Darker Days Bring on Seasonal Affective Disorder

I can always tell when autumn hits even before all the leaves are off the trees. That’s usually when I see a rise in appointments and referrals for patients who are feeling the effects of Seasonal Affective Disorder (SAD) or their teenage kids are experiencing Delayed Sleep Phase Syndrome. While we’re pretty fortunate to live in the top five places in Canada for the highest number of sunny days per year, the combination of cold weather and early darkness can be the perfect storm for depression, excessive sleepiness, sluggish energy, anxiety and weight gain.

Most of us chalk it up to ‘hibernating’; but the truth is, adults and children may be experiencing SAD or Delayed Phase Syndrome (very common in teenagers), and may not know they actually have one of these conditions.

Let’s tackle SAD first. Research has shown that anyone can be affected. But interestingly, 75 per cent of sufferers are women. It also has a hereditary component. If you already live with a sleep disorder or depression, SAD symptoms can just add more aggravation to the mix. Children can also experience SAD and parents may need to keep an eye on the signs.

What is SAD?

Seasonal Affective Disorder is identified as a major, recurring depressive disorder, which occurs at certain times of the year.

Up to 10 per cent of Canadians can experience SAD symptoms including:

Depression - Low mood and withdrawal from social activities, but most people still function in essential roles.

Anxiety - Creating feelings of worry, tension, low stress tolerance.

Lethargy and sleepiness - In comparison to regular depression, which manifests with insomnia, SAD patients complain more of fatigue/sleepiness and the need to sleep longer.

Increased carbohydrate craving - In comparison to much healthier eating in the summer months, patients notice significant carbohydrate cravings of food such as bread, pasta, chocolate, etc. This can result in significant weight gain during the winter months.

Lack of sexual desire - Sufferers can experience loss in libido or interest in physical contact.

Aggravation of existing sleep disorders - For those already living with one or more sleep disorders, SAD can increase the effects of the condition and make it even more difficult to get a full, restorative rest.

Some of the treatment options for SAD may include:

Light therapy - A special light unit that you can use at home or at the office, exposes your eyes (and signals your brain that it is getting healthy daylight) to intense light, specifically in the morning, within two to three hours of waking. It should always be done under medical supervision, since it is contraindicated in certain psychiatric and eye conditions.

Medications - Some of the more stimulating antidepressants have been studied and demonstrated to be effective as well.

Physical daytime activity - Exposure to the outdoors during the day (even if the sun isn’t shining) can help with your mental and physical health.

Curtailing carbohydrate cravings - To avoid weight gain, controlling your carbohydrate cravings is important. This begins by paying attention to your diet. Some of the treatments mentioned, such as light therapy and medications, will help with that as well.

Teenage sleepyheads

Delayed Sleep Phase Syndrome

The lack of sunlight during the darker part of the school year can also hamper ‘get up and go’ energy in teenagers and young adults, in particular. Along with SAD, teens can also experience Delayed Sleep Phase Syndrome (DSPS). It’s all due to their continued brain growth and the production of melatonin, which affects their circadian rhythm. We used to think it was predominantly due to late bedtimes, texting and online chatting, etc., but it is quite clear now that it has a strong biological basis as well, starting in the early teens.

Circadian rhythm is the synchronization of the body’s functions to the natural light-dark cycle. It helps to coordinate our periods of sleep to the nighttime. When this becomes delayed, it can cause significant delays in the ability to fall asleep, in relation to desired sleep time. Sleep is normal as long as your teen sleeps in, but results in significant sleep deprivation if they can’t sleep in - and then you might need a truck to drag your teen out of bed on school days.

For growing kids, it can produce symptoms of excessive sleepiness, depression, lack of interest in activities, trouble concentrating in school and sports, including struggling to keep awake at school. It also contributes to drowsy driving in later years, and reduced reaction time behind the wheel.

Teens who experience DSPS will often begin having difficulties with the onset of puberty. There may be underlying genetic factors as well. Up to 10 per cent of teens have DSPS, but they or their parents often don’t know it.

If your child is found to have DSPS or SAD, there are things you can try to bring balance back into their sleep and health:

Help them understand how these conditions affect their body and their mind. Let them know it’s common so they don’t feel different.

Encourage them to get more exercise indoors and outdoors - join in to make it a family activity.

Limit their exposure to TV, music, computers, cellphones or social media during homework time and late at night, if possible; this can aggravate DSPS symptoms.

Keep an eye out for depression, insomnia, irritability and disconnection.

Establish a sleep schedule that gets your kids to sleep earlier, and they should avoid caffeine, sugar, late-night snacking or heavy exercise before bed.

Light units, similar to the ones used in SAD, are the most effective tools correcting DSPS as well.

You can also seek help for you or your child through an assessment by a knowledgeable psychiatrist (for SAD) or sleep specialist, which is covered under provincial health care plans. If you think you or a family member is experiencing symptoms of SAD or DSPS, talk to your primary care physician first and request a referral. With a little bit of patience and persistence, positive treatment and healthy habits can help you and your family members see the sunnier side of long, dark winter days.

Dr. Adam Moscovitch is the Medical Director of the Sleep & Fatigue Institute in Calgary and Airdrie. He has been treating sleep disorders in Alberta and across Canada for 30 years, and is an Associate Clinical Professor at the University of Calgary. He is also a father of four school-age children between the ages of 6 and 16. For more information on treatment options for SAD or DSPS, call 403-455-3747 or email admin@sleep-fatigue.com.

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