Sleep specialist Karin Johnson, MD, FAAN, FAASM, vice president of Save Standard Time, spreads awareness of the harmful impacts of DST.

By Chaunie Brusie, RN, BSN

While many people mark Daylight Saving Time (DST) on their calendars with a groan of annoyance, sleep physician Karin Johnson, MD, FAAN, FAASM, sees the twice-yearly time changes as something far more serious.

According to Johnson, vice president of the nonprofit Save Standard Time and co-chair of the American Academy of Sleep Medicine’s (AASM) Coalition for Permanent Standard Time steering committee, the DST changes that occur in the fall and spring are associated with a host of dangerous impacts, from worsened heart health to higher rates of depression to an increase in fatal car crashes.

For her efforts against DST, Johnson, who is also a professor of neurology at UMass Chan School of Medicine-Baystate and medical director of the Regional Sleep Medicine Program, was the co-recipient of the AASM 2023’s Mark O. Hatfield Public Policy or Advocacy Award for developing public policy that positively affects the healthy sleep of all Americans.

In 2023, she also won the Sleep Research Society Public Service Award for her work in publishing early papers and chapters on obstructive sleep apnea (OSA) and stroke, sleep apnea and headaches, treatment-emergent sleep apnea, advanced positive airway pressure (PAP) technology, the COVID-19 pandemic’s impact on sleep services, scoring and treatment of mild sleep apnea, and DST.

Save Standard Time president Jay Pea, co-recipient of the AASM’s Mark O. Hatfield Public Policy or Advocacy Award, describes Johnson as “one of the top authorities” on the science behind Standard Time.

Budding Interest in Circadian Rhythms

The circadian rhythm is often dubbed the “internal clock” that regulates everything from appetite and digestion to hormone production and sleep.

Johnson’s introduction to circadian rhythms came from none other than Charles Czeisler, PhD, MD, FRCP, Harvard’s Baldino Professor of Sleep Medicine and senior physician in the Division of Sleep and Circadian Disorders at Brigham and Women’s Hospital.

Johnson found Cziesler’s circadian rhythm course “fascinating.” That education, in combination with her exposure to pulmonary physiology from her pulmonologist-sleep specialist father, led her down her life path in sleep medicine.

Her father, Douglas C. Johnson, MD, an associate professor of medicine at Baystate Medical Center, says, “We did a research study while she was doing her neurology residency and I was director of the sleep laboratory at Spaulding Rehabilitation Hospital in Boston, which showed that bilevel PAP worsens central apneas1 during sleep. I think this helped interest her further in sleep medicine and deciding to do a sleep fellowship.”

Impacts of DST

Johnson is also the sleep chair of the American Academy of Neurology, where she set out to learn more about all the impacts of DST on sleep and overall health.

What she uncovered has led to passionately educating others about why the data supports permanent Standard Time for overall health, sleep, and circadian alignment.

Outside of more clear impacts—like sleepiness or sleep disruptions with the time change—she says it’s the more “hidden” impacts, like higher rates of heart attacks,2 cancer,3 obesity,4 and even suicide,5 tied to DST that need to be acknowledged.

Johnson points to data that emerged after Russia tried permanent DST, revealing an increase in seasonal depression and social jet lag and a decrease in both with permanent Standard Time.6

“Changing to Standard Time can help us get more aligned and improve our health, well-being, and productivity, especially for our teens and anyone who has to get up by 8 am and reduce structural disparities,” she says.

Sleep physician Karin Johnson, MD, FAAN, FAASM is vice president of the nonprofit Save Standard Time.

Saving Standard Time

According to the elder Johnson, “Karin is an ideal advocate for Standard Time because she has great knowledge, effectiveness, pertinacity, and ability to advocate and bring people and organizations to support year-round Standard Time.”

Pea, who started Save Standard Time in 2019, thought so too. He identified Johnson as the ideal person to spearhead the volunteer-run group’s efforts to expand into scientific and physician partnerships. 

Johnson “has proven invaluable in finding, gathering, and analyzing new and older scientific papers and in networking with other physicians and scientists around the world,” Pea says. “She is highly engaged in both the research community and in political advocacy. She knows well the science of sleep, as well as the workings of legislation.”

In addition to the risks of DST, the benefits of establishing permanent Standard Time are equally valid, Johnson says. “Standard Time naturally puts us in better alignment with the sun, which strengthens our circadian rhythms and increases the chance for people to get the sleep they need for the best physical and mental health, productivity, and safety,” she says. 

Johnson notes that a “critical early step” that allowed her and other advocates to more fully evaluate the topic and enhance collaboration was the Community Sleep Health and Public Awareness grant the coalition received from the American Sleep Medicine Foundation to create a video series called the Science of Clock Change, viewable on YouTube.

Along with gaining support from others in medical and scientific communities, the coalition is working alongside business and trade organizations to cosign a letter to enact permanent Standard Time to state and federal legislators. 

Some of the other efforts of the “Ditch DST” movement include:

  • an educational session for transportation industry workers and leaders;
  • voter voice campaigns for state bills;
  • Capitol Hill visits to educate legislators and find a sponsor for a federal permanent Standard Time bill;
  • speaking sessions at grand rounds, sleep conferences, and other venues to educate doctors and scientists;
  • op-eds and other writing to the lay press.

“We’re very excited about the large increase in stories and radio and TV and podcasts that are correcting the many half-truths and misconceptions that are commonly spread by permanent DST supporters,” Johnson says.

Beyond the Standard

Beyond advocating for Standard Time, Johnson maintains an interest in other ways sleep impacts health. “She is very passionate about improving access of sleep care to all,” says Joyce K. Lee-Iannotti, MD, FAASM, director of the Sleep Disorders Center at Banner University Medical Center and medical director of sleep laboratories at Banner University Medical Center and Banner Desert Medical Center.

For instance, Johnson has investigated the many health impacts of OSA, as well as the long-term impacts of the pandemic on sleep medicine, primarily how it has led to more home-based therapies and interrupted avenues of research.

There “is still a lot we need to learn” about the long-term health outcomes of OSA, specifically whether treatment with CPAP improves those risks. “We have a lot of data showing the increased risk of many disorders, such as stroke, heart disease, dementia, car crashes, hypertension, and atrial fibrillation with OSA,” she says. The problem sleep medicine researchers run into is that it’s challenging to run large studies on CPAP for OSA, which leads to a lack of confirmation in randomized trials for the efficacy of CPAP, she says.

“Work on tailoring treatments to different endotypes and phenotypes and using adaptive treatment models where CPAP isn’t the only treatment option, as well as using other trial designs, will be needed to get beyond some of these limitations and show what we see in our office every day: people’s lives being transformed by treatment of OSA,” Johnson says. “We are still a relatively new field, but I am excited by the increased interest in sleep by other fields, including the American Heart Association labeling sleep as one of Life’s Essential 8.”

“I think we will know a lot more in the next 10 years,” she adds.

Although her work with Standard Time has been “pretty all-consuming,” Johnson makes time for other work, for instance, a book chapter about restless legs syndrome pathophysiology, and even squeezes in a little downtime. She stays busy with her two children’s soccer matches and trumpet practices, as well as enjoys the occasional trip down the ski slopes. She stays active in her downtown Springfield, Mass, community, frequenting the museums and restaurants, which, perhaps with her continued efforts, may someday be accessible on Standard Time year-round.

According to Lee-Iannotti, who is also vice chair, Sleep Section, American Academy of Neurology, and director of AASM Foundation board of directors, Johnson’s efforts are making an impact that could affect life, sleep, and overall health for generations. “I admire her in so many ways and commend her for her incredible trailblazing work in circadian rhythm advocacy,” she says.

References

1. Johnson KG, Johnson DC. Bilevel positive airway pressure worsens central apneas during sleep. Chest. 2005 Oct;128(4):2141-50.

2. Sandhu A, Seth M, Gurm HS. Daylight savings time and myocardial infarction. Open Heart. 2014;1:e000019. 

3. Gu F, Xu S, Devesa SS, Zhang F, et al. Longitude position in a time zone and cancer risk in the United States. Cancer Epidemiol Biomarkers Prev. 2017 Aug;26(8):1306-11.

4. Roenneberg T, Allebrandt KV, Merrow M, Vetter C. Social jetlag and obesity. Curr Biol. 2012 May 22;22(10):939-43.

5. Berk M, Dodd S, Hallam K, et al. Small shifts in diurnal rhythms are associated with an increase in suicide: The effect of daylight saving. 2008. Sleep Bio Rhythms. 6(1):22-5.

6. Borisenkov MF, Tserne TA, Panev AS, et al. Seven-year survey of sleep timing in Russian children and adolescents: chronic 1-h forward transition of social clock is associated with increased social jetlag and winter pattern of mood seasonality. Bio Rhythm Res. 2017;48(1):3-12.

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