Sleep doctors’ orders: Use standard time 365 days a year

Timothy M. Smith , Contributing News Writer

Don’t fall back. Don’t spring forward. Don’t even touch the clock unless the power goes out.

That seems to be message from the country’s physicians as this Sunday most Americans  will lose an hour of sleep when clocks “fall back” to standard time from daylight saving time (DST). But the semiannual ritual of adjusting the time by an hour isn’t just an annoyance, they say.

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In a position statement published in the Journal of Clinical Sleep Medicine, the American Academy of Sleep Medicine (AASM) is unequivocal in advocating elimination of daylight saving time, the practice of setting clocks ahead one hour between mid-March and early November.

“The U.S. should eliminate seasonal time changes in favor of a national, fixed, year-round time,” says the position statement, adding that “current evidence best supports the adoption of year-round standard time, which aligns best with human circadian biology and provides distinct benefits for public health and safety.”

An online survey of 2,005 adults conducted on behalf of AASM in March found that 64% of Americans  support eliminating seasonal time changes.

Last year, the AMA House of Delegates also moved to support ending DST.

“For far too long, we’ve changed our clocks in pursuit of daylight, while incurring public health and safety risks in the process. Committing to standard time has health benefits and allows us to end the biannual tug of war between our biological and alarm clocks,” said AMA Trustee Alexander Ding, MD, MA, MBA, a diagnostic and interventional radiologist.

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Studies have shown the transition from standard time to daylight saving time in the spring is associated with more cardiovascular morbidity. In addition, the spring transition triggers missed medical appointments and more emergency department and hospital return visits, but the reversion in the fall doesn’t.

“Many people's circadian rhythms are somewhat resilient, but if you're going to make a change, it would be much more favorable to go with standard time,” said Patrick J. Strollo, MD, a sleep-apnea researcher and pulmonologist and professor of medicine and clinical and translational science at the University of Pittsburgh. Dr. Strollo also represents the AASM in the AMA House of Delegates.

Daylight saving time has been a national standard since Congress passed the Uniform Time Act of 1966. U.S. law allows states to opt out of it, but only two—Hawaii and Arizona—have claimed the exemption.

“While broad support exists for the elimination of the spring and fall time changes, proposed solutions are conflicting: Some states have introduced legislation proposing variations of permanent DST, and a nearly equal number of states have introduced legislation to establish permanent standard time,” says the AASM position statement.

Originally published in 2020, the AASM position statement has since been endorsed by, among others, the:

  • American Academy of Cardiovascular Sleep Medicine.
  • American Academy of Dental Sleep Medicine.
  • American Association of Sleep Technologists.
  • American College of Chest Physicians.
  • American College of Occupational and Environmental Medicine.
  • National Safety Council.
  • Society of Anesthesia and Sleep Medicine.
  • Society of Behavioral Sleep Medicine.
  • World Sleep Society.

Moving to either permanent standard time or permanent DST nationwide would require congressional approval. In 2022, the U.S. Senate passed a bill to establish permanent DST, but there is a lot of daylight between that version and the AMA-endorsed approach. Twenty states have endorsed year-round DST, but Congress must act for the changes to take effect.

“Eliminating the time changes in March and November would be a welcome change. But research shows permanent daylight saving time overlooks potential health risks that can be avoided by establishing permanent standard time instead,” the AMA’s Dr. Ding said. “Sleep experts are alarmed. Issues other than patient health are driving this debate. It’s time that we wake up to the health implications of clock setting.”

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With Congress unlikely to act soon on the issue, experts suggest that their physician colleagues keep an eye out for patients who may be struggling with the time change.

“Patients generally don't seek advice about how to deal with it, but particularly as we get older, we're less able to tolerate circadian time shifts,” said Alejandro D. Chediak, MD, professor of medicine and associate chief of clinical affairs in the Division of Pulmonary, Critical Care and Sleep Medicine at the University of Miami Miller School of Medicine. Dr. Chediak also represents the AASM in the AMA House of Delegates.

“If we remain stuck in this twilight zone of daylight saving time oscillating with standard time, making the change more gradually can help,” he said, noting that physicians could be proactive with patients. “So instead of making the one-hour change all at once, you can do it by 15 minutes a day for four days prior to the change.”