Daylight Saving Time - American Academy of Sleep Medicine Position Statement (October 15, 2020)
Summary
A journal article, "Daylight saving time: an American Academy of Sleep Medicine position statement," dated October 15, 2020, with Muhammad Adeel Rishi, MD, listed first among the authors. The opening abstract says an abundance of accumulated evidence indicates that the acute transition from standard time to daylight saving time incurs significant public health and safety risks, including increased risk of adverse cardiovascular events, mood disorders, and motor vehicle crashes. It states the position of the American Academy of Sleep Medicine that seasonal time changes should be abolished in favor of a fixed, national, year-round standard time. The acknowledgments list endorsing organizations, including the National PTA.
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“Daylight Saving Time - American Academy of Sleep Medicine Position Statement (October 15, 2020).”
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https://doi.org/10.5664/jcsm.8780
SPECIAL ARTICLES
Daylight saving time: an American Academy of Sleep Medicine
position statement
Muhammad Adeel Rishi, MD1; Omer Ahmed, MD2; Jairo H. Barrantes Perez, MD3; Michael Berneking, MD4; Joseph Dombrowsky, MD5;
Erin E. Flynn-Evans, PhD, MPH6; Vicente Santiago, MD7; Shannon S. Sullivan, MD8,9; Raghu Upender, MD10; Kin Yuen, MD, MS11; Fariha Abbasi-Feinberg, MD12;
R. Nisha Aurora, MD, MHS13; Kelly A. Carden, MD, MBA14; Douglas B. Kirsch, MD15; David A. Kristo, MD16; Raman K. Malhotra, MD17; Jennifer L. Martin, PhD18,19;
Eric J. Olson, MD20; Kannan Ramar, MD20; Carol L. Rosen, MD21; James A. Rowley, MD22; Anita V. Shelgikar, MD, MHPE23; Indira Gurubhagavatula, MD, MPH24,25
1
Department of Pulmonology, Critical Care and Sleep Medicine, Mayo Clinic, Eau Claire, Wisconsin; 2Department of Medicine, Division of Pulmonary, Critical Care and
Sleep Medicine, New York University School of Medicine, New York, New York; 3Baylor College of Medicine, Houston, Texas; 4Concentra, Inc., Grand Rapids, Michigan;
5
8 Hour Sleep Clinic, El Paso, Texas; 6Fatigue Countermeasures Laboratory, Human Systems Integration Division, NASA Ames Research Center, Moffett Field, California; 7Sleep
Medicine, The Permanente Medical Group, Manteca, California; 8Department of Pediatrics, Division of Pulmonary, Asthma & Sleep Medicine, Stanford University School of Medicine,
Palo Alto, California; 9Eval Research Institute, Palo Alto, California; 10Department of Neurology, Division of Sleep Medicine, Vanderbilt Medical Center, Nashville, Tennessee;
11
Sleep Disorders Center, UCSF Health, San Francisco, California; 12Sleep Medicine, Millennium Physician Group, Fort Myers, Florida; 13Department of Medicine, Rutgers Robert
Wood Johnson Medical School, New Brunswick, New Jersey; 14Saint Thomas Medical Partners - Sleep Specialists, Nashville, Tennessee; 15Sleep Medicine, Atrium Health, Charlotte,
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North Carolina; 16University of Pittsburgh, Pittsburgh, Pennsylvania; 17Sleep Medicine Center, Washington University School of Medicine, St. Louis, Missouri; 18Veteran Affairs
Greater Los Angeles Healthcare System, North Hills, California; 19David Geffen School of Medicine at the University of California, Los Angeles, California; 20Division of Pulmonary and
Critical Care Medicine, Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota; 21Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio; 22Wayne State
University, Detroit, Michigan; 23University of Michigan Sleep Disorders Center, University of Michigan, Ann Arbor, Michigan; 24Division of Sleep Medicine, Perelman School of
Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; 25Corporal Michael Crescenz VA Medical Center, Philadelphia, Pennsylvania
The last several years have seen intense debate about the issue of transitioning between standard and daylight saving time. In the United States, the annual
advance to daylight saving time in spring, and fall back to standard time in autumn, is required by law (although some exceptions are allowed under the statute). An
abundance of accumulated evidence indicates that the acute transition from standard time to daylight saving time incurs significant public health and safety risks,
including increased risk of adverse cardiovascular events, mood disorders, and motor vehicle crashes. Although chronic effects of remaining in daylight saving
time year-round have not been well studied, daylight saving time is less aligned with human circadian biology—which, due to the impacts of the delayed natural
light/dark cycle on human activity, could result in circadian misalignment, which has been associated in some studies with increased cardiovascular disease risk,
metabolic syndrome and other health risks. It is, therefore, the position of the American Academy of Sleep Medicine that these seasonal time changes should be
abolished in favor of a fixed, national, year-round standard time.
Citation: Rishi MA, Ahmed O, Barrantes Perez JH, et al. Daylight saving time: an American Academy of Sleep Medicine position statement. J Clin Sleep Med.
2020;16(10):1781–1784.
INTRODUCTION only acute personal disruptions, but significant public health
Copyright 2021 American Academy of Sleep Medicine. All rights reserved.
and safety risks.2
The American Academy of Sleep Medicine (AASM) is a pro-
fessional society that advances sleep care and enhances sleep
health to improve lives. The AASM advocates for policies that
BACKGROUND
recognize that sleep is essential to health.
The period of the year between spring and fall, when clocks Scientific, public and political debate about DST abounds. In
in most parts of the United States (U.S.) are set one hour ahead response, the European Biological Rhythms Society (EBRS),
of standard time, is called daylight saving time (DST), and European Sleep Research Society (ESRS), and Society for
its beginning and ending dates and times are set by federal Research on Biological Rhythms (SRBR) published a joint
law (the second Sunday in March at 2:00 AM and the first statement, declaring that permanent standard time is the best
Sunday in November at 2:00 AM, respectively), while the option for public health.3 In fact, the following year the SRBR
remaining period between fall and spring of the following year published the position paper, “Why Should We Abolish Day-
is called standard time.1 light Saving Time?”2 Also, the European Parliament voted to
The light/dark cycle is key in circadian entrainment. The end the mandatory DST change by 2021.4
acute alterations in timing due to transitions to and from DST In the U.S., the Congressional Research Service has iden-
contribute to misalignment between the circadian biological tified dozens of states that have introduced legislation that
clock and the light/dark cycle (or photoperiod), resulting in not would support changes to the observance of DST.5 While
Journal of Clinical Sleep Medicine, Vol. 16, No. 10 1781 October 15, 2020
MA Rishi, O Ahmed, JH Barrantes Perez, et al. Position statement: daylight saving time
broad support exists for the elimination of the spring and fall Although most acute health-related effects are noted only
time changes, proposed solutions are conflicting: Some states when transitioning from standard time to DST, transitions both
have introduced legislation proposing variations of permanent into and out of DST have been associated with sleep
DST, and a nearly equal number of states have introduced disruption,13 mood disturbances and suicide.18 Traffic accidents
legislation to establish permanent standard time. Although increase in the first few days after the change from standard
U.S. statute allows state-level exemption from DST,1 and the time to DST,19 with an increase in fatal crashes of up to 6% in
exemption was claimed by Hawaii and Arizona, moving to the United States.20
permanent DST nationwide would require legislative approval On the Monday after the transition to DST, volatility in stock
by the U.S. Congress. markets in the U.S. has been observed.21 While reasons for this
are not entirely clear, proposed mechanisms include the impact
of sleep deprivation on frontal lobe functioning, which may
result in impaired judgement and decision-making capacity.22
POSITION
It is the position of the AASM that the U.S. should eliminate Chronic effects of DST
seasonal time changes in favor of a national, fixed, year- There is little direct evidence regarding the chronic effects of
round time. Current evidence best supports the adoption of DST. Most studies have either been retrospective or have
year-round standard time, which aligns best with human addressed the issue indirectly. DST has been associated with a
circadian biology and provides distinct benefits for public decrease in crime rate, 23 and it may be associated with a modest
health and safety. overall decrease in risk of motor vehicle crashes, possibly due to
hours of daylight lasting longer in the evening when most accidents
occur, along with other, less obvious reasons.5 However, when
temporary, year-round DST was adopted in response to an
DISCUSSION
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Organization of the Petroleum Exporting Countries (OPEC) oil
embargo, increased fatalities among school-aged children in
Light is the most powerful exogenous zeitgeber, or cue, to the the morning were noted between January and April. These
regulation of the endogenous circadian rhythm.2 The human findings may be due to darkness lasting longer in the morning
circadian phase responds to light in a predictable fashion, by when children are traveling to school, while other factors
delaying phase (with endogenous biological sleep onset and also may be at play.24
offset preferences occurring at a later clock time) in the setting DST is less well-aligned with intrinsic human circadian
of both morning darkness and evening light.6 DST, therefore, physiology, and it disrupts the natural seasonal adjustment
induces phase delay by increasing the exposure to both morning of the human clock due to the effect of late-evening light on
darkness and evening light.2 the circadian rhythm.25 DST results in more darkness in the
The recommendation in support of permanent standard time morning hours, and more light in the evening hours. Both
is based on a review of existing literature that describes the early morning darkness and light in the evening have a similar
acute, adverse effects of switching between standard time and effect on circadian phase, causing the endogenous rhythm to
DST twice yearly, and the chronic effects of DST during the shift to later in the day. There is evidence that the body clock
spring, summer and fall months. does not adjust to DST even after several months. 26 Permanent
DST could therefore result in permanent phase delay, a
Acute effects of switching between standard time condition that can also lead to a perpetual discrepancy be-
and DST tween the innate biological clock and the extrinsic environ-
Copyright 2021 American Academy of Sleep Medicine. All rights reserved.
Shifting from standard time to DST has been associated mental clock, as well as chronic sleep loss due to early
with increased cardiovascular morbidity, including risk morning social demands that truncate the opportunity to sleep.
of myocardial infarction,7,8 stroke,9 and hospital admissions The chronic misalignment between the timing of demands
due to the occurrence of acute atrial fibrillation.10 An in- of work, school, or other obligations against the innate cir-
crease in missed medical appointments and increased emer- cadian rhythm is called “social jet lag.”27 Studies show that
gency room visits and return visits to the hospital are also social jet lag is associated with an increased risk of
seen only during the spring transition from standard time to obesity,28 metabolic syndrome,29 cardiovascular disease,30 and
DST.11,12 The one-hour time shift in the spring results in less depression.31 One study found that in the fall, during the shift
exposure to light in the morning and greater exposure to from DST back to standard time, there was a reduction in the
evening light. In the presence of continuing social or oc- rate of cardiovascular events,7 suggesting that the risk of
cupational demands in early morning hours, this delay re- myocardial infarction may be elevated because of chronic ef-
sults in sleep loss and resultant sleep debt,13 in addition to fects of DST.32 Social jet lag associated with DST may be worse
circadian misalignment. 2 The end result is a variety of cellular in the western-most areas within a given time zone, where sunset
derangements, including altered myocyte gene expression, 14 occurs at a later clock time.33 Adopting permanent DST also
altered epigenetic and transcriptional profile of core clock would undo the benefits of delaying start times for middle
genes,15 increased production of inflammatory markers,16 schools and high schools.34
lower vagal tone resulting in higher heart rate and blood During the 1973 OPEC oil embargo, minimal, if any, of
pressure, and reduced sleep. 17 the purported energy savings were actually observed in
Journal of Clinical Sleep Medicine, Vol. 16, No. 10 1782 October 15, 2020
MA Rishi, O Ahmed, JH Barrantes Perez, et al. Position statement: daylight saving time
the U.S., and the policy was highly unpopular, 35 especially in 10. Chudow JJ, Dreyfus I, Zaremski L, et al. Changes in atrial fibrillation
rural areas of the U.S. After a single winter, the policy was admissions following daylight saving time transitions. Sleep Med. 2020;69:
155–158.
reversed by an overwhelming congressional majority. The
11. Ellis DA, Luther K, Jenkins R. Missed medical appointments during shifts to and
unpopularity of the act was likely because, despite greater from daylight saving time. Chronobiol Int. 2018;35(4):584–588.
evening light, the policy resulted in a greater proportion of 12. Ferrazzi E, Romualdi C, Ocello M, et al. Changes in accident & emergency visits
days that required waking up on dark mornings, particularly and return visits in relation to the enforcement of daylight saving time and
in the winter. photoperiod. J Biol Rhythms. 2018;33(5):555–564.
13. Lahti TA, Leppämäki S, Lönnqvist J, Partonen T. Transitions into and out of
daylight saving time compromise sleep and the rest-activity cycles. BMC Physiol.
2008;8(1):3.
FUTURE DIRECTIONS 14. Martino TA, Tata N, Belsham DD, et al. Disturbed diurnal rhythm alters gene
expression and exacerbates cardiovascular disease with rescue by
Although the acute, adverse effects of DST are well-described, resynchronization. Hypertension. 2007;49(5):1104–1113.
few studies have evaluated the chronic effects of DST on 15. Malow BA, Veatch OJ, Bagai K. Are daylight saving time changes bad for the
physiology, performance, health, economics and safety. Such brain? JAMA Neurol. 2020;77(1):9–10.
studies should attempt to address confounding seasonal effects, 16. Wright KP Jr, Drake AL, Frey DJ, et al. Influence of sleep deprivation and
including the length of the photoperiod. In addition, more circadian misalignment on cortisol, inflammatory markers, and cytokine balance.
Brain Behav Immun. 2015;47:24–34.
studies are needed to determine how eastward or westward
17. Grimaldi D, Carter JR, Van Cauter E, Leproult R. Adverse impact of sleep
position in a time zone influences health and safety outcomes.
restriction and circadian misalignment on autonomic function in healthy young
Studies that compare the impacts of permanent standard time adults. Hypertension. 2016;68(1):243–250.
to permanent DST are also needed.36 18. Berk M, Dodd S, Hallam K, Berk L, Gleeson J, Henry M. Small shifts in diurnal
rhythms are associated with an increase in suicide: The effect of daylight saving.
Sleep Biol Rhythms. 2008;6(1):22–25.
Downloaded from jcsm.aasm.org by 170.232.227.249 on February 15, 2021. For personal use only. No other uses without permission.
CONCLUSIONS 19. Robb D, Barnes T. Accident rates and the impact of daylight saving time
transitions. Accid Anal Prev. 2018;111:193–201.
Existing data support the elimination of seasonal time 20. Fritz J, VoPham T, Wright KP Jr, Vetter C. A chronobiological evaluation of the
changes in favor of a fixed, year-round time. DST can cause acute effects of daylight saving time on traffic accident risk. Curr Biol. 2020;30(4):
729–735.e2.
misalignment between the biological clock and environmental
21. Kamstra MJ, Kramer LA, Levi MD. Losing sleep at the market: The daylight
clock, resulting in significant health and public safety-related saving anomaly. Am Econ Rev. 2000;90(4):1005–1011.
consequences, especially in the days immediately following 22. Alhola P, Polo-Kantola P. Sleep deprivation: Impact on cognitive performance.
the annual change to DST. A change to permanent standard Neuropsychiatr Dis Treat. 2007;3(5):553–567.
time is best aligned with human circadian biology and has 23. Doleac JL, Sanders NJ. Under the cover of darkness: How ambient light
the potential to produce beneficial effects for public health influences criminal activity. Rev Econ Stat. 2015;97(5):1093–1103.
and safety. 24. U. S. National Bureau of Standards. Review and technical evaluation of the
DOT Daylight Saving Time Study. Washington, DC; Government Printing Office;
1976:125-351.
25. Kantermann T, Juda M, Merrow M, Roenneberg T. The human circadian clock’s
REFERENCES seasonal adjustment is disrupted by daylight saving time. Curr Biol. 2007;17(22):
1996–2000.
1. Advancement of time or changeover dates Act of 1973, 15 U.S. Code § 260a 26. Hadlow NC, Brown S, Wardrop R, Henley D. The effects of season, daylight
2. Roenneberg T, Wirz-Justice A, Skene DJ, et al. Why should we abolish daylight saving and time of sunrise on serum cortisol in a large population. Chronobiol Int.
saving time? J Biol Rhythms. 2019;34(3):227–230. 2014;31(2):243–251.
Copyright 2021 American Academy of Sleep Medicine. All rights reserved.
3. European Biological Rhythms Society; European Sleep Research Society; 27. Roenneberg T, Kantermann T, Juda M, Vetter C, Allebrandt KV. Light and
Society for Research on Biological Rhythms. To the EU Commission on DST. the human circadian clock. Handb Exp Pharmacol. 2013;217(217):
Accessed August 26, 2020. https://esrs.eu/wp-content/uploads/2019/03/ 311–331.
To_the_EU_Commission_on_DST.pdf 28. Roenneberg T, Allebrandt KV, Merrow M, Vetter C. Social jetlag and obesity.
4. Debyser A, Pape M; European Parliamentary Research Service. Discontinuing Curr Biol. 2012;22(10):939–943.
seasonal changes of time. Published March 2019. Accessed March 14, 2020. 29. Koopman ADM, Rauh SP, van ’t Riet E, et al. The association between
https://www.europarl.europa.eu/RegData/etudes/BRIE/2018/630308/ social jetlag, the metabolic syndrome, and type 2 diabetes mellitus in
EPRS_BRI(2018)630308_EN.pdf the general population: The New Hoorn Study. J Biol Rhythms. 2017;32(4):
5. Congressional Research Service. Daylight saving time. Updated July 18, 2019. 359–368.
Accessed March 14, 2020. https://fas.org/sgp/crs/misc/R45208.pdf 30. Wong PM, Hasler BP, Kamarck TW, Muldoon MF, Manuck SB. Social jetlag,
6. Duffy JF, Czeisler CA. Effect of light on human circadian physiology. Sleep Med chronotype, and cardiometabolic risk. J Clin Endocrinol Metab. 2015;100(12):
Clin. 2009;4(2):165–177. 4612–4620.
7. Manfredini R, Fabbian F, De Giorgi A, et al. Daylight saving time and myocardial 31. Levandovski R, Dantas G, Fernandes LC, et al. Depression scores associate
infarction: should we be worried? A review of the evidence. Eur Rev Med with chronotype and social jetlag in a rural population. Chronobiol Int. 2011;28(9):
Pharmacol Sci. 2018;22(3):750–755. 771–778.
8. Janszky I, Ljung R. Shifts to and from daylight saving time and incidence of 32. Roenneberg T, Winnebeck EC, Klerman EB. Daylight saving time and artificial
myocardial infarction. N Engl J Med. 2008;359(18):1966–1968. time zones - a battle between biological and social times. Front Physiol. 2019;
9. Sipilä JO, Ruuskanen JO, Rautava P, Kytö V. Changes in ischemic stroke 10:944.
occurrence following daylight saving time transitions. Sleep Med. 2016;27-28: 33. Blume C, Schabus M. Perspective: daylight savings time - an advocacy for
20–24. balanced view and against fanning fear. Clocks Sleep. 2020;2(1):19–25.
Journal of Clinical Sleep Medicine, Vol. 16, No. 10 1783 October 15, 2020
MA Rishi, O Ahmed, JH Barrantes Perez, et al. Position statement: daylight saving time
34. Skeldon AC, Dijk DJ. School start times and daylight saving time confuse Society, Start School Later, Tennessee Sleep Society, Wisconsin Sleep Society, and
California lawmakers. Curr Biol. 2019;29(8):R278–R279. World Sleep Society.
35. Gray TR, Jenkins JA. Congress and the political economy of daylight saving
time. Hoboken, NJ: Wiley; 2018.
36. Dijk DJ, Vandewalle G, Wright KP Jr, Winnebeck E. Panel discussion. Daylight
saving time – forever? Published September 27, 2018. Accessed March 14, SUBMISSION & CORRESPONDENCE INFORMATION
2020. http://www.sleepscience.at/wp-content/uploads/2016/10/Panel-
Submitted for publication August 21, 2020
Discussion_ESRS_SUMMARY_final.pdf
Submitted in final revised form August 21, 2020
Accepted for publication August 21, 2020
Address correspondence to: M. Adeel Rishi, MD, Department of Pulmonology, Critical
ACKNOWLEDGMENTS Care and Sleep Medicine, Mayo Clinic Health System, 1221 Whipple Street, Eau Claire,
The board of directors thanks AASM staff members who assisted with the development of WI, 54703; Tel: (715) 838-1900; Email: rishi.muhammad@mayo.edu
this position statement, which has been endorsed by the following organizations: American
Academy of Cardiovascular Sleep Medicine, American Academy of Dental Sleep Medicine,
American Association of Sleep Technologists, American College of Chest Physicians
(CHEST), American College of Occupational and Environmental Medicine, California DISCLOSURE STATEMENT
Sleep Society, Dakotas Sleep Society, Kentucky Sleep Society, Maryland Sleep
Society, Michigan Academy of Sleep Medicine, Missouri Sleep Society, National PTA, The authors are the 2019–2020 members of the AASM Public Safety Committee and the
National Safety Council, Society for Research on Biological Rhythms, Society of 2019–2020 members of the AASM Board of Directors. This statement is published by the
Anesthesia and Sleep Medicine, Society of Behavioral Sleep Medicine, Southern Sleep AASM as an advisory that is to be used for educational and informational purposes only.
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Copyright 2021 American Academy of Sleep Medicine. All rights reserved.
Journal of Clinical Sleep Medicine, Vol. 16, No. 10 1784 October 15, 2020
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