4 Tips to Help Your Patients Fend Off the Winter Blues

Shorter days and cold weather may interfere with your patients’ normal circadian rhythm. For example, if you live in the northern United States, you may experience a greater health impact due to staying indoors more during the winter, as this can lead to less exposure to natural light. Additional factors during this time of year include less physical activity, stress of the holidays and juggling finances. It is important to make sure your patients are intentionally getting enough sleep. Proper amounts of deep sleep help fend off stress and fatigue and allow us to get through our days with more energy, greater productivity, and sharper cognitive alertness. Our bodies also heal and repair while sleeping, and can better fend off infection and inflammation.

Circadian Rhythm Disruption

The circadian rhythm of sleep is controlled by hormone release associated with light and darkness. The main hormone we consider when discussing the sleep cycle is melatonin. Melatonin is suppressed when light hits the back of the eye and the information travels to the suprachiasmatic nucleus (SCN). When darkness is upon us, the photoreceptors detect the decrease in day light, and we convert serotonin to melatonin in the pineal gland. Again, the SCN coordinates the release of signals throughout the brain to start the sleep cycle.

So, why do our patients’ have trouble sleeping? Obvious disruptors are evening caffeine or alcohol consumption. Caffeine is a stimulant, so that is an easy explanation. But alcohol is a depressant, so shouldn’t that help us sleep? The answer is that as much as we think alcohol helps induce sleep, it actually decreases the ability to achieve that deep, restful REM sleep that we so desperately need to wake up refreshed. Along the same lines, eating before bedtime is another disruptor, especially if the meal is high in sugar and other carbohydrates. A stressful day may contribute to heightened energy due to sympathetic nervous system activation and higher cortisol at a time of day when we’re supposed to be ramping down. Evening workouts can be a contributing factor because the body may not be able to calm itself down in time to fall asleep at an appropriate hour.

As mentioned earlier, circadian rhythm is controlled by the day-night cycle. Lack of natural light during the day tricks the brain into thinking it is dark and therefore time to sleep. You may have patients who work inside all day and go to and from work when its dark outside. Make sure you express the importance of getting outside for a 30-minute walk twice a day to help keep them alert. Exposing their eyes to natural sunlight helps suppress melatonin production and decreases their need for caffeine! Also, remind them that blue light can trick their brain into thinking that it is daytime, so exposure to bright lights at night are certainly important to avoid.

A final thought on stress—it depletes key nutrients needed for optimal circadian rhythm. If your patients are experiencing mood or sleep disturbance, be sure to address their stress with relaxation techniques, scheduled downtime, and healthy eating.

Common Circadian Rhythm Disruptors

Infection, Inflammation & Circadian Balance

It goes without saying that wintertime is cold and flu season. Our patients are less likely to be able to get outside to exercise and are couped indoor and vulnerable to other peoples’ germs for long periods of time. Infections and inflammation run rampant this time of year and create a vicious cycle of stress burden on the human physiology. The congestion and coughing may keep our patients awake, while they experience fatigue and brain fog during the day.

Along with managing stress and avoiding common circadian disruptors above, consider reducing inflammation and providing antioxidant support with high-dose melatonin. Melatonin is well-known for its sleep-supportive properties, but research is also showing  many benefits of administering higher doses. Several studies are reporting the beneficial effects of melatonin for severe infections as a safe treatment without adverse side effects.¹ Melatonin inhibits the NLRP3 inflammasome activation induced by many different activators, whether its smoking or caused by a reaction to any other pathogen. It is also a powerful antioxidant, both directly and indirectly protecting cells from oxidative damage.² These capabilities have been shown to support optimal cellular health, are neuroprotective, and help maintain normal inflammatory balance.  

How to Support Circadian Balance: Tips for Your Patients

1. Sleep Hygiene

• Schedule
  1. Clock timing: Even though it gets dark early, try to keep regular bedtime and wake-up schedule. Try timing your bedtime around when you know you need to be awake the next day so you’re getting a solid seven to nine hours of sleep each night. 
• Routine and Environment
  1. Light timing: About two hours prior to your intended bedtime, turn off the blue light devices and turn down bright indoor lights. Dimming switches are helpful for this or use non-direct light from other parts of the house so you’re not shutting down your melatonin production.
  2. Food timing: Avoid eating food for that same two-hour time frame before sleep. Rest and digest are parasympathetic nervous system actions, so this may sound counterintuitive.
  3. Keep it dark: Ambient light from alarm clocks, windows or other sources can keep you awake, whether it’s due to the stimulating light itself, or because you start focusing on the time spent not being able to fall asleep.
  4. Room temperature: Keep the bedroom cool. Temperatures at 65-67°F can induce sleep and enhance melatonin production.
  5. Stress: This could be worries about finances, relationship stress with family members, or work-related stress. Either way, keeping a journal can be a good way to write down your stressor(s) and release some of the tension surrounding them. 
  6. Pets in the bedroom: Our pets are part of the family, but if they are a part of why you’re awakening, it may be time to let our furry friends sleep in a different room.

2. Daytime Light Exposure

• Get outside twice a day to expose your eyes to real light, morning and afternoon. Exposure to natural sunlight for a minimum of 30 minutes helps regulate the sleep/wake cycle. If this isn’t possible, consider a circadian rhythm light lamp. There are 10,000 lux lamps available to keep your day-night cycle in sync.

3. Regular Exercise

• Getting regular exercise has been shown to improve sleep quality. Moderate intensity exercise, preferably in the morning or early evening, is best. Avoid moderate to high intensity exercise before bedtime, as it can be stimulating.

4. Supplements that Support Circadian Balance

• Melatonin
  1. Melatonin is a sleep-promoting hormone naturally released by the body and may be supplemented to support deep stages of restorative sleep.
  2. Its antioxidant and anti-inflammatory capabilities support the immune system against infection and inflammation.
• 5-HTP
  1. 5-HTP is an amino acid intermediate that converts directly into the calming neurotransmitter serotonin and the end product is the sleep-promoting hormone melatonin.
• PharmaGABA®
  1. GABA is a naturally produced inhibitory neurotransmitter that promotes relaxing alpha brain waves to help soothe stress. This branded source of GABA has been proven in several human clinical trials to increase the ability to fall asleep.
• Phosphatidylserine
  1. This phospholipid reduces elevated levels of cortisol, which can contribute to difficulty falling asleep and frequent waking throughout the night.
• Magnesium
  1. Approximately 80% of the American population is deficient in magnesium. Magnesium helps regulate neurotransmitters that are directly related to sleep, such as serotonin. It also provides its own relaxing effects to help calm, improve ability to fall asleep and improve sleep quality.

The Bottom Line

The body is an amazing machine of intertwining activities from the cellular level to our multiple body systems. The nervous system and many hormones play a major role in keeping us and our patients innately healthy by constantly adapting to our environment. The circadian rhythm of being awake and sleeping is a fascinating phenomenon that we should prioritize keeping healthy and in sync. The better we take care of our bodies, the more energetic we will feel and the less likely we will require disease management as we age. It seems everything goes back to the basics—eat a colorful, healthy diet, avoid toxins the best we can, and get adequate exercise and rest.

STACEY SMITH, DC

Stacey Smith, DC earned her doctorate in chiropractic from the National University of Health Sciences (NUHS) in Lombard, Illinois in 2004. She obtained two bachelor of science degrees, biochemistry from Michigan State University and human biology from NUHS. She worked alongside her chiropractic parents and brother in a family practice in Michigan for 16 years and focused on lifestyle and physical medicine. 

References

1. Tan, Dun-Xian., Hardeland, R. 2020. Potential utility of melatonin in deadly infectious diseases related to the overreaction of innate immune response and destructive inflammation: focus on COVID-19. Melatonin Research. 3,1 (Mar. 2020), 120-143.
2. Zhou, Y., Hou, Y., Shen, J., Huang, Y., Marin, W., Cheng, F. Network-based drug repurposing for novel coronavirus 2019-nCoV/SARS-CoV-2. Cell Discov. 2020;6:14.