The Effect of Season on Sleep patterns, Circadian

rhythms, and Mood

By

A Dissertation

Submitted to the Faculty of Health and Medical Sciences

University

In partial fulfilment of the Requirements for the Degree of Biomedical Science

March 2022
List of abbreviations

 KSS – Karolinska Sleepiness Scale, ST – Subjective Test, SAD – Seasonal Affective Disorder
 (S – Stress level, U – Unhappiness, A – Anxiety level, D – Depression level L – Lethargy)
Table of Contents
Introduction.................................................................................................................................................5
Materials and methods...............................................................................................................................8
KSS...........................................................................................................................................................8
ST.............................................................................................................................................................8
Figures and tables......................................................................................................................................10
Connective narrative test..........................................................................................................................15
Results.......................................................................................................................................................15
Discussion..............................................................................................................................................17
Limitation..............................................................................................................................................17
Conclusion.................................................................................................................................................17
Abstract

It has been difficult to evaluate previous research on seasonal affects on sleep because

of methodological inconsistencies and issues about the number or quality of data.

Objective, continuous, and unobtrusive evaluations of sleep and local weather were

used to study the sleep habits of 216 persons across the United States for almost a

year. We also took into account demographics and trait-like characteristics that have

been linked to sleep habits in the past. Sleep duration, bedtime, and waking time

differed depending on the season and climate zone. We found that seasonal and

climatic factors had a small but statistically significant impact on people's sleep patterns.

With earlier waking hours in the spring and shorter sleep durations, seasonal

differences in wake and sleep timings are most pronounced (compared to the reference

season winter). As the days get longer, the amount of time spent sleeping reduces

(between the winter and summer solstice). Bedtimes and wake-up times tend to be a

little later when the temperature outside rises.

Introduction
One of the most important aspects of one's health and well-being is getting enough sleep. Many
sleep-related traits, such as mood, personality, sleep quality, and chronotype, have been
discovered because of the importance of sleep. This includes but is not limited to demographic
data, such age, sex and income, as well as homeostatic sleep demand.

Circadian mechanisms have an impact on how we sleep. Internal timekeeping cells are used by
circadian systems to keep track of the time inside the body. Other circadian responses, such as
promoting sleep in the dark and staying awake in the light during the day, maintaining the lowest
possible level of core body temperature while sleeping, or avoiding temperature extremes that
could disrupt sleep are all coordinated by these "clock cells" when you're sleeping. Circadian
pacemakers are "clock cells" (Achermann et al.,1993). Clock: The circadian pacemaker
regulates body temperature and melatonin, a hormone that makes you want to sleep, helps you
sleep, makes you wake up, and helps you stay awake. It can change seasonally in animal
models. When there are more hours of light and warmer temperatures, this pacemaker can
make people wake up for longer. When there are less hours of light and cooler temperatures,
this pacemaker can make people wake up for shorter periods. People can clearly tell that
artificial light is messing with their circadian rhythms. If artificial light interferes with seasonal
changes in circadian systems in any way, or if these effects cause documented seasonal
changes in sleep metrics like sleep length, it's not yet clear how these effects work.

As a result, it's not clear how seasonal changes in artificial light might affect people's sleep in
the real world. Seasonal changes to sleep have had different results in studies. Three days
before an experiment, Wehr et al. asked 21 men to record how much light they were exposed to
and how much sleep they got. In the winter and summer months, they gathered temperature
and hormone samples. Using light sensors, researchers discovered that the seasons were
changing throughout the year. Neither the length of sleep time nor the level of melatonin
production was altered as a result of the experiment. Honma et al. looked at ten males for four
days each season in an experimental living facility that had environmental control, sleep tests,
and natural light. In the winter, they started and ended their sleep more quickly than in the
summer. There was no difference in how long they slept because of the season.

Small sample sizes and limited time periods have revealed unexpected seasonal effects in
research using wearable sensors. Wearables and sleep diaries can be used to track 46 people
for one week during each season, however the researchers found no significant seasonal
effects. According to Lehnkering and Siegmund, people slept more in the fall, but there was no
seasonal effect on bed or wake time. Summer and winter preindustrial societies were studied by
De la Iglesia et al., who looked at 44 different hunter-gatherer tribespeople, comparing those
who had and did not have access to electricity during a seven-day period. In the winter, both
groups say they sleep more, but the time they go to bed is the same. Summer has a later
waking time when the two groups are combined. According to a study of 72 people in three
preindustrial nations, the amount of time spent sleeping in winter was longer than the amount of
time spent sleeping in the summer. Eight- to eleven-year-olds, as well as 50- to 64-year-olds,
showed seasonal differences in sleep duration throughout a seven-day period in three seasons.
Once the participant data had been combined, it was possible to estimate the seasonal effects.

In general, these studies have a bigger sample size and do show seasonal effects in at least
some subgroups, but they frequently lack information on when people go to bed and when they
wake up. Evening chronotypes had seasonal sleep duration changes, whereas morning
chronotypes didn't according to a study by Allebrandt et al. People with low incomes and those
over 65 had a higher likelihood of not getting enough sleep during hot summer evenings,
according to research and weather data. Despite this, there were no apparent seasonal
influences on the quality of people's sleep. Study participants in Ghana kept sleep diaries for a
week in both the summer and winter to see how rest varies between latitudes. There was no
significant variation in the amount of time Ghanaians slept during the summer months compared
to the winter months. There was no substantial variation in sleep duration between the
Norwegians and the rest of Europe. Thorleifsdottir and her team studied 668 children who kept
sleep diaries for a decade. They analyzed their sleep patterns to see how restless they were
and how frequently they woke up. Parents of small children tend to sleep more throughout the
winter months than during the spring. They're also up later and in bed sooner because of it. If
you're under the age of five, the seasons have a significant impact on how much sleep you get,
but only on weekends for children aged five to ten. Children under the age of ten have no effect.
They all agreed that their 9 to 12-year-old girls slept more during the winter. These impacts
were more pronounced in the northern latitudes, and younger children's elder relatives didn't
have as big of an impact on them as the northern latitudes did. It's possible to conduct research
using sensors that don't necessitate a person to wear them. Due to school breaks and longer
vacations, you slept more in the winter than you did in the summer, which explains why
teenagers sleep more in the summer. As the seasons changed, those who use biomotion
sensors in Japan discovered that their waking times did as well. Even on weekends, winter
waking hours were later than summer waking times. Sleep duration varies widely throughout the
winter, according to research based on phone call recordings.

If seasonal impacts are found, it is most likely that the lengthening of daytime hours or the rise
in average adult body temperature are to blame, with the greatest impact on children and the
elderly, as well as communities that did not have access to electricity or artificial lighting.
However, the demands of school or the workplace may interact with these adjustments.

Methodological inconsistencies and research limits are likely to be to blame for the results' lack
of clarity. Differences in study settings, dataset selection, and population studied could all
contribute to the observed seasonal variation in sleep characteristics. In other studies, the
season is only examined for one to two weeks, thus seasonal impacts, particularly in the fall and
spring, may be missed. Many large-scale studies rely on participants' self-reports, which are
prone to recall biases or are drawn from a small sample of people over a long period of time.
Laboratory discoveries may be imperceptible in ordinary life, may not apply to pre-industrial
settings, or may relate to only a subset or civilisation. Additionally, seasonal weather elements
such as snow, overcast days, or rain may have an effect on sleep. However, prior research on
seasonal items has not taken seasonal weather trends into consideration.

It is the goal of the current study to investigate how weather and season affect sleep, while
avoiding the methodological flaws of previous research. We looked at a wide range of factors
affecting everyday sleep habits. There are few sleep studies in the Table that use objective,
continuous, and long-term sleep measurements like ours. In-situ sleep patterns of 216 adults in
the US were tracked using wearable sensors, which were adjusted for a range of trait-like
factors previously associated with sleep behavior. We were able to collect daily localized
weather data, which other research have ignored save for temperature, which we were able to
obtain. In addition to offering a more contextualized view of rest in light of previous studies, this
comprehensive method allowed us to determine if seasons and weather had an effect on sleep
across the industrialized globe.
Materials and methods
Description of Tests from which data was gathered:

To collect the data Participants were requested to stay in the lab for 4 days during the summer
(2019 June) then again during winter (2019 Dec) in controlled conditions (see what is meant by
controlled conditions in the protocol of the supervisors research, should that be included here?)
There was an additional winter session (2019 Jan)

Description of Tests from which data was gathered:

To collect the data Participants were requested to stay in the lab for 4 days during the summer
(2019 June) then again during winter (2019 Dec) in controlled conditions (see what is meant by
controlled conditions in the protocol of the supervisors research, should that be included here?)
There was an additional winter session (2019 Jan)

KSS
 See the blank KSS in the appendix
 Measures sleepiness throughout the day on a 1-9 scale
 Data was recorded every two hours from 8am to 10pm on day 2, 3, and 4
 This was done both during summer and winter for each 8 participants
 For participants 915 and 914, the KSS data from December (2019) is incomplete (due to
missing appointments), therefore, for these participants, the January (2019) KSS data
was used, as these were fully completed
 January (2019) session was only completed by participants 915, 914, 911 and 912
 Data for participant 915 on Summer (2019) day 3 and 4 were not available
 Some scores are missing due to participant not filling out the form (specify which ones
and how it affects calculations) -> there has to be a way to be able to use incomplete
data in statistics

ST
 See the blank ST in the appendix
 A self-test that recorded on a 1-9 scale their level of alertness, stress level, unhappiness,
anxiety level, depression level, lethargy level and hunger
 The ST was recorded throughout days 2-4 every two hours concurrently with the KSS
data
 For the purpose of this study, alertness and hunger were not included as the former is
identical to the KSS value, and the latter is irrelevant for this study
 The studied elements included for this dissertation are: Stress level, Unhappiness,
Calmness, Depression level, Lethargy
 Sleepiness =/= lethargy (lethargy = lack of enthusiasm, mental fatigue)
 For participants 915 and 914, the January (2019) ST values were used in order to
maintain greater comparableness to the KSS data recorded on the same days
Figures and tables
For easier comparison we chose to draw the graphs on two parallel columns showing Winter
January (2019) from date 17, 18 and 19 respectively.
In this charts descriptive serial number 1 to 8 represents times from 08:00, 10:00, 12:00, 14:00,
16:00, 18:00, 20:00 and 22:00 as indicated on the tables in the appendix document.
Participant 915/001 Participant 914/002

January 17 KSS KSS

8
10%
1
20%
8 1
14 14
7 % %
15% 1
2 2
7
9% 11 3
% 4
5
6
2 7
15% 6
6 9% 8
10%
3
5 17
9% %
5 3 4
10% 10% 17%
4
10%
KSS 1 2 3 4 5 6 7
8

8
7 6%
6 6%
6%
5 1
11% 44%

4
6%3
6%
2
17%

January 18 1 2 3 4 5 6
7 8
 KSS

8
17 1
% 23
%

7
11
%

2
14
6 %
9%

5 3
9% 9%
4
9%
1 2 3 4 5 6 7
8
January 19 KSS KSS
4
14%

2
43%

1
50%

3 1
29% 57%

2
7%
1 2 3 4
1 2
In this graphs descriptive serial number 1 to 8 represents times from 08:00, 10:00, 12:00, 14:00,
16:00, 18:00, 20:00 and 22:00 as indicated on the tables in the appendix document. The data
was collected from January 25, 26 and 27 respectively.

Participant 911/003 Participant 912/004

KSS KSS
4.5 2.5

2
3.5

3
1.5
2.5

2
1
1.5

1 0.5

0.5

0 0
1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8
 KSS KSS
2.5
7
6 2
5
1.5
4
3 1

2
0.5
1
0 0
1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8

KSS KSS
6 2.5

5 2
4
1.5
3
1
2
0.5
1

0 0
1 2 3 4 1 2 3 4
Connective narrative test
Non-additive interactions between circadian phase and previous wakefulness influence mood changes.
Modest alterations in the sleep-wake cycle can have a big impact on mood.

Multiple mechanisms exist by which light can influence mood, including altering neurotransmitters like
serotonin directly and entraining and stabilizing circadian rhythms to address circadian rhythm
desynchronization and sleep, which are both quite frequent in patients with mental problems. This has
led to a rise in the use of light as an intervention in the treatment of mood disorders and other
psychiatric conditions.

However, we don't know exactly how light affects mood. A pathway from the retina to the habenula has
recently been implicated in mediating light's impact on mood in animal models in addition to the SCN-
mediated circadian effects of light (Rahman et al., 2018). Some ipRGCs are linked to the habenula via
this pathway, which avoids the SCN totally and may be a mediator for light-induced mood alterations.
Researchers aren't sure how much of this information can be applied to people, but imaging studies
reveal that our habenulae are also sensitive to variations in light levels. The mechanics underlying light
treatment need to be studied further.

We'll go over some of the most common clinical uses for light therapy, as well as a quick primer on how
to put it to use in the real world.

Results
The use of light therapy as an adjunctive treatment for a variety of different medical issues has grown in
popularity in recent years. Light elevates mood and assists those suffering from anorexia and bulimia
nervosa in coping with specific symptoms of their disorders. According to well-controlled long-term
research, light has antidepressant effects in older adults and can also help delay the progression of
dementia's cognitive decline. BLT is becoming an increasingly significant technique in senior care since it
can help persons who struggle with sleep-wake issues and general lulliness sleep better and remain up.
BLT may be beneficial for adults with attention deficit hyperactivity disorder (ADHD) and other sleep-
wake issues such as schizophrenia or neurodegenerative diseases. This is due to the fact that light has a
stabilizing influence on the human body. Internal medicine is also utilizing it in novel ways, such as in
intensive care units, where the contrast between day and night lighting is typically relatively minimal.
This results in a disrupted sleep-wake cycle for patients, which has a detrimental influence on their
rehabilitation (Sack et al., 1998). BLT has also been shown to benefit patients with sleep-wake disorders
following kidney transplantation, as well as those with cirrhosis, severe brain injury, and Parkinson's
disease. In sleep medicine, light is utilized to assist individuals suffering from certain circadian rhythm
sleep-wake disorders (CRSWDs), such as advanced and delayed sleep-wake phase disorder. These
problems can be triggered by jet lag, shift employment, being a sighted non-24, or having an abnormal
sleep-wake phase pattern.

In general, these studies have a bigger sample size and do show seasonal effects in at least some
subgroups, but they frequently lack information on when people go to bed and when they wake up.
Evening chronotypes had seasonal sleep duration changes, whereas morning chronotypes didn't
according to a study by Allebrandt et al. People with low incomes and those over 65 had a higher
likelihood of not getting enough sleep during hot summer evenings, according to research and weather
data. Despite this, there were no apparent seasonal influences on the quality of people's sleep. Study
participants in Ghana kept sleep diaries for a week in both the summer and winter to see how rest varies
between latitudes. There was no significant variation in the amount of time Ghanaians slept during the
summer months compared to the winter months. There was no substantial variation in sleep duration
between the Norwegians and the rest of Europe. Thorleifsdottir and her team studied 668 children who
kept sleep diaries for a decade. They analyzed their sleep patterns to see how restless they were and
how frequently they woke up. Parents of small children tend to sleep more throughout the winter
months than during the spring. They're also up later and in bed sooner because of it. If you're under the
age of five, the seasons have a significant impact on how much sleep you get, but only on weekends for
children aged five to ten. Children under the age of ten have no effect. They all agreed that their 9 to 12-
year-old girls slept more during the winter. These impacts were more pronounced in the northern
latitudes, and younger children's elder relatives didn't have as big of an impact on them as the northern
latitudes did. It's possible to conduct research using sensors that don't necessitate a person to wear
them. Due to school breaks and longer vacations, you slept more in the winter than you did in the
summer, which explains why teenagers sleep more in the summer. As the seasons changed, those who
use biomotion sensors in Japan discovered that their waking times did as well. Even on weekends,
winter waking hours were later than summer waking times. Sleep duration varies widely throughout the
winter, according to research based on phone call recordings.

If seasonal impacts are found, it is most likely that the lengthening of daytime hours or the rise in
average adult body temperature are to blame, with the greatest impact on children and the elderly, as
well as communities that did not have access to electricity or artificial lighting. However, the demands of
school or the workplace may interact with these adjustments.

Methodological inconsistencies and research limits are likely to be to blame for the results' lack of
clarity. Differences in study settings, dataset selection, and population studied could all contribute to the
observed seasonal variation in sleep characteristics. In other studies, the season is only examined for
one to two weeks, thus seasonal impacts, particularly in the fall and spring, may be missed. Many large-
scale studies rely on participants' self-reports, which are prone to recall biases or are drawn from a small
sample of people over a long period of time. Laboratory discoveries may be imperceptible in ordinary
life, may not apply to pre-industrial settings, or may relate to only a subset or civilization. Additionally,
seasonal weather elements such as snow, overcast days, or rain may have an effect on sleep. However,
prior research on seasonal items has not taken seasonal weather trends into consideration.

It is the goal of the current study to investigate how weather and season affect sleep, while avoiding the
methodological flaws of previous research. We looked at a wide range of factors affecting everyday
sleep habits. There are few sleep studies in the Table that use objective, continuous, and long-term
sleep measurements like ours. In-situ sleep patterns of 216 adults in the US were tracked using wearable
sensors, which were adjusted for a range of trait-like factors previously associated with sleep behavior.
We were able to collect daily localized weather data, which other research have ignored save for
temperature, which we were able to obtain. In addition to offering a more contextualized view of rest in
light of previous studies, this comprehensive method allowed us to determine if seasons and weather
had an effect on sleep across the industrialized globe.
Discussion
People who are depressed benefit most from exposure to light early in the morning. For CRSWD, the
timing of therapeutic light exposure is dictated by the type of circadian disturbance and the direction of
phase shift that must be accomplished in order to come back in sync with the rest of the body. Using a
proper circadian phase marker can help you determine the phase position, which will help you
determine when to utilize lights on your child. To be sure you're in the correct time zone, look at this
clock and see whether it changes. To do this, you need to measure the so-called "dim-light melatonin
onset." This happens when melatonin levels rise above baseline, which means that melatonin secretion
has begun. It is still hard to use DLMO assessment in clinical practice because there aren't many places
that can do melatonin analysis, as well as the costs of this diagnostic process, which aren't covered by
most European health insurance plans at the time of this writing.

At least 30–60 minutes a day, BLT should be exposed to light. This is the best way for it to work. As a
result, it is often done at home, which makes it easier for people to keep their appointments, frequency,
and length of treatment. Short breaks from light therapy can cause SAD to return quickly, but normal
sleep-wake schedules are unlikely to have an impact on CRSWD circadian rhythm stabilization if regular
sleep-wake schedules are maintained.

For understanding how light impacts human physiology, it is essential to have an understanding of light.
There are three types of electromagnetic radiation: visible, infrared, and ultraviolet. By looking at its
spectral distribution, one can get a clearer picture of how much energy it contains as a function of
wavelength.

It's possible to experience daytime light intensities of 100,000 lx in direct sunshine, or as high as 25,000
lx in broad daylight. Because of this, office lighting is often less than 500 lx when used in confined
spaces. The day spectrum, which is sunlight filtered by the atmosphere, has a rather broad distribution.
The amount of daylight accessible is location- and season-dependent. Artificial light, which provides light
throughout all hours of the day, is a relatively recent development in the history of humankind. Both
indoor and outdoor environments can be illuminated using artificial light. It is available in a variety of
configurations, including incandescent, fluorescent, and LED lighting. It may appear that these
technologies produce "white" light, but the underlying spectrum is actually quite different. The retina
may make a wide variety of varied ranges appear to be identical. The circadian clock can be influenced in
different ways by different perspectives, even though the visual consequences are the same.

Several methods exist for determining how light affects human physiology, and this is an important
aspect to keep in mind. It's not necessary to look at the color temperature of a hypothetical black-body
radiator to get an idea of the luminance, although many researchers do so because it's easier to
visualize. As a result of this lack of standardization, the chronobiological and sociological literature on
light's impacts has been difficult to summarize. As the world's foremost authority on light measurement,
the International Commission on Illumination (CIE) has just released a new set of guidelines for
measuring light's influence on non-visual functions (Chellappa et al.,2013). When using light as an
intervention, experimenters should at least explain to their participants what they are seeing when they
look at the light. The bare minimal requirements are clearly stated.
Limitation
Long-term usage of light treatment has the potential to induce eye discomfort and impaired vision. Side
effects are extremely infrequent and usually disappear after a few days or at a lower dosage. In patients
with bipolar disorder, there have been a few instances of increased excitability following light therapy.
Improper light exposure, the most prevalent cause of sleep disturbances, can make it difficult to fall
asleep at night or to wake up early in the morning. You can easily reschedule your light therapy sessions
in order to make things right. 

Conclusion
It is common knowledge that the human sleep-wake cycle is an example of a circadian behavioral
rhythm, as it incorporates periods of sleep at night and awake during the daytime hours. It is brought on
by a combination of the circadian drive to sleep and the homeostatic demand on sleep that interacts.
Sleep onset and length are accounted for by the "two-process model of sleep," which considers the
interplay between the circadian "process C" and the homeostatic "process S." Studies have revealed that
the SCN's clockmaker and sleep hemostat work together to maintain a consistent pattern of wakefulness
and sleep throughout the day and night in a scientifically controlled setting (Garbarino et al., 2016). In
order to counteract the increased sleep pressure caused by daytime arousal, the circadian pacemaker's
activity is precisely timed to do so. A longer nocturnal sleep period is made possible by the rise in
circadian sleep inclination that occurs at night, which makes up for the decrease of sleep propensity
over time.

In terms of setting the circadian rhythm, light serves as the principal zeitgeber, as previously mentioned.
Non-image-forming pathways connect the retina and the SCN's master clock, allowing it to communicate
with it. Light has a direct impact on sleep, which isn't a surprise. Natural sunshine at high intensities,
such as those seen outside buildings, has been demonstrated to increase sleep time, duration, and
quality. As an example, Roenneberg and coworkers describe the phase-advancing effects of sunshine
more thoroughly. The more time spent outside, the faster you sleep, according to questionnaire results.
This phase advancement can also be caused by daytime physical activity, which is often misunderstood
to be time spent outside. It's still unclear how light and physical activity play a role. Longer sleep
durations have been associated with less exposure to the bright noon sun (Fernandez et al.,2018).
Melatonin secretion time was shown to be longer when people had less sun exposure and more time in
the dark. Sleep duration may therefore be affected by a seasonal influence. Exposure to daylight has
also been shown to lengthen sleep, possibly through advancing the time spent asleep. In addition,
exposure to daylight has an impact on sleep quality.
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