If you’ve been feeling a little off and not yourself lately, you’re not alone. You might be experiencing seasonal affective disorder (SAD). To make matters worse, we turn the clocks back Sunday, November 2, as part of daylight saving time, which means it’s going to get darker one hour earlier.

“Seasonal affective disorder is also known as seasonal depression. It's a form of depression that occurs during different seasons,” says Erin Wojewodzki, APRN, a nurse practitioner with OSF HealthCare. “There's winter onset seasonal affective disorder, which typically begins during the fall months. And then there's a summer depression, where symptoms develop during spring and summer.”

In the United States, approximately 5% of adults experience SAD. It’s typically diagnosed between the ages of 18 to 30, and it's more common in women. People with a family history of mental health challenges or depression are more likely to experience SAD. And so do people who live in areas farther away from the equator and experience more cloudier days including Alaska, Vermont and New Hampshire.

There are a range of symptoms that come with SAD, from feeling a little anxious to much more serious issues that could require medical attention.  

“The symptoms of the winter onset SAD include symptoms such as depression, feelings of guilt, and a lack of desire to do those things that you typically love doing,” says Wojewodzki. “There's a carbohydrate craving, it can impact sleep, and there can be feelings of suicidal ideation or thoughts.” 

Experts aren’t sure what causes SAD. Most theories revolve around a lack of sunlight and sun exposure. 

“We have this biological clock within us that's used to so much sunlight in the wintertime – that changes,” says Wojewodzki. “It gets darker earlier, and that can impact our mood, our sleep, our hormones, and lead to some of these symptoms.” 

Another issue is vitamin D deficiency. Sunlight helps boost vitamin D, which helps improve serotonin levels. Serotonin is the hormone in charge of boosting mood. Low levels of serotonin can lead to depression.

Finally, melatonin is another hormone that impacts our sleep. When you lack sunlight it can affect your melatonin, which makes us sleepier and groggier, which is easy to do when it turns dark by late afternoon.

Talk to your health care provider 

There is no blood test or scan to diagnose SAD. Instead, your health care provider will discuss family history, review symptoms and may make a referral to a psychologist. Health care providers also use a patient questionnaire called PHQ-9, a tool that assesses degrees of depression.

“We look at things like, are you having symptoms of depression?” says Wojewodzki. “Are those symptoms of depression occurring during a specific time of the year, every year, and have those symptoms occurred two or more times during a specific season where you've experienced these feelings?” 

A treatment plan is tailored specifically for each patient. Wojewodzki says that plan might include light therapy that can boost serotonin. Getting outside as often as possible can help. Your provider may recommend taking Vitamin D supplements or prescribe antidepressant medications until spring arrives. Medication called selective serotonin reuptake inhibitors (SSRIs) can improve mood by managing serotonin levels in your body. Finally, spend time with people you enjoy, which can boost your mood.

Dealing with changes that winter brings can be tough on anyone, especially those who suffer from SAD. But by sticking to your treatment plan, caring for yourself and planning ahead, Wojewodzki says malaise feelings can be overcome.

“If you are feeling symptoms of depression, isolation, sleep issues, gaining weight, not yourself, and especially feeling like harming yourself, I want you to reach out to your health care provider,” she says.  “We can discuss different options to you, whether that's medication or non-medication options to help you through this hard time.”

For more information on SAD or other behavioral health issues, visit the OSF HealthCare website. 



 

Interview Clips

A federal panel recently advised women get a mammogram every other year starting at age 40, rather than 50.

And the American Cancer Society estimates that in 2023, nearly 300,000 women in the United States will learn they have breast cancer. About 43,700 women will lose their life due to the disease.

The headlines are reminders to know your breast cancer risks. While many risks are out of your control, there’s just as much you can control, says Heather Thompson, a breast health navigator at OSF HealthCare.

Major risks you can control

• Active lifestyle and healthy eating: Thompson puts it plainly. If you eat junk, you’ll feel like junk. And any exercise will give you more energy and burn fat. Fat produces estrogen, which feeds cancer cells.

“You want to make sure you’re well-maintained with your weight, even after menopause,” Thompson says.

• Taking hormones: This impacts your ovaries, reducing or adding estrogen. Whether you’re at a routine appointment or you have been diagnosed with breast cancer, talk to your provider about what hormones you’re taking.

“We don’t encourage people who are having menopause symptoms [like hot flashes] to take hormones,” Thompson lists as an example. “We encourage other things to help treat those. It eliminates those estrogen cells increasing.”

• Alcohol and smoking: They are a risk for any type of cancer. But Thompson says one drink per day can increase a woman’s breast cancer risk by 12%. Alcohol is sugary, and that’s a fuel for estrogen.
   
• Night shift work: Thompson says our body expects to sleep when the sun goes down. Night work throws that off.

                “You’re getting artificial light all night. That changes the melatonin that the body naturally makes,” Thompson explains. “When your melatonin is off, it increases estrogen.”

                If you don’t work the traditional day job, see if you can work different shifts so you are not up all night all the time.

Risks you can’t control

• Age: Thompson says women generally develop breast cancer at age 50 and above. 
   
• Family history and genetic mutations: A family history of breast cancer puts you at a higher risk. Thompson says the higher risk is often seen on the person’s mother’s side of the family. For example, your mother and her sister (your aunt) may have breast cancer, and so you’d need to talk to your provider about your risk.

              Some women diagnosed with breast cancer and who have a family history may undergo a genetic test.

“Those tests can tell us if this is something being passed down from generation to generation,” Thompson says.

• Reproductive history: Young women who develop menstruation before age 12 and women who go through menopause after age 55 have an increased risk.

“That gives them a longer time with their ovaries working. They’re producing estrogen,” Thompson says.

• Dense breast: More tissue and less fat mean a dense breast and an increased cancer risk, Thompson says. Usually, the younger you are, the denser your breast is. The density of your breast is something that will be noted on every mammogram result. Thompson says mammogram technology is getting better at finding cancer in dense tissue. An early diagnosis may mean a better outcome.

Takeaways

Make sure your health care provider knows about your circumstances so they can decide on the best preventive care, like a different schedule for mammograms. Some of the information to have handy: a family history of cancer and any physical change you noticed during your monthly breast self-check.

Learn more about breast health and breast cancer care on the OSF HealthCare website.

Interview clips

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A breast cancer survivor's toolkit
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Getting plenty of sleep is vital - not only for your ability to feel well rested and alert, but also for your health and wellbeing in general. The National Institutes of Health warns a chronic lack of sleep can increase the risk for a myriad of health issues, including stroke, seizures, high blood pressure and heart disease.

For many Americans, however, sleep doesn’t always come easily. In fact, nearly 60 million Americans a year experience insomnia and wake up feeling unrefreshed. For some, getting back into a sleep routine is as easy as counting sheep. For others, it might take a bit of assistance.

Dr. Sarah Zallek is a neurologist who specializes in sleep disorders for OSF HealthCare Sleep. She says sleep disruptions can have countless causes such as personal losses, stress or sadness. The COVID-19 pandemic also impacted sleep for many.

“A huge number of people had sleep disruption during COVID, and a lot of people turned to over the counter medications or other therapies for their sleep during that time,” says Dr. Zallek. “It's not just COVID, though. I think people are more aware of sleep and its disruptions, and there's a lot of marketing out there for products and services to help sleep for better or worse.”

One sleep aid option that is becoming more popular is the use of melatonin supplements. Melatonin is a hormone your brain produces in response to darkness. It helps with the timing of your circadian rhythms and with sleep.

Melatonin can be made synthetically and is most often used as a supplement in this form. According to recent study findings published by the U.S. Centers for Disease Control and Prevention (CDC), its use is becoming more popular; melatonin sales increased 150% between 2016 and 2020.

But does melatonin really work? Dr. Zallek says while melatonin does have some value, finding the reason behind a sleep disruption is the best long term solution.

“The vast majority of us who have sleeping problems aren't going to need melatonin or a prescription sleeping pill or anything else for their sleep because we want to treat the underlying problem. But if you have trouble sleeping, melatonin might be helpful.”

In the U.S., melatonin is sold as a supplement and is not regulated as a drug. This means the U.S. Food and Drug Administration (FDA) doesn’t have oversight over the purity of ingredients or the accuracy of dosage claims. Without that oversight, Dr. Zallek warns that there might be more – or less – than you bargained for in your bottle.

“Manufacturers of something like melatonin can put a lot of different things in the bottle without necessarily being noticed. In old studies I know that they've analyzed some melatonin products and found none, and found a lot more melatonin in other products. One product had valium in it, which will definitely make you go to sleep but is not the goal. So you don't know what's in the bottle and over the counter products are risky for that reason,” she warns.

Adults aren’t alone when it comes to sporadic sleep issues. Kids can suffer from insomnia and other sleep disorders as well, and more and more often, parents are turning to melatonin to help their kids fall – and stay - asleep. Dr. Zallek admits that some pediatricians might recommend melatonin for their patients. She, however, does not, citing concern for the unknowns.

“Melatonin is widely distributed throughout the body. Melatonin is a naturally occurring substance. It's a very normal hormone that we all produce. Some of us have more or less of it, but it helps regulate our internal clock for a lot of things – including sleep – and it has some crosstalk with other hormones. We don't really know what the effect is on children who take it consistently for some time,” explains Dr. Zallek.

Because melatonin is sold as an over the counter supplement similar to vitamins, parents may think it’s safe to leave on a nightstand or within a child’s reach. Dr. Zallek cautions against that. Melatonin is often packaged in kid-enticing forms like gummies, and kids might be tempted to ingest too much without understanding the danger.

In fact, pediatric melatonin ingestions reported to U.S. poison control centers increased 530% from 2012 to 2021. Last year alone, U.S. poison control centers received more than 52,000 calls about children consuming worrisome amounts of the supplement.

“It's incredibly important to keep all medications away from kids, because even an over the counter medication is potentially dangerous,” Dr. Zallek warns. “So everything in the wrong dose is dangerous, and kids are curious creatures and might be very apt to try something that you don't know they're taking.”

Dr. Zallek urges anyone – adults and kids alike – to speak to their doctor before starting a melatonin routine for sleep. While melatonin has not been found to be habit forming, it doesn’t solve the root problem of most sleep issues. There are easy steps you can take to try to curb insomnia without medication. These include:

• Maintaining the purpose of your bed: Use your bed only for sleeping and intimacy. When you get in bed, your brain should know it’s time to go to sleep.
• Following a sleep schedule: Go to bed and wake up at the same time every day.
• Staying active: Activity is an important sleep hygiene step. However, to avoid restlessness, you should schedule this active time a few hours before you plan on going to bed.
• Scheduling meals: Avoid late dinners and late-night snacks, and limit caffeine.

Those with persistent trouble sleeping or sleeplessness should see a provider who specializes in sleep medicine.

Most people with insomnia do not need medication or a sleep test. A sleep specialist can usually help reduce the issues that might be leading to insomnia, or work around them with sleep-promoting strategies.

Interview Clips

Television host Carson Daly is the latest celebrity to try what some call sleep divorce. Couples who sleep in the same bed but are not getting that coveted seven to eight hours of shut eye will slumber with some degree of separation: in the same bed but with separate blankets, in separate beds in the same room or in separate rooms.

Daly called the move the “best thing” for his marriage during a summer episode of the Today Show.

“We both, admittedly, slept better apart,” he said.

The concept is one worth exploring for couples who are kept up by snoring, restlessness, differences in sleep schedule or other nighttime issues, says Nadeem Ahmed, MD, a pulmonologist at OSF HealthCare in Alton, Illinois.

But let’s get one thing straight.

“I don’t like the term ‘sleep divorce’ because it tends to blame other people. It’s not a good word. It brings anxiety,” Dr. Ahmed says.

“I like to use ‘sleep alliance.’ They’re working together. They’re working things out. They want to make sure it’s healthy for both bed partners and the sleep disturbances don’t affect the other partner’s life,” he says.

Have the discussion

Dr. Ahmed says he encounters sleep issues, like snoring, in his practice “almost every day,” and many people are shy about it.

Every case is different. Dr. Ahmed says couples should first talk out their sleep issues and try to find a solution. The partners could try sleeping in separate beds during the week and in the same bed on the weekend so intimacy is not completely lost. Some mattresses have different firmness, temperature and slant on each side, which can help.

If needed, the partners should talk to a pulmonologist or psychologist.

“A lot of psychologists will do similar things that a physician will do. It’s just the comfort level of the person,” Dr. Ahmed explains. “Sometimes they don’t want to go to a medical doctor for the sleep problem. They would rather talk to a psychologist.”

“The idea is to discuss it with some type of professional,” he says.

Dr. Ahmed adds that sleeping separately should be a short-term solution.

“Tell your bed partner this is an issue, and we need to address it. As opposed to just getting mad or feeling crummy or sleepy the next day,” Dr. Ahmed says, “Because it can affect your job, like if you’re a machine operator or have to drive a truck.”

A major cause

Dr. Ahmed says a big cause of the restlessness that leads to sleep alliance discussions is sleep apnea, when people stop breathing during sleep. This can lead to loud snoring or body movement in bed and crabbiness or grogginess the next day.

Dr. Ahmed says there are two types of sleep apnea: obstructive and central. Obstructive sleep apnea is a product of obesity. Central sleep apnea is associated with neurological deficits like a stroke.

“[Sleep apnea] is not fatal because our brains are hard-wired to let you go to a certain time, and then it triggers you to take a breath,” Dr. Ahmed explains.

But, if the condition is left untreated, there is a litany of possible issues: hypertension, cardiac arrhythmia, diabetes, dementia, headaches and frequent urination.

Diagnosis of sleep apnea would involve a sleep study, either in your home or at a hospital.

Treatment options include a mask and machine combination known as a CPAP or BiPAP, a mouth guard or a small device that’s implanted in your body in outpatient surgery. All those options aim to help you breathe normally and sleep peacefully.

“Along with that, we have to stress lifestyle changes,” to rid oneself of sleep apnea, Dr. Ahmed adds. “Eating healthy. Losing weight. Getting exercise.”

Over-the-counter options for better sleep include melatonin, an eye mask, earplugs, thick window curtains, a plush mattress and sheets and a white noise device like a smart speaker. Don’t eat or drink, aside from water, a couple hours before bedtime, Dr. Ahmed also advises.

Learn more

Learn more about healthy sleep on the OSF HealthCare website. If you’re having sleep problems, especially if it’s impacting your daytime life, talk to your primary care provider, a pulmonologist or a behavioral health provider.

Interview clips

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TikTok trend deemed dangerous
Catch your ZZZs
Getting a wake-up call
Chronic fatigue is nothing to sleep on
Slumber hours slump
OSF HealthCare blog entries on sleep