Social engagement can help with sleep
Q: I had been spending a lot of time alone, so I made a point of joining friends at a museum, going on a group hike and volunteering at a book sale. I had been struggling with poor sleep but on each of those nights I slept really well. Could socializing have made a difference?
A: A growing body of research links having a robust social life with improved physical and mental health. It turns out that, as you have found in your own efforts to get out and about, it may help you sleep better, too. Where someone goes or what they do when they get there doesn't appear to matter. What counts are the many mental, physical and emotional tasks they wind up performing over the course of the outing. That includes the planning involved in conceiving and arranging the outing, getting dressed and otherwise preparing to leave the house, making the physical journey from home to the destination, and navigating the many rhythms and currents of the event itself.
It is interesting to note that novelty also appears to play a role. A typical workweek, which often involves familiar actions repeated in the same place and under the same conditions, can be mentally and physically taxing. And yet high-quality sleep may still be elusive. But participating in something that is unfamiliar, unexpected or unpredictable appears to engage and even tire us out not only mentally but physically, as well.
A number of studies have looked into the potential link between social engagement and improved sleep. One followed 3,200 adults over the age of 60. Those who frequently participated in group hobbies, community-based organizations and team sports were found to have a better quality of sleep than those who did not. In another study, interviews with 175 healthy adults between the ages of 44 and 75 found that having meaningful social connections, including friendships and family relationships, correlated with better sleep.
In your letter you mention sleeping better after joining friends for a hike. That lines up with numerous studies that have linked the simple act of spending time in the natural world with feelings of well-being, which can lead to improved sleep. Volunteering has also repeatedly been shown to confer both physical and mental health benefits on those who regularly take part. All of this is important because unfortunately, as we have discussed before, poor sleep is a widespread and growing problem in our modern world. Chronic poor sleep is linked to a higher risk of developing heart disease, Type 2 diabetes and obesity; high blood pressure; and certain types of cancers. Cognition and mental health can be adversely affected as well.
Being sedentary, being stressed and the near-constant exposure to artificial light have been identified as contributing factors to sleep problems. Aging plays a roll, too. As people grow older, physiological changes begin to adversely affect both sleep quality and sleep duration. This makes the idea that robust and diverse social engagement can help us to sleep better all the more important.
Light box therapy one treatment plan for sad
Q: Each year when we switch away from daylight saving time, I get that SAD thing. I start feeling low and eventually get depressed. Why does that happen? I've read there are special lights that can help and would like to know more about that.
A: You are one of the estimated 20 million people in the United States dealing with a condition known as seasonal affective disorder, or SAD. First identified in the mid-1980s, it is a type of depression tied to the cycle of the changing seasons. In the majority of cases, SAD is triggered by the waning light at the close of the year. Symptoms often appear in autumn, peak in January and February and ease with the lengthening days of springtime. For about 10% of people, it's the spring and summer months that trigger the onset of symptoms. These differ from winter-pattern SAD.
In winter-pattern SAD, people may experience sadness, hopelessness or depression; loss of energy; lack of interest in usual activities; increased irritability; an inability to feel happiness or joy; increased sleep; difficulty rousing in the morning; increased appetite; and social withdrawal. Individuals with summer SAD often become anxious, feel restless or agitated, experience a loss of appetite and develop disordered sleep or insomnia.
The causes of either form of the disorder are not yet clear. However, light-driven chemical changes in the brain, possibly including an under- or overproduction of melatonin, are suspected to play a role. Studies have found lower levels of serotonin, a brain chemical that helps regulate mood, in people with winter-pattern SAD.
The light therapy you are asking about, known as bright light therapy, has proven beneficial for many people with winter-onset SAD. It involves daily exposure of 30 to 40 minutes to a light box. This is a device outfitted with specific types of full-spectrum bulbs that mimic natural outdoor light. Light boxes can be extremely bright and may not be appropriate for everyone. Bright light therapy is often used in combination with additional forms of treatment, including antidepressants, exercise and talk or cognitive behavior therapy.
For people who know they have SAD, planning ahead can be helpful. The cyclic nature of the condition makes this possible. It's a good idea to begin to exercise more as the summer draws to a close, as being physically active has been shown to help ease symptoms of depression. If you do use a light box, begin a few weeks before your symptoms typically appear. And if it's possible, plan a getaway during the darkest days of winter. If a visit to a sunnier location isn't possible, time off that frees you from being indoors all the time can help.
Anyone who suspects they have winter-onset SAD should see their health care provider. The symptoms overlap with several other conditions, which need to be ruled out. These can include anemia, major depression and some thyroid disorders. If SAD is the diagnosis, your doctor can help craft your individual approach to therapy and offer support throughout the winter months. If symptoms don't ease as sunlight returns, be sure to let your doctor know.
• Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health. Send your questions to askthedoctors@mednet.ucla.edu.