus.

Other Steps to Reduce Infection

Getting good sleep and preventing aspiration is just one piece of the puzzle. In addition to the nighttime routine outlined above, it is also important to follow the CDC’s recommendations for reducing exposure to the virus.

Keep Your Hands Clean

The CDC recommends washing your hands frequently. Especially when handling food, before eating food, when caring for someone who is sick, after blowing your nose, coaching, or sneezing, and when returning home. They suggest using warm water and soap and lathering hands for at least 20 seconds before rising—this is the equivalent of singing the “Happy Birthday” song twice. Be sure to scrub the back of your hands, between your fingers and underneath nails.

If you’re not near a sink, they suggest using hand sanitizer with at least 60 percent isopropyl alcohol. Place the gel on the palm of your hand and rub your hands together until dry—this should take about 20 seconds.

Avoid Touching Your Face

Even if your hands are clean and disinfected, it is a good practice to avoid touching your face at all times. Trace amounts of the virus could linger, so it is best to keep your hands away from the face and avoid touching your eyes, nose, or mouth.

Practice Social Distancing

Social distancing is often a big sacrifice for many Americans. We enjoy eating out with friends, going to the gym, and getting together with loved ones. But right now, we are working to protect an entire community, not just ourselves. Though severe symptoms are less likely in those under 65, they are not unheard of. The evidence we have suggests everyone is affected by this virus. Since many of us also have older loved ones who are more vulnerable, we have to do our best to keep our distance from one another and help control the spread.

Clean and Disinfect Common Areas

In your home or your workplace, commonly touched areas must be cleaned with disinfectant each day. These areas include countertops, light switches, door handles, sinks, and toilets. Even when staying home, this is still an essential task because we could bring the virus inside with us.

Overall, the goal is to avoid exposing your lungs to the virus as much as possible. Since we are vulnerable during sleep, we must take steps to remove any potential threats from ourselves and our sleep surface before bed. To ensure a good night’s sleep and reduce aspiration, an elevated can also help. As you work to ward off infections, a healthy defense system, proper rest, and good hygiene are more important than ever.

This article is for informational purposes and should not replace advice from your doctor or other medical professional.