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The Dose Transcript for March 8, 2023

Host: Dr. Brian Goldman

STORIES FROM THIS EPISODE

BRIAN GOLDMAN: Hi, I'm Dr. Brian Goldman. Welcome to The Dose, if you're like me, changing the clocks for daylight Saving time messes with your sleep schedule. Right after the time change. I'm less sharp mentally and a bit cranky. But there are things we can do to make the transition smoother. So this week we're asking: How can I sleep better around daylight Saving time? Hi, Elliot. Welcome back to The Dose.

ELLIOT LEE: Hi. Thanks for having me, Brian.

BRIAN GOLDMAN: So how much do you dread the clock change?

ELLIOT LEE: Personally, I'm not too bad, but I know other people really suffer. Different people have different sensitivities to it, but I just try to tough it out for a couple of days. And then usually for myself personally, I'm okay. But it can be difficult for a lot of people for sure.

BRIAN GOLDMAN: And that's why we wanted to have you back on the show. So before we begin, can you give us a Hi, my name is tell us what you do and where you do it. Just ad lib.

ELLIOT LEE: Hi, my name is Elliot Lee. I am the medical director of the Sleep Disorders Clinic at the Royal Ottawa Mental Health Center. We deal in sleep disorders, including sleep apnea, insomnia, restless leg syndrome, and other neurological and psychiatric issues as they affect sleep.

BRIAN GOLDMAN: No question. Daylight Saving Time affects the quality of our sleep. How does it do that?

ELLIOT LEE: Well, what happens with Daylight Savings Time is we get more light exposure in the evenings and more darkness in the morning. So fundamentally that will actually shift our circadian rhythm and so accelerate any kind of misalignment of our sleep to our circadian rhythm that contributes overall to sleep deprivation and a a misalignment of sleep to our circadian rhythm, sometimes called social jetlag. And so over time, that can have various consequences. In large groups of people, we see a higher risk of cardiovascular morbidity, more E.R. visits, higher traffic accidents, even missed medical appointments because people are just not used to having that that loss of that hour when we spring forward.

BRIAN GOLDMAN: We're going to get into that in just a moment. But I'm kind of stunned to hear you talk about this as as as something that could be more persistent. How long is our sleep usually affected by the time change?

ELLIOT LEE: So for most people, they can overcome that over a few days. But for some people, it can take several weeks even to overcome that time change. And that can cause considerable problems in that time period for which people are trying to overcome that time change. But it's a very subtle and insidious problem for for people.

BRIAN GOLDMAN: I happen to have a big problem with sleep. I've suffered from insomnia for four decades. Is it worse? Is the switch to daylight saving time worse for people like me?

ELLIOT LEE: Well, ironically, for people with insomnia, it's actually the other time change that often is a little bit worse because when you when you spring forward, you actually lose time that you have to stay awake at night. So you actually can jump into your day a little bit more quickly. So sometimes for people insomnia, it's actually a little bit better for the daylight savings, but the standard time or falling backwards, that sometimes bothers people more because they have to they have to spend another hour awake at nighttime. But it really depends on what kind of problems people have for for the majority of people who are generally sleep deprived to start out with and already a little bit misaligned, the daylight savings can really make that misalignment worse.

BRIAN GOLDMAN: You know, we tend to think of insomnia as a highly individual problem. You know, some people can be having a lot of trouble sleeping when everybody else around them is sleeping just fine. But the switch to DST is a mass event. So to what extent is that switch a mass sleep depriving event affecting most everyone?

ELLIOT LEE: Well, there are multiple studies showing that this really affects a lot of people. And from a systemic point of view, we see a lot of different problems arise with the shift to daylight savings. In particular, there's a higher risk of cardiovascular morbidity and mortality, higher incidence of stroke and heart attacks, more E.R. visits. During that time, more traffic accidents even missed medical appointments because people are just aren't used to that and generally are not only sleep deprived in that time, but also suffering from a misalignment of their sleep to their other daily rhythms.

BRIAN GOLDMAN: Is that is it the misalignment per say, or is it the extra hour of morning darkness that's that's causing some of these effects?

ELLIOT LEE: So it's not really entirely clear. Truthfully, it's probably a little bit of both. So we know that for sleep to be restorative and to do whatever it is it's supposed to do, you need three things to happen. You need a good quantity of sleep. And so this is affected by daylight savings because, you know, people are generally dropping an hour of their sleep unless they prepare ahead of time. But it's also the quality of sleep that suffers with that misalignment, because if the timing of sleep is not aligned with our own circadian rhythms, then both the quality and the quantity suffer. So but disentangling those is actually a complicated process.

BRIAN GOLDMAN: And I gather that there are a number of hormones, chemicals, neurochemicals and body chemicals that have to kick in when you wake up in the morning. So effectively, if if it's later than then your body thinks it is, it's not ready to start the day. Have I got it right?

ELLIOT LEE: That's pretty much right. The main one that we do, we depend on to kind of start our day is cortisol. So right in the morning when we wake up, we all have kind of a cortisol surge that helps us to be most alert first thing in the morning and then it kind of dies down. But then most of our circadian rhythms for the day are centered around that wake up time. That's partly why the wake up time is the most important thing to in train or align our circadian rhythm to keep it intact. And probably why the daylight savings or any kind of shift like that is associated with a lot of excess inflammation and stress on the cardiovascular system.

BRIAN GOLDMAN: So those are some of the reasons why there might be an increased rate of heart attack. In strokes, and I have certainly seen that as an emergency physician. What about the connection between the switch to daylight saving time and traffic accidents?

ELLIOT LEE: So that's quite interesting. It's not really clear whether the traffic accidents are related to people just not sleeping enough because they lose that hour of sleep. But it's also probably influenced by the misalignment of the circadian cycle to the regular sleep rhythm. So again, people, we know that when quantity and quality of sleep suffer, cognitive processes, including reaction time, also suffer as well. So this is probably why there's just a higher risk of accidents in the day. We see this all the time with shift work, you know, for for residents when they're not sleeping at the right time relative to their own internal clock. Oh, there are some tragic consequences that can occur for residents on call. Now, their misalignment is obviously much worse than what would happen in daylight savings, but the concept is still, still there.

BRIAN GOLDMAN: And we've been talking about what happens in the morning with the extra hour of darkness and not being ready to start the day. Your body's not ready to start the day when when the light cues are telling us we're supposed to start. What about at the other end? What's the impact of that one hour longer of evening light.

ELLIOT LEE: So that extra hour of sleep, evening light will actually serve to slightly delay the circadian rhythm and make it a little bit harder to fall asleep at night. So again, it's just making the misalignment worse between the sleep cycle and our other bodily rhythms, which are normally under a very tight circadian control, particularly body temperature, but also several hormones like cortisol that we also talked about.

BRIAN GOLDMAN: So given everything we've talked about so far, what are some of the ways that we might be able to prepare in advance for the time change?

ELLIOT LEE: So I think the first thing to do is to be aware of when the time change is occurring and start our preparations two or three days ahead of the time change. So ideally it would be ideal to advance the bedtime by 15 to 20 minutes every day for two or three days before the time change, so that by the time the time change occurs, the person is already adjusted to the new sleep schedule and then adjust all the other things that normally in train or circadian rhythm to our sleep rhythms. So the time we eat, even our work activities, if people have kids, for example, the time that they have their nap, just doing the same thing, advancing everything by 15 or 20 minutes for two or three days leading up to the time change, those things can be helpful. And then when the time change occurs, trying not to do too many important things right after the time change. So don't schedule important activities because people are generally just still tired or not functioning at their optimal level, especially in the first two or three days after the time change. So trying to make if you have that luxury, trying to make work a little bit easier, not scheduling a heavy workday, you know, right after the time change occurs.

BRIAN GOLDMAN: You talked about sleep hygiene. You just mentioned that. Can you define what we mean by that and how it can help our bodies deal with the time change?

ELLIOT LEE: So sleep hygiene fundamentally is just habits that we can do to train ourselves to be a better sleeper. One of the first things we recommend is really having a good wind down routine. Everybody needs a lower lowered arousal to to facilitate sleep onset and maintenance. So we really need to disassociate ourselves from the things of the day that can make us stressed. So really get away from work from other obligations for at least an hour, preferably 2 hours before the sleep time to kind of wind down and get into sleep and then really to associate the bed only with sleep and not to do other activities that we would normally associate with wakefulness. So not doing a lot of work in bed or watching TV in bed, and especially the backlit screens, not only is there a physiologic arousal from the light, from the screens that can shift the circadian rhythms and suppress the production of melatonin that we normally need, but also the psychological arousal that can come from those devices? The the content that we're watching that often is very engaging and then difficult to dissociate from. And similarly, we also have to look at our daytime activity as well, try to exercise, especially early in the morning would be better. And it helps to in train or circadian rhythm, try not to nap too long, especially in the day. And then basically you're doing other avoiding other things that are toxic to our sleep, like alcohol and caffeine and things like this.

BRIAN GOLDMAN: So so you've mentioned naps and I want to jump on that for a second. What what's the optimal time for a nap? What's too much and what's the best time of day to nap if you feel like you need to because a lot of people will be sleep deprived.

ELLIOT LEE: Yeah, everybody's a little bit different. So naps can actually be helpful for people as long as they're used judiciously and carefully. So for most people, usually a half hour nap is probably the optimal time to a nap. Once people start to get to an hour or two, it actually can sabotage the sleep that night. And by that time, people often develop something called a sleep inertia because they get into too much deep sleep. It can actually make it difficult to to awaken from the nap. And so usually for the first half hour or an hour after that kind of long nap, people will actually be a little bit groggy and be impaired. But a half hour for most people is usually provides enough energy and restorative power for sleep to actually carry one throughout the the remaining parts of the day. The optimal time from a circadian point of view to nap usually is somewhere between 2 and 6 p.m.. That's where we typically have our highest propensity for sleep. Napping too late will impair usually the sleep onset or maintenance of the following night. Too early. It's actually too hard to nap. The worst time to actually nap is sometime between 6 and 9 p.m.. So there's actually a sort of a second wind that most people get. That makes it actually very difficult to nap in that time.

BRIAN GOLDMAN: You mentioned parents of infants and young children a while back and what to do about them. Would you say that infants and children find it more difficult to adapt to Daylight Saving Time?

ELLIOT LEE: I think as a general group, yes, because infants and toddlers, they they really need a strong rhythm to and train their sleep because they don't have the usual biological devices that adults have to kind of tolerate different changes in their sleep patterns. So they benefit much more than adults from sort of a regular sleep schedule and regular predictable schedule. So they suffer a lot more when that schedule is misaligned, you know, through forces that are beyond their their control. I think one of the funniest things I heard because people don't always recognize, as one of my colleagues said when they were having their first baby, well, I don't know why people have problems with their sleep, because when we have our baby there, that baby is going to sleep on our schedule, not the other way around. Like nothing could make me laugh more. And because they have their own rhythm and we just have to do our best to kind of accommodate that rhythm for for kids. And only later, when you get older can you maybe shift it a little bit.

BRIAN GOLDMAN: So how important is it for parents of of young kids, preschoolers, infants, who to to get them outside in the morning light to try to synchronize to synchronize their they're their circadian rhythms around the new schedule.

ELLIOT LEE: So it's really ideal, if possible. Obviously, it's much harder when in for example, the the winter months where, you know, there's, you know, not as much light outside as long as it's not too cold. It's probably the single biggest thing that we can do to help keep the circadian rhythm intact for for kids is to get them that morning light exposure, particularly outside.

BRIAN GOLDMAN: You know, there are lots of over-the-counter sleep aids. Are any of them helpful with people in adjusting to the time change?

ELLIOT LEE: Probably the only aid that has a chance of helping people for adjusting to the time change is melatonin. So that's a hormone that's normally produced in our brain in response to darkness, but it also has some chronobiotic activity. So it can actually help shift our sleep cycle if properly timed and dosed. But that's that's the key. If people take the wrong dose or at the wrong time, it actually does nothing or sometimes can even make things worse. But taken at the right time. And the timing for the window is very narrow. For some people it's only like an hour wide, but at a small dose it can actually help accelerate the adjustment to the time change so people can use us, for example, for adjusting to like jet lag. But the timing and the the dose, it's very important actually, and sometimes overlooked when people try to use this.

BRIAN GOLDMAN: What is the ideal time to take melatonin to switch to during the switch to Daylight Saving time?

ELLIOT LEE: So it really depends on one's own circadian rhythm that will actually determine the timing. I would say as a general rule, especially if they have some delayed sleep phase tendencies to begin with, if they have a little bit of an evening preference or a little bit of a a night owl tendency, probably one or three milligrams at 7 p.m. is just sort of a rough guess, might be most helpful, but it's usually sometime between 7 and 9 p.m.. But everybody has to sort of experiment a little bit with their own circadian rhythm, but taken at that time, it can help accelerate the adjustment to daylight savings in the right person. But everybody be a little bit different. Start to worry about potential for side effects. It can be a little sedating. Sometimes it can cause some disturbing dreams, so sometimes there can be some certain drug drug interactions. So if there's any problems, it's important to talk with the physician about their use of melatonin under those circumstances.

BRIAN GOLDMAN: You mentioned the importance of the quality of sleep as one of three things that that we need to pay attention to. So while we have you here, I want to ask you all a little bit more general question about sleep. A new study came out last month suggesting that the quality of sleep or quality sleep can add years to your life. So what defines quality sleep?

ELLIOT LEE: So there's a certain sleep architecture that occurs when we sleep. One of my mentors referred to this as like a symphony, you know? So even if the quantity is good, if the quality is not good, then the quantity doesn't doesn't matter. And so each night of sleep has a certain sleep architecture or a fingerprint, if you will. There's typically more deep sleep in the first half of the night, more REM sleep in the second half of the night, and we cycle in and out of REM sleep throughout the night. And so that fingerprint or signature is what really defines a good quality of sleep for for most people. And again, if that quality suffers, then the quantity doesn't matter. So the way I like to think about this is like trying to study for an exam. You know, if I give people an exam, and say, Here's the book you need to read and here's the exam. I'll put you in a quiet room for 8 hours. That's like the total sleep time. Chances are, if they're properly motivated, they'll do quite well. They have the book and they have 8 hours of study in that room, But I can give them the same room, the same book. But I go into the room during the 8 hours every 5 minutes. I just ask them like, How do you spell your name and where was your mother born and what city are you from? And just all, you know, silly, innocent questions. But I do that the whole 8 hours. Then how are they going to do on the exam? You know, just probably not as well as if I left them there quietly, but I gave them the right time. I give them the right book, I give them the quantity, but I did not give them the quality.

BRIAN GOLDMAN: So is the equivalent of of of what you just talked about in that in that kind of jocular experiment of of interrupting students with, with trivial comments over an eight hour period like on a repeated basis is that is the equivalent to that when we're talking about sleep somebody waking up multiple times a night?

ELLIOT LEE: Pretty much, yeah. So just imagine listening to a symphony, you know, it's a beautiful music, but how good is that experience if you keep getting static, you know, or something just in the middle of it and getting it five or ten times like really compromises experience of the symphony. And so, you know, the quality is really important as well as the quantity. And both quality and quantity suffer if the timing is also off as well.

BRIAN GOLDMAN: So is there anything that we can do to improve sleep quality?

ELLIOT LEE: So it depends on really what the problem is for the quality. So, you know, if people are doing the regular sleep habits, you know that it's always in the media, you know, having a regular sleep and wake time trying to avoid things that are toxic to sleep like backlit screens, alcohol, cannabis, caffeine, trying to disassociate the bed from wakeful behaviors like, you know, not doing work in the bed and things like this and not napping in the day. And there's still a problem with the quality or quantity of sleep probably by that time, especially if people are seeing an impairment in their daytime functioning or their job or relationships or irritability or mood or anxiety disturbances, by that time, it's probably good to consult a health care professional about maybe having sleep assessed more carefully, perhaps by a sleep specialist, to rule out other sleep disorders, which sometimes can be very insidious, like sleep apnea or other neurological problems, like something called periodic limb movement disorder, where people twitch at night or sometimes people just do very strange things at night that interrupt their sleep, but usually they're not aware of it. And so this is where the sleep study or the Polysomnography study can be very important and helpful.

BRIAN GOLDMAN: Last question I wanted to ask you, what's your best piece of advice for people who are struggling to get those three things that you talked about that are so important the quantity, the quality and the timing of sleep?

ELLIOT LEE: Oh, my best piece of advice, There's so many things I can think of in terms of behaviors, ideally getting outside in some capacity to make sure that sunlight enters our eyes because our whole circadian rhythm is actually entrained or centered around that light exposure that we get in the morning and that that will entrain the rest of our circadian rhythms for the whole day. So a light first thing in the morning, ideally outside if possible, where we get the most exposure to light would be perhaps my best single tip for entraining our own circadian rhythm to align our sleep with our own biological rhythms.

BRIAN GOLDMAN: Dr. Elliot Lee, lots of great tips and advice. Thank you so much for speaking with us once again on the dose.

ELLIOT LEE: It's been my pleasure. Thank you for having me, Brian.

BRIAN GOLDMAN: Dr. Elliot Lee is the medical director of the Sleep Disorders Clinic at the Royal Ottawa Mental Health Center. Here's your dose of smart advice. Don't take the switch to Daylight Saving Time lightly. Changing your exposure to sunlight throws off your body's circadian rhythm. The internal clock that helps control your sleep. Although the clock shifts only one hour at a time, this abrupt time change can cause significant sleep disruption and sleep deprivation in ways that affect thinking, decision making and productivity. The switch to daylight Saving time is associated with a short term risk of heart attacks, stroke traffic accidents, emergency room visits and mood disturbances. Here are some ways that you can lessen the impact. First, in the weeks prior to the switch, try to get the best sleep you can so you're not sleep deprived to begin with. Second, get a head start on adjusting to DST by gradually shifting your sleep wake cycle in the week before the switch. Go to bed 10 to 20 minutes earlier each day and adjust meal and exercise times accordingly. Don't wait till 2 a.m. to reset your clocks. Get a jump on Daylight Saving time by switching clocks the day prior to the switch. Since daylight is the main driver of your circadian rhythm, get as much sunlight as you can during the days following the switch. If you have young children, adjust their bedtime routine and make sure they get outside in the morning hours. Following the time change to get exposed to the natural light. If you get irritable around the clock change, try relaxation techniques like deep breathing mindfulness and meditation, not to mention exercise. In the days following the switch. Don't overload your workday. Schedule important meetings or events later in the week when you've had more time to adjust and avoid long drives right after the time change. For daytime sleepiness, take a short nap under 30 minutes. Only the best time to nap without disrupting nighttime sleep is early in the afternoon. And don't forget to make your sleep routine healthier by avoiding caffeine and alcohol, especially in the afternoon and evening, and by staying off your devices at least 30 minutes before bed. If you have topics you'd like discussed or questions answered, our email address is the dose at CBC UK. If you like this episode, please give us a rating and review wherever you listen. This edition of the Dose was produced by Stephanie Dubois and Isabelle Gallant. Our senior producer is Colleen Ross. The dose wants you to be better informed about your health. If you're looking for medical advice, see your health care provider. I'm Dr. Brian Goldman. Until your next dose.

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How can I sleep better around Daylight Saving Time?- Transcript

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