Article

A clinical approach to circadian rhythm sleep disorders

Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Sleep Medicine (Impact Factor: 3.15). 09/2007; 8(6):566-77. DOI: 10.1016/j.sleep.2006.11.017
Source: PubMed

ABSTRACT

Circadian rhythm sleep disorders are characterized by complaints of insomnia and excessive sleepiness that are primarily due to alterations in the internal circadian timing system or a misalignment between the timing of sleep and the 24-h social and physical environment. In addition to physiological and environmental factors, maladaptive behaviors often play an important role in the development of many of the circadian rhythm sleep disorders. This review will focus on the clinical approach to the diagnosis and management of the various circadian rhythm sleep disorders, including delayed sleep phase disorder, advanced sleep phase disorder, non-entrained type, irregular sleep-wake rhythm, shift work sleep disorder and jet lag disorder. Diagnostic tools such as sleep diaries and wrist activity monitoring are often useful in confirming the diagnosis. Because behavioral and environmental factors often are involved in the development of these conditions, a multimodal approach is usually necessary. Interventions include sleep hygiene education, timed exposure to bright light as well as avoidance of bright light at the wrong time of the day and pharmacologic approaches, such as melatonin. However, it should be noted that the use of melatonin is not an FDA-approved indication for the treatment of circadian rhythm sleep disorders.

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Available from: Phyllis C Zee, Feb 04, 2014
    • "For optimal efficacy, LT should be combined with dim light in the evening (Hoban & Sulzman, 1985). Compliance is a problem in LT (Barion & Zee, 2007). Long durations (>1 hr) of light exposure are often hard for patients to accomplish in their daily routines. "
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    ABSTRACT: Delayed sleep phase disorder (DSPD) is common among young people, but there is still no evidence-based treatment available. In the present study, the feasibility of cognitive behavioral therapy (CBT) was evaluated as an additive treatment to light therapy (LT) in DSPD. A randomized controlled trial with participants aged 16 to 26 years received LT for two weeks followed by either four weeks of CBT or no treatment (NT). LT advanced sleep-wake rhythm in both groups. Comparing LT+CBT with LT+NT, no significant group differences were observed in the primary endpoints. Although anxiety and depression scores were low at pretreatment, they decreased significantly more in LT+CBT compared to LT+NT. The results are discussed and some suggestions are given for further studies.
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    • "Light as a therapeutic intervention for circadian-based sleep and medical disorders ( " phototherapy " ) is most commonly prescribed to occur before normal wake time or after normal bed time (Morgenthaler et al., 2007). While highly efficacious in theory, this type of therapy has poor effectiveness because compliance is low and, when compliance is adhered to, the therapy leads to chronic sleep deprivation (Bjorvatn and Pallesen, 2009; Barion and Zee, 2007). Our demonstration of effective light treatment during sleep without gross interference of sleep opens new avenues of therapy because the light treatment is nonintrusive and requires no change in behavior from the recipient. "
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    • "Because of this delay the adolescent is often not able to initiate sleep at their desired time [10]. This mismatch between the desired sleep time and the circadian rhythm commonly leads to secondary insomnia-type symptoms, such as increased sleep onset latency, and in particular increased cognitive arousal [10] [13] [14]. Cognitive treatments have been applied to samples of adolescents with DSPD (e.g., cognitive restructuring, mindfulness-based stress reduction) [10] [14], however, the field is limited in its understanding of the cognitive aetiological factors associated with DSPD in adolescents [15]. "
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