Sleep 101
Snooze or Lose: How to Outsmart the Seasonal Blues

Autumn is approaching fast! And while the changing leaves and cooler temperatures can be delightful news for our overheated nights, the Fall Equinox can bring about more than just a change in the weather. 

For many, this time of year marks the onset of Seasonal Affective Disorder (SAD), a.k.a. Seasonal Depression, a type of depression that usually occurs in the fall and winter months in large part due to the progressive reduction of exposure to sunlight. SAD can present a wide variety of symptoms; in this Blog Article, we’ll focus on its impact on sleep, and how quality sleep can help counteract its effects.

 

What is Seasonal Affective Disorder?

Seasonal Affective Disorder (SAD) is a form of depression that is often misdiagnosed or ignored due to its inconstant nature. According to a study conducted in the U.K., SAD presented itself in 2.4% of the population during key times of seasonal transition [1]. However, its prevalence can depend heavily on latitude, with rates increasing to as high as 16% in areas with extreme seasonal changes [2]. It is unclear what and how the exact causes of SAD may interact, but the medical community is aligned on the fact that it is heavily dependent on:

  • Circadian Rhythm Disruption: mainly due to the progressive transition into shorter and shorter days with less and less daylight.
  • Melatonin Levels Imbalance: this comes as a direct consequence of Circadian Rhythm disruption and consequent disorientation in our body’s capacity to adapt to new daylight conditions.
  • Serotonin Levels Imbalance: Serotonin is a neurotransmitter that is mainly concerned with mood regulation; its levels tend to decrease in correspondence with the onset of SAD [3].

SAD is notorious for its recurrent nature, but the predictability of its onset too often brings people to believe that it is just an occasional problem, a “case of the blues” as popularly labeled. As it turns out, however, longitudinal data (i.e. data that is taken across a period of time) suggests that it spontaneously goes into remission in only 27% of cases [2]. 

Furthermore, a study conducted in German-speaking countries found that up to 80% of those diagnosed with SAD can face a recurrent depressive episode the following fall/winter [4]. This cyclical pattern is the very reason why it is crucial to understand and manage the disorder effectively.

One of the most profound ways SAD manifests is through changes in sleep patterns. Individuals with Seasonal Depression often experience increased sleep duration and difficulty waking up and getting active in the morning. 

These symptoms are largely due to the body's response to reduced daylight, which can disrupt circadian rhythms and melatonin production. These disruptions can lead to a chemical imbalance in the brain, exacerbating existing mental health conditions or triggering other issues, thus entering a vicious cycle that is very hard to put in disarray.

How To Fight It!

Maximize Daylight Exposure

One of the most recommended lifestyle changes for managing SAD is optimizing your exposure to natural daylight. Here are some practical tips:

  • Morning Sunlight: Try to spend at least 30 minutes outside before starting your workday.
  • Work Environment: Position yourself near a window to benefit from natural light.
  • Afternoon Breaks: Take a 15-30 minute walk outside in the afternoon.

Maintain a Regular Sleep-Wake Cycle

Keeping a consistent sleep schedule can help regulate your circadian rhythms. Aim to go to bed and wake up at the same time every day. Especially during the weekends, when you have more opportunities to enjoy some direct exposure to daylight, it is fundamental to make the effort and not sleep in, as we would be wasting precious moments of daylight by doing so, further destabilizing our circadian and biological clocks.

Limit Screen Time Before Bed

As discussed in our past articles (see “Prioritizing the Power of Sleep: 6 Steps Towards a Better You”), the blue light emitted by screens can interfere with melatonin production. Avoid prolonged screen time at least 1 hour before bedtime.

Light Therapy

Light Therapy can be deeply beneficial in counteracting circadian rhythm disruptions. According to a 2014/15 study, 72% of institutions treating SAD recommended Light Therapy [4]. Here’s how it works:

  • Intensity: Light Therapy uses exposure to high-intensity light, generally ranging from 2,500 to 10,000 lux.
  • Duration: Typically, light therapy sessions last 30 to 60 minutes every day, shortly after waking.
  • Method: Patients face the light but can engage in other activities, such as reading or exercising, during therapy.

Light Therapy is considered very low risk (the bright midday sun is equivalent to about 50,000 to 100,000 lux of light) and it can be implemented by purchasing specialized lamps that are commercially available. Dawn Simulation, an alternative to Light Therapy, uses a weaker light gradually applied at the end of the sleep cycle [5].

A 2005 meta-analysis of eight randomized controlled trials (RCTs) involving 228 patients demonstrated that Light Therapy and Dawn Simulation are effective treatments for SAD with effect size of 0.84, very similar to that of Antidepressant Therapy [6]. Furthermore, a recent meta-analysis of 19 studies including 610 patients showed that bright light therapy was effective compared to a placebo, significantly improving depression scores [7].

 

Conclusion

While it is often misdiagnosed or ignored, understanding the symptoms of Seasonal Depression and implementing strategies to manage it can make a world of difference. Maximizing daylight exposure, maintaining a regular sleep-wake cycle, limiting screen time before bed, and considering light therapy are all effective ways to combat the symptoms of SAD.

Remember, quality sleep and proper daylight exposure are crucial in maintaining mental well-being during the darker months. By taking proactive steps, you can mitigate the effects of Seasonal Depression and enjoy a healthier, happier winter season.

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References:

  • [1] Michalak, E E et al. “Seasonal affective disorder: prevalence, detection and current treatment in North Wales.” The British journal of psychiatry : the journal of mental science vol. 179, 2001: 31-4. doi:10.1192/bjp.179.1.31
  • [2] Freed, M.C., Osborn, R.L., Rohan, K.J. “Estimating the Disease Burden of Seasonal Affective Disorder”. Handbook of Disease Burdens and Quality of Life Measures. 2010. Springer, New York, NY. https://doi.org/10.1007/978-0-387-78665-0_90
  • [3]https://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/symptoms-causes/syc-20364651
  • [4] Nussbaumer-Streit, B et al. “Prevention of seasonal affective disorder in daily clinical practice: results of a survey in German-speaking countries.” BMC psychiatry vol. 17,1 247. 11 Jul. 2017, doi:10.1186/s12888-017-1403-2
  • [5] Lam RW, Levitt AJ, eds. “Canadian consensus guidelines for the treatment of seasonal affective disorder”. 1999. Accessed March 17, 2020. https://med-fom-ubcsad.sites.olt.ubc.ca/files/2013/11/CCG-SAD-1999.pdf
  • [6] Golden RN, Gaynes BN, Ekstrom RD, et al. “The efficacy of light therapy in the treatment of mood disorders: a review and meta-analysis of the evidence”. Am J Psychiatry. 2005;162(4):656-662.
  • [7] Pjrek E, Friedrich ME, Cambioli L, et al. The efficacy of light therapy in the treatment of seasonal affective disorder: a meta-analysis of randomized controlled trials. Psychother Psychosom. 2020;89(1):17-24.

 

Any questions or comments, drop a note to the DEEPS Blog Team on the Contact Us page.

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