Every year, around daylight saving time, I often see a peak of sleep problems from my patients. I had a great conversation with Dr. Neikrug. He is an assistant clinical professor from the School of Medicine, UC Irvine, and he will share with us his knowledge and suggestions

 Dr.Yishan Xu 00:29

Hi, Dr. Neikrug, welcome to the Deep into Sleep podcast. 

Dr. Ariel Neikrug 00:33

Well, thank you very, very, very much for having me over here. And I'm delighted to be here. 

Dr.Yishan Xu 00:38 

I'm really excited to have you. I know you have done a lot of great research work and clinical work in the sleep field. So I want to ask you, daylight saving, it's right coming up. And a lot of people I have noticed feel very uncomfortable, right after or even weeks after the time change. Is that normal? 

Dr. Ariel Neikrug 01:01

You bring up a great point, I mean, twice a year, we have a situation in which we have this daytime saving. What it does, it really changes our social clock. And independent of the light clock of the real clock, right. So we're just changing the social clock. And basically what happens is we move it on the second Sunday in March we get we move it a little one hour later. And then in November, I think it's the first Sunday in November, and the clock moves about back one hour. As a result of this. It's extremely common to hear individuals reporting a great deal of dysfunction after. But it's more than just reporting, right? I mean, sleep problems can come the few days, and the days are the few days after. But we also have much more than just sleep. We have occurrences of injuries at work, car accidents, heart attacks, that are much more common after these changes. And this is just because there is a real mismatch that is created between your social time and your biological clock. Because of this artificial shift when there's a mismatch between environmental demands and our biological internal clock, our circadian rhythms, that mismatch can cause a lot of dysfunction, internal biological or circadian rhythms are actually a little bit longer than the 24 hour day, these very great studies that look that the time of the internal biological clock show us really that it's close to maybe even 25 hours but every day, there's this magic process. We call it entrainment right. This process in which our biological clock gets shifted down to the 24-hour clock, the daytime and nighttime for the 24 hour period that we know the strongest out say time queue or in trainer or zeitgeber. We call it in, in professional language, which is in German for time giver. The strongest one is a bright light, mainly in the morning. But it's not the only one. There are other things that can act as zeitgeber as these time cues. Routines provide a great deal of entrainment meal timing, even exercise, right lead time can be used for entrainment of circadian rhythms. And these days of shifts, like the ones coming up, what happens is we create this mismatch between the biological clock and our social clock our time clock is just shifting, while our biological clocks stay the same. It's actually different from traveling across time zones. Because in that situation, we're actually changing our internal biological clock. But here the only thing that's changing is the clock. Not the biological clock.

Dr. Yishan Xu 04:34

It sounds like either traveling across time zones or this kind of artificial time shift. It can both cause a mismatch between our clocks.

Dr. Ariel Neikrug 04:46

Correct. In different ways, but the mismatches of it resulting in both outcomes right when you sleep normally normalizes a few days. Usually, After we change, but the outcomes can actually be much longer than what we experienced. We know that traveling across time zones, if we fly from the west coast to the east coast, I never would say for every hour of change, it will take you one day to normalize your sleep. So three hours, it will take you, you know, three days. However, the biological changes, the internal biological changes could last for much longer weeks, even though sleep normalizes, so there is really an acute effect that you can see. And then there's the chronic effect. 

Dr. Yishan Xu 05:47

So any of the consequences people should be aware of?

Dr. Ariel Neikrug 05:51

There are some links between negative health outcomes, heart attacks, accidents, and post-change, especially in the spring, though, really, we need to be careful of fatigue and loss of sleep, and to make sure that we're able to maintain our functionality at a healthy capacity. We need to be aware of our sleep time and our habits in general about sleep, we need to be able to prioritize sleep. I think that in our culture, in general, there is a huge deal of sleep loss that people are not sleeping enough. So we're coming into this change, well, a lot of people are already at a deficit. And then you put on top of the sleep loss that people are experiencing on a chronic basis. Now you're causing an acute problem of a circadian misalignment, which could cause even worse problems and outcomes, more sleepiness, and more impact on the functionality of the individual, it is really important to know and to manage your sleep and health much before you come up to a few days. Before the time changed. I tend to see patients in the clinic come to me about a week before two weeks and say, Doc, well, what should I do right now is the time change? How am I going to manage it?

Really, to manage sleep, we need to look at a much much bigger picture, right, we need to look at over time, we need to make sure that our sleep pressure is healthy that our sleep drive is there when we need it, we also need to make sure that our circadian rhythms are in trained and are strong. These two are very important processes that are involved in creating healthy sleep. So if we miss aligning the circadian rhythm, and we have other deficits in the sleep drive, right, we're even more sleep deprived because we have sleep loss coming into this we will experience more deficit possibly experience more deficit. So having a healthy sleep routine much before is really a key to coming to these time changes with an advantage. Now there are some strategies and how to change your behavior and in the days coming up to these time changes. 

Dr. Yishan Xu 08:41

So how many days ahead of time are we talking about? 

Dr. Ariel Neikrug 08:45

I believe that people should prioritize sleep every single day of their lives.

Dr. Yishan Xu 08:52

Great. So for those people who are not sleeping should think about it right before this time changes.

Dr. Ariel Neikrug 09:05

You know, there is a difference between a routine and a habit. And, and we need to get into the habit of healthy sleep. And if we have healthy sleep and we prioritize sleep, we wake up every day at the same time we go to sleep when we're sleepy and we don't expand extend extended times in bed, then we can come into the week before the change and we can start going to sleep a little bit earlier and waking up a little bit earlier and I would say that waking up a little bit earlier would be more important. We can wake up and then go and have a good dose of bright light, a good amount of entrainment in the first couple of hours of after wake up closer to wake As possible, I tend to say to clients that the best thing is for you to go outside, it doesn't matter how much overcast there is, or how many don't start counting clouds just be outside, spend 30 minutes, have a healthy breakfast every morning, start your gut biology. There's a lot of new trends with dieting approaches that have shown the importance of morning. A good and healthy morning bout meal to start your circadian gut biology. And when you do that, in the few days prior to the time change, you're more likely to have less impact. Again, you're doing a non-natural change. So you will have some impact, but you're trying to minimize the impact on functionality. A big thing I say I tell my clients is Don't forget to change the clocks the day before, not don't do this the day after because that's a sure way to sleep in another hour. So don't forget to change the clocks before you go into bed on the night of the change. And wake up at your normal time. Don't sleep in. Don't, don't try to sleep in that additional hour. 

Dr. Yishan Xu 11:35

Also changing the clock is interesting. Because for me, I'm thinking, I'm very lazy, I just let my phone automatically change it. And as a result of course I don't sleep and get up whatever time sometimes I  get very confused. I wake up at the natural time. But then look at the clock. Oh, it's not time yet. So I put it so I can sleep more.

Dr. Ariel Neikrug 11:56

Right. It's true that a lot of times we use, we rely right now on our smartphones, and it does it for us. We need to be aware of that change in the evening before we start, we need to start and the few evenings even in a few mornings before. So this entire behavior is anticipating a time change and trying to move our biological clock in shorter increments of like 15 minutes every day a little bit earlier. This is obviously for the spring. Do you remember I said earlier that our internal biological tendency is actually to be longer than 24 hours? And therefore delaying our sleep is actually much easier. We do it. It's much easier for us because of that. Because we have that internal biological tendency to go to sleep later. And therefore the spring is particularly difficult and creates this time loss. But one would think that we would get that hour back asleep on the other side. We don't. Studies don't support that. 

Dr. Yishan Xu 13:15

I really liked this suggestion and strategies to really think about several days, at least before what we can do, what changes we can make. And it's interesting, you mentioned we are actually 40 minutes less. Because a lot of time we are thinking well, I often hear people say Am I losing one hour as this time changes or I'm having one more hour as this time changes. 

Dr. Ariel Neikrug 13:41 

And what we see is that overall, there's about a 40-minute decrease in total sleep time. And this is a study that was published in the Journal of Applied Psychology and I think in 2009. And this was in the context of looking actually at work injury and what the end they looked specifically at mineworkers and mineworkers overall ended up having 40 minutes less of sleep and experienced much more workplace injuries. Now, why there is less it's much easier to explain obviously in the spring, but it's also actually really easy to explain this also in the fall. Because what happens a lot in the fall is that individuals would delay their sleep time, but their biological time doesn't really change. So they will end up waking up and their desired wake-up will relatively stay stable. So it's very common to see that it would result because of the way we change our behavior in anticipation of these events will end up losing sleep, not adding sleep at all, even in the times when we possibly can earn that hour. But our bodies don't work. That way, we can just chase sleep and try to achieve that sleep that was lost. And really, my recommendation would be not to think about going to sleep earlier. But just trying to wake up earlier in the days coming earlier, creating more sleep pressure when you go to sleep at night. So it allows you to go to sleep a little bit earlier, even if it's by 15 minutes every time. It would be easier if we wake up earlier in the morning, and start building that sleep drive. Remember, sleep is a drive that we have a few drives in our human body like hunger thirst, these drives grow throughout the day, we want to make sure they're fairly high at night, we want to make sure that we're very hungry for sleep when we get into bed. And then we're able to fall asleep quickly. When that time changes. And we need to go to sleep a little bit earlier, to achieve the same amount of sleep, we will only be able to do that if we have sufficient drive. So a good way to achieve that drive. And to maintain that drive is to wake up consistently at the same time every morning. And then if you want to increase that drive, you can just wake up a little bit earlier 15 minutes every day. And you'll get a little bit more sleepy before you get into bed at night, which will allow you to then go to sleep earlier in the time of the change. 

Dr. Yishan Xu 16:46 

Because I know a lot of people always think sleep is just a nighttime thing. Right? I just need to consider when I go to bed, and it ends, sleep ends when I get up. And then, whatever I do during daytime sleep is just for the night,

Dr. Ariel Neikrug 17:02 

You know, when you think about what is the definition of sleep? And it's a period of quiescence, right? Generally at night. It's, it looks like a certain thing. However, it's from our perspective, we look at it as a rhythm as a pattern. And it involves several mechanisms and processes. But it oscillates over time. And it's a process. And we really look at it you know that Yang and Yang and two parts of the whole, because I need to be asleep a certain amount, and in a certain way to be able to be awake for a certain amount in a certain way. But I also need to be awake a certain amount in a certain way in order to be able to be asleep for a certain amount in a certain way. So really, they really depend on each other. And we look at all of these pillars of health together, we look at sleep, we look at diet, we look at exercise, physical activity, right? We need to make sure that we maintain those three pillars. Here's the problem with pillars. If you take one pillar away or make it shorter or higher, nothing will help and you will not be able to stand on it effectively. They all need to be worked on more of one doesn't overcome less of another. More exercise doesn't

make for the deficits in lost sleep. More sleep does not make the difference for eating poorly. It doesn't work that way. We need to maintain all of these pillars to ensure that health is balanced and stable on top of them. 

Dr. Yishan Xu 19:11

I love that. Hopefully, everyone who is listening can really take that right to remember that its three pillars sound like they need to be equally strong and similar in height so they can really all support our health together. Just want to know if people don't prepare ahead of time they might make it hard. Is that possible?

Dr. Ariel Neikrug 19:36 

If you can prepare. And I believe that if you're hearing this right now, you didn't prepare because today is Friday and it's happening in a couple of days right. So you can prepare. So my advice to you is to wake up at your normal time. Try to go to sleep a little bit earlier. Not too much, but wake up at the same time and get a great deal of sunlight in the morning when you wake up. Spend a minimum of 30 minutes outside, no sunglasses. Try to be active during that day, especially in the hours between 4 and 6 pm. And then regulate your meal times so that they have a healthy breakfast, make sure that you have lunch and you have a normal dinner. Also, don't excessively use caffeine during that day. Don't use caffeine in the afternoon, and avoid alcohol on the day and on the night before the change that means on Saturday night and on Sunday night. So avoid alcohol or drugs during this time.

Dr. Yishan Xu 20:58

Right, great suggestion. I'm very happy. So people now by the time they listen to our podcast, possibly a little bit not a lot of time left for them to prepare, but still sounds like there is quite something people can think of doing to help them as much as possible. But if people are aware of this, like for example, they listen to this and they prepare for the fall time change, then they know Okay, or ahead of time, you can start making adjustments. So near the end of our show today, is there any final wisdom you want to send to our audience?

Dr. Ariel Neikrug 21:36

You know, if you're listening to this podcast, that means you're prioritizing and you're thinking about your sleep. This is a lifelong value. I highly advise for really, really prioritizing your sleep in the prioritization of your health, prioritize your health, prioritize sleep, and the three pillars. That would be my only advice.

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