Daylight Savings Time:

Jacob Schor ND FABNO

November 20, 2008

With Spring fast approaching I’m already dreading the shock of switching back to Daylight Savings Time (DST).  This leads me to ponder why we still bother switching the clocks like this.  I can never remember when we do it and which way we are supposed to move the clock, no less why.    The rationale to justify DST is no longer valid and published data suggests that DST may be detrimental to our health.

Benjamin Franklin is given credit for being the first to suggest DST. This stems from a letter Franklin wrote while living in Paris in 1784 in which he half-jokingly calculated how much money might be saved if people were to wake earlier in the morning. At the time the fashion was to stay up late and sleep through the morning, at least the crowd Franklin was hanging out with did. His math suggested the 100,000 inhabitants of Paris could save 64,050,000 pounds of candle wax over a 6-month period. Franklin as always was ahead of his time.

Before we talk about DST we first must talk about Standard Time.  Up until recently all time was local.  Clocks were set to noon when the sun reached its daily zenith.  This worked fine until people started traveling faster than they could by foot.

It was the railroads that messed things up.  Trains created the need for standard time, they needed all clocks in all towns set to the same time.  Without a common time how could you run a train on schedule?  Standard Time was first adopted in Britain; Great Western Railway set all its trains to London Time and by 1847 most other British railroads had done the same.  By 1855, most clocks in Britain were set to Greenwich Mean Time (GMT) (though the legal system held out and didn’t adopt GMT until 1880 causing all sorts of curious peculiarities that seem perfectly suited for the British to have tolerated.)

 

Our country was behind the time.  Standard Times and Time Zones were adopted in 1883. Detroit held out, keeping a local time, 28 minutes later than Central Standard Time, until 1900.

During the First World War, Germany and Austria initiated Daylight Savings Time (DST) on April 30, 1916, moving their clock hands one hour ahead to conserve energy. The rest of Europe, Canada and Australia immediately copied the Germans. The U.S. held out until 1918.  DST was unpopular in our country and was repealed in 1919.

Roosevelt re-instituted year-round Daylight Saving Time from February 1942 to September 1945. It was a free for all from 1945 to 1966 with states and localities making their own decisions whether to observe DST. Confusing?  You bet, especially for TV, radio, trains, and airlines.

In the winter of 1974, Nixon restarted DST as an emergency measure during the oil embargo. Congress returned us to Standard Time in October 1974. Daylight Saving Time resumed on February, 1975 and ended on October, 1975. Looking back it all appears rather random, arbitrary, and almost chaotic.

These days in most of the United States Daylight Saving Time begins at 2:00 a.m. on the second Sunday in March and reverts to standard time on the first Sunday in November.

There are problems coming to light with this entire DST business.  First off it’s dangerous and second it doesn’t ‘save’ anything. 

Our recent worries started with an article published in the 2004 the Journal of the American College of Cardiology on the ‘Effect of sleep loss on C-reactive protein, an inflammatory marker of cardiovascular risk.’  In simple terms missing sleep triggers an inflammatory reaction, a reaction that we now know increases risk of having a heart attack or stroke.

When we shift into and out of DST we disrupt our circadian clocks.   Actually it’s more complicated than that.  Although work and school schedules follow the clock, biological rhythms stick with the sun and don’t adjust like we pretend they do.    Messing with internal clocks is trouble.  Even waking on time for work on Monday mornings is a problem.

Back in 2005 the European Journal of Epidemiology reported that men were more likely to have heart attacks on Mondays than any other day of the week. “The odds ratio (OR) of sudden cardiac death on Monday compared to other days of the week was 1.20 ….. The excess mortality due to the Monday peak amounted to 4.9 per 1000 deaths. The Monday peak was more pronounced in non-hospitalised ….. than in hospitalised patients …..”

So when you feel like everything is an up hill slog through mud on a Monday morning, well, your heart agrees with you.

Real concern about DST started, just before over our most recent ‘time shift’  when, on October 30, the New England Journal of Medicine published an article, “Shifts to and from Daylight Saving Time and Incidence of Myocardial Infarction.”   Imre Janszky of the Karolinska Institute carefully evaluated Swedish medical records and found, “The incidence of acute myocardial infarction was significantly increased for the first 3 weekdays after the transition to daylight saving time in the Spring…. In contrast, after the transition out of daylight saving time in the autumn, only the first weekday was affected …..” 

Jansky explains this phenomenon; “The most plausible explanation for our findings is the adverse effect of sleep deprivation on cardiovascular health. According to experimental studies, this adverse effect includes the predominance of sympathetic activity and an increase in pro-inflammatory cytokine levels.  Our data suggest that vulnerable people might benefit from avoiding sudden changes in their biologic rhythms.”

“… people in Western societies are chronically sleep deprived, since the average sleep duration decreased from 9.0 to 7.5 hours during the 20th century.  Therefore, it is important to examine whether we can achieve beneficial effects with prolonged sleep.”

Noting the prior reports of higher infarction risk on Mondays  were explained as simply associated, “with the mental stress of starting a new workweek and the increase in activity,”  Jansky provides another explanation,  “… that there is another, sleep-related component in the excess incidence of acute myocardial infarction on Monday. Sleep-diary studies suggest that bedtimes and wake-up times are usually later on weekend days than on weekdays; the earlier wake-up times on the first workday of the week and the consequent minor sleep deprivation can be hypothesized to have an adverse cardiovascular effect in some people. This effect would be less pronounced with the transition out of daylight saving time, since it allows for additional sleep.”

Sleep deprivation and attempts to suddenly shift circadian rhythm create inflammatory reactions in the body makes sense.  That these changes can be measured in mortality still is surprising.

Though this association with DST and heart attack risk is new, safety experts knew already to expect increased car accidents during shifts both into DST in the spring and out of it in the fall.

While it is becoming clear that DST isn’t good for us, the rationale that DST saves energy and money has also been undermined.  In an op-ed piece in the November 20 New York Times  Matthew Kotchen and Laura Grant from the university of California, Santa Barbara, talk about their research that disproves this idea. In Ben Franklin’s time it was relevant to calculate candle wax spared from using “sunshine rather than candles” but his calculations no longer hold.

Kotchen and Grant conducted “a study in Indiana, where daylight time was instituted statewide only in 2006. Before that year, daylight time was in effect in just a handful of counties. This change of policy offered a unique, natural experiment to measure the overall effect on residential electricity consumption.” 

They found, “that daylight time caused a 1 percent overall increase in residential electricity use….. Daylight time costs Indiana households an average of $3.29 a year in higher electricity bills, or about $9 million for the whole state.”

Why such an increase?

“…[while] daylight time reduces demand for household lighting, it increases demand for heating in the early spring and late fall (in the mornings) and, even more important, for cooling on summer evenings. Benjamin Franklin was right about candles, in other words, but he did not consider air-conditioners.”

They point out that, “In regions of the United States where demand for air-conditioning is greater than in Indiana, this spike in cooling costs is likely to be even greater.”

Their article was based on a paper they have written for the National Bureau for Economic Research.

So if DST increases heart attack incidence, increases car accidents, and costs us more in energy consumed, why do we do it?  There doesn’t seem to be a good reason, it’s just something we tried and turns out doesn’t work.   Franklin’s candle wax calculation were written half in jest, not so much as a practical suggestion, but more as a critique of life in Paris where the well off rarely got out of bed before noon.  It may prove difficult to unmake this tradition or perhaps the energy saving that could result from repealing the DST laws may make it a no-brainer.

In the meantime, come April, it would make sense to address the increased health risks associated to changing to DST, at least with our high risk patients.  The easiest fix would be to make the change gradually, for example, changing the alarm at daily ten-minute increments for a week rather than the full hour on one day.  I plan to tell our front desk to start my patient appointments later for a few days.     Or we could compensate for the expected increase in inflammation and c-reactive protein by having them drink a bottle of tomato juice or grape juice over the course of the week.  Watch out though, Astrazeneca may start suggesting a week of Crestor to compensate!

The real benefit of all this information  is that it provides an excellent springboard twice a year to point out the value to your patients of a good nights sleep.  Whether we are falling back to return to Standard Time in the Fall or springing forward to DST in the Spring, people will complain.  Take advantage of this conversational topic.  Tell them that even that hour lost in the Spring or the hour gained in the Fall doesn’t just change c-reactive protein but is enough to cause a measurable change in heart attack rates.  We might not be able to abolish DST but we can certainly help our patients appreciate the danger of sleep deprivation and send them home with a greater appreciation of the importance of sleep.   

Ben Franklin’s letter:

http://www.webexhibits.org/daylightsaving/franklin3.html

2004. Journal of the American College of Cardiology published and article on the ‘Effect of sleep loss on C-reactive protein, an inflammatory marker of cardiovascular risk.’ http://content.onlinejacc.org/cgi/content/abstract/43/4/678?ijkey=3dd2b39a00b5b0cb5f33f0c47e9416cd91a6d225&keytype2=tf_ipsecsha

Jansky’s article in NEJM: http://content.nejm.org/cgi/content/full/359/18/1966

Kotchen and Grant on DST in Indiana paper: http://74.125.45.132/search?q=cache:Yo4BmdumUTEJ:www2.bren.ucsb.edu/~kotchen/links/DSTpaper.pdf+MATTHEW+J.+KOTCHEN+and+LAURA+E.+GRANT&hl=en&ct=clnk&cd=2&gl=us&client=firefox-a

Franklin, Ben. Letter to the Editor of the Journal of Paris, 1784

   Curr Biol. 2007 Nov 20;17(22):1996-2000. Epub 2007 Oct 25.    

    The human circadian clock's seasonal adjustment is disrupted by daylight saving time.

    Kantermann T, Juda M, Merrow M, Roenneberg T.

    Ludwig-Maximilian-University, Goethestrasse 31, D-80336 Munich, Germany.

    A quarter of the world's population is subjected to a 1 hr time change twice a year (daylight saving time, DST). This reflects a change in social clocks, not environmental ones (e.g., dawn). The impact of DST is poorly understood. Circadian clocks use daylight to synchronize (entrain) to the organism's environment. Entrainment is so exact that humans adjust to the east-west progression of dawn within a given time zone. In a large survey (n = 55,000), we show that the timing of sleep on free days follows the seasonal progression of dawn under standard time, but not under DST. In a second study, we analyzed the timing of sleep and activity for 8 weeks around each DST transition in 50 subjects who were chronotyped (analyzed for their individual phase of entrainment). Both parameters readily adjust to the release from DST in autumn but the timing of activity does not adjust to the DST imposition in spring, especially in late chronotypes. Our data indicate that the human circadian system does not adjust to DST and that its seasonal adaptation to the changing photoperiods is disrupted by the introduction of summer time. This disruption may extend to other aspects of seasonal biology in humans.

Eur J Epidemiol. 2005;20(5):395-9.

Excess cardiac mortality on Monday: the importance of gender, age and hospitalisation.

    Witte DR, Grobbee DE, Bots ML, Hoes AW.

    Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.

    BACKGROUND: Available evidence suggests a peak in the incidence of cardiovascular events on Mondays compared to other days of the week. The underlying mechanism may be summarised as naturally occurring rhythmic fluctuations in human physiology, and socially determined rhythms in human behaviour. Change in these rhythms may lead to attenuation of the peak on Mondays. OBJECTIVE: To quantify the excess risk associated with the Monday peak in cardiovascular mortality and to explore the role of age, gender and hospitalisation. METHODS: Details on time and cause of all deaths which occurred in the city of Rotterdam between November 21, 1988 and November 21, 1990 were obtained by sending a questionnaire to the physician who signed the death certificate. We studied the weekly distribution of 1828 confirmed cases of sudden cardiac death, for the group as a whole and in subgroups according to gender, age (< 65 years/65 years) and hospitalisation. RESULTS: The odds ratio (OR) of sudden cardiac death on Monday compared to other days of the week was 1.20 (95% CI: 1.06-1.36). The excess mortality due to the Monday peak amounted to 4.9 per 1000 deaths. The Monday peak was more pronounced in non-hospitalised (OR: 1.25; 95% CI: 1.08-1.44) than in hospitalised patients (OR: 1.06; 95% CI: 0.83-1.37), in men (OR: 1.25; 95% CI: 1.06-1.48) than in women (OR: 1.14; 95% CI: 0.95-1.36), and in those younger than 65 (OR: 1.29; 95% CI: 0.95-1.74) compared to those aged 65 years or over (OR: 1.18; 95% CI: 1.03-1.35). Yet, the confidence limits overlap. CONCLUSION: The incidence of sudden cardiac death is markedly increased on Monday, more pronounced in non-hospitalised patients. Our results may point to the relevance of naturally occurring rhythmic fluctuations in human physiology, and socially determined rhythms in human behaviour as underlying mechanism.

Imre Janszky,. Shifts to and from Daylight Saving Time and Incidence of Myocardial Infarction. NEJM. Vol. 359:1966-1968, Oct 30, 2008, Num 18.

Sleep Med. 2001 Jan;2(1):31-36.    

    Fatal accidents following changes in daylight savings time: the American experience.

    Varughese J, Allen RP.

    Department of Symbolic Systems, School of Humanities and Sciences, Stanford University, CA, Stanford, USA

    Objective: This study examines specific hypotheses that both sleep loss and behavioral changes occurring with the time shifts for Daylight Savings Time (DST) significantly effect the number of fatal traffic accidents in the United States of America. Background: It has been reported that there is a significant increase in the number of automobile accidents in the spring shift to DST due to the loss of 1 h of sleep. But the extra hour gained at night with the shift from DST in the fall has been variably reported to be associated with increases and decreases in the number of automobile accidents which may reflect either behavioral anticipation with an extended late night prior to the change or the benefit of extra sleep after the change. Methods: Data from 21 years of United States' fatal automobile accidents were gathered. The mean number of accidents on the days at the time of the shifts (Saturday, Sunday and Monday) was compared to the average of the corresponding mean number of accidents on the matching day of the weeks preceding and following the shift. This was repeated for each DST shift. The number of accidents for a particular shift was also correlated with the year of the accidents. Results: There was a significant increase in accidents for the Monday immediately following the spring shift to DST (t=1.92, P=0.034). There was also a significant increase in number of accidents on the Sunday of the fall shift from DST (P<0.002). No significant changes were observed for the other days. A significant negative correlation with the year was found between the number of accidents on the Saturdays and Sundays but not Mondays. Conclusions: The sleep deprivation on the Monday following shift to DST in the spring results in a small increase in fatal accidents. The behavioral adaptation anticipating the longer day on Sunday of the shift from DST in the fall leads to an increased number of accidents suggesting an increase in late night (early Sunday morning) driving when traffic related fatalities are high possibly related to alcohol consumption and driving while sleepy. Public health educators should probably consider issuing warnings both about the effects of sleep loss in the spring shift and possible behaviors such as staying out later, particularly when consuming alcohol in the fall shift. Sleep clinicians should be aware that health consequences from forced changes in the circadian patterns resulting from DST come not only from physiological adjustments but also from behavioral responses to forced circadian changes.

New York Times

November 20, 2008

Op-Ed Contributor

What’s the Point of Daylight Time?

By MATTHEW J. KOTCHEN and LAURA E. GRANT