We spoke to an Icelandic sleep specialist about the effects of winter—and how to fight back
When I meet working psychologist and PhD student Erla Björnsdóttir, it’s already dark outside. Reykjavík’s streets are becoming treacherous as compacted snow freezes into sheets of slippery ice, and the streetlights have been lit for a couple of hours already, throughout the late afternoon. People clutch their hot drinks in the coffeehouse, and a barman lights candles on the tables. The atmosphere is tangibly hushed as the winter season hangs over the city.
Around 101’s many downtown bars and cafes, sleep issues become a common topic of conversation at this time of year. Whilst some locals carry on as normal, others spend many extra hours in bed throughout the dark Icelandic winter, rising at noon as the sky finally begins to brighten. Others still toss and turn all night, becoming strung out, unwell and drowsy.
SAD is real
“Melatonin sets the internal body clock,” Erla explains, “and morning light is important for melatonin production. In winter, people don’t see the morning light until 11am, when they’re probably in the office and too busy to look out the window. Then, when they leave for the day, it’s dark again. So they don’t have enough melatonin, which can cause sleep difficulties.”
Alongside other symptoms—such as lethargy, low moods and even full-blown depression—winter sleep dysfunction comes under the term Seasonal Affective Disorder, also known by the somewhat apt acronym SAD. A quick Googling of SAD reveals an ongoing debate within the medical community, with some doctors and psychologists questioning the existence of the condition.
“Well, it definitely exists,” says Erla, “but we need new studies to measure it. My feeling as a working psychologist is that SAD rates are high here. There are many of people suffering from a lack of energy, sleeping troubles, and a feeling of constant drowsiness in the darkest months. Right now is the peak time in my clinic—we have a long waiting list.”
SAD can get bad
SAD can cause all kinds of problems, from increased sick days at work, to an impact on people’s relationships and social lives. Erla says the rate of drop-outs at Iceland’s high schools and universities peaks in the winter as young people struggle to maintain a normal schedule, as does the number of people reporting symptoms of depression.
Depression in general, and of course SAD, can get really bad,” she explains. “People can feel unable to get out of bed at all—what would help them most is to see people or take a walk, but they really just can’t. Some people cannot get out of bed, mentally and physically, when they suffer this. So it can be serious.”
Stop the clocks
When people suffer these kinds of problems, their first port of call is often their doctor. “Icelandic people have the world record in hypnotics use,” says Erla. “Last year there were eight million sleeping tablets prescribed here, which is crazy. Sometimes it is necessary to use antidepressants, and I certainly have nothing against that. But in some age groups we have 70% using sleeping tablets, when long-term usage is very bad for your health. We need to admit that something isn’t right here—and I think the lack of daylight has something to do with it.”
With this in mind, Erla is part of a large-scale study to find out more about the sleeping habits of Icelanders in the dark months that will examine, amongst other things, whether a change to the clock might benefit those having trouble.
“We’ll send out questionnaires to 10,000 Icelandic people this January,” says Erla, “not necessarily about SAD, but about their general sleeping habits. We want to know if Icelandic people are sleeping less than those in nearby countries. The data from this study will be very helpful in deciding whether changing the Icelandic clock would be helpful.”
But with so little daylight available, how would a clock shift help? “It would move what little daylight we have to the morning,” says Erla. “We actually used to have summer and winter time here in Iceland—I think it was in 1969 when it was decided to stick to the summer time. If we changed the clock by just one hour, we’d get six more weeks of light mornings, which could really help people suffering from these problems.“
Today, we fight back
There is also a range of practical measures that sufferers can take. Erla recommends that people take lýsi (cod liver oil) or Vitamin D supplements throughout the winter, as well as simple but effective routines like exercise, socialising, balanced meals and avoiding excessive consumption of alcohol and caffeine, particularly late in the day.
“I also highly recommend SAD lamps,” she says. “There are recent studies showing very promising results. You have to make sure to use the right kind of lamp, an approved 10,000-lumen lamp, and to use it correctly, when you wake up, for half an hour. That should boost your energy and help you sleep the following night. At the sleep clinic, all of us have a lamp on our table. Between Vitamin D and sun lamps, this can help alleviate mild symptoms.”
If those measures don’t work, there are psychologists in Iceland who offer specialised treatments, such as cognitive behavioural therapy. But it can be a prohibitively pricey process. “The government doesn’t help out with the cost of these treatments,” says Erla. “I think this is one reason that we see such an abnormal level of sleep medicine usage—it’s more affordable for people to go to see the doctor and get a prescription, but it can be difficult to get into a psychologist’s office.”
Searching for solutions
Erla is also involved in a forward-thinking project that moves to remedy this via an online service for those unable to pay for private therapy. “We have a web treatment now here in Iceland at www.betrisvefn.is, also available in Norwegian at www.somnify.com. The concept is one I think we’ll see more and more in the health system—that is, internet-based interactive treatment. It’s an Icelandic entrepreneurial project by myself and two other young doctors, trying to find solutions for these problems.”
So, armed with Vitamin D supplements and sunlamps, and with new studies and an English-language self-treatment website on the way, perhaps people can sleep a little easier this winter.
Erla’s private clinic is at Sálfræðiráðgjöfin in Laugavegur and she also runs a group insomnia therapy programme at Heilsuborg.
Snow, darkness, SAD –Is it time to hibernate?
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