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4 - Circadian rhythm disorders

from SECTION 2 - SLEEP DISORDERS

Published online by Cambridge University Press:  08 August 2009

Christopher D. Fahey
Affiliation:
Northwestern University Feinberg School of Medicine, USA
Phyllis C. Zee
Affiliation:
Northwestern University Feinberg School of Medicine, USA
Harold R. Smith
Affiliation:
University of California, Irvine
Cynthia L. Comella
Affiliation:
Rush University Medical Center, Chicago
Birgit Högl
Affiliation:
Inssbruck Medical University
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Summary

Introduction

Circadian rhythms are physiologic or behavioral cycles which are generated by an internal pacemaker with an oscillatory frequency of approximately 24 hours. The most conspicuous function of circadian rhythms which have evolved in humans is the control of the sleep/wake cycle, with wakefulness commonly promoted during daylight hours and sleep promoted during evening hours. When abnormalities in the phase relationship between the endogenous circadian system and the exogenous light/dark cycle occur, circadian rhythm sleep disorders may ensue. Circadian rhythm sleep disorders are thus defined by this desynchronization and result in a sleep/wake schedule at odds with societal norms or work schedules, with consequent symptoms of excessive daytime sleepiness, insomnia, or an impairment of social, occupational, or academic functioning.

Six currently recognized circadian rhythm sleep disorders exist. The delayed sleep phase type, the advanced sleep phase type, the non-24-hour sleep/wake syndrome, and the irregular sleep/wake rhythm all entail a primary abnormality of an individual's circadian system. The other two circadian rhythm sleep disorders, shift work sleep disorder and jet lag disorder, involve an alteration in the light/dark or social-activity cycles of the surrounding environment which conflicts with the individual's intrinsic circadian timing. Considerable advances in the understanding of the genetic, physiologic, and anatomic basis of circadian rhythms have led to new insights into the pathophysiology of these disorders. This chapter will discuss circadian rhythms and the known factors which influence them as well as provide an update on the evaluation and treatments of the six circadian rhythm sleep disorders.

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Chapter
Information
Sleep Medicine , pp. 56 - 77
Publisher: Cambridge University Press
Print publication year: 2008

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References

Alessi, CA, Martin, JL, Webber, AP, et al. Randomized, controlled trial of a nonpharmacological intervention to improve abnormal sleep/wake patterns in nursing home residents. J Am Geriatr Soc 2005; 53:803–10.CrossRefGoogle ScholarPubMed
American Academy of Sleep Medicine. The International Classification of Sleep Disorders: Diagnostic and Coding Manual, 2nd edn (ICSD-2). Westchester, IL: American Academy of Sleep Medicine, 2005.
Barion, AZee, PC. A clinical approach to circadian rhythm sleep disorders. Sleep Med 2007; 8:566–77.CrossRefGoogle ScholarPubMed
Bellingham, J, Foster, RG. Opsins and mammalian photoentrainment. Cell Tissue Res 2002; 309:57–71.CrossRefGoogle Scholar
Burgess, HJ, Crowley, SJ, Gazda, CJ, Fogg, LF, Eastman, CI. Preflight adjustment to eastward travel: 3 days of advancing sleep with and without morning bright light. J Biol Rhythms 2003; 18:318–28.CrossRefGoogle ScholarPubMed
Czeisler, CA, Allan, JS, Strogatz, SH, et al. Bright light resets the human circadian pacemaker independent of the timing of the sleep-wake cycle. Science 1986; 233:667–71.CrossRefGoogle ScholarPubMed
Czeisler, CA, Johnson, MP, Duffy, JF, et al. Exposure to bright light and darkness to treat physiologic maladaptation to night work. N Engl J Med 1990; 322:1253–9.CrossRefGoogle Scholar
Dagan, Y, Yovel, I, Hallis, D, Eisenstein, M, Raichik, I. Evaluating the role of melatonin in the long-term treatment of delayed sleep phase syndrome (DSPS). Chronobiol Int 1998; 15:181–90.CrossRefGoogle Scholar
Dijk, DJ, Lockley, SW. Integration of human sleep-wake regulation and circadian rhythmicity. J Appl Physiol 2002; 92:852–62.CrossRefGoogle ScholarPubMed
Eastman, CI, Stewart, KT, Mahoney, MP, Liu, L, Fogg, LF. Dark goggles and bright light improve circadian rhythm adaptation to night-shift work. Sleep 1994; 17:535–43.CrossRefGoogle Scholar
Fahey, CD, Zee, PC. Circadian rhythm sleep disorders and phototherapy. Psychiatr Clin North Am 2006; 29:989–1007; abstract ix.CrossRefGoogle ScholarPubMed
Herxheimer, A.Jet lag. Clin Evid 2005; 13:2178–83.Google Scholar
Lu, BS, Zee, PC. Circadian rhythm sleep disorders. Chest 2006; 130:1915–23.CrossRefGoogle Scholar
Manthena, P, Zee, PC. Neurobiology of circadian rhythm sleep disorders. Curr Neurol Neurosci Rep 2006; 6:163–8.CrossRefGoogle ScholarPubMed
Rosenthal, NE, Joseph-Vanderpool, JR, Levendosky, AA, et al. Phase-shifting effects of bright morning light as treatment for delayed sleep phase syndrome. Sleep 1990; 13:354–61.Google Scholar
Sack, RL, Brandes, RW, Kendall, AR, Lewy, AJ. Entrainment of free-running circadian rhythms by melatonin in blind people. N Engl J Med 2000; 343:1070–7.CrossRefGoogle ScholarPubMed
Shochat, T, Martin, J, Marler, M, Ancoli-Israel, S. Illumination levels in nursing home patients: effects on sleep and activity rhythms. J Sleep Res 2000; 9:373–9.CrossRefGoogle ScholarPubMed
Weitzman, ED, Czeisler, CA, Coleman, RM, et al. Delayed sleep phase syndrome: a chronobiological disorder with sleep-onset insomnia. Arch Gen Psychiatry 1981; 38:737–46.CrossRefGoogle ScholarPubMed
Wyatt, JK. Delayed sleep phase syndrome: pathophysiology and treatment options. Sleep 2004; 27:1195–203.CrossRefGoogle Scholar
Wyatt, JK, Dijk, DJ, Cecco, Ritz-De A, Ronda, JM, Czeisler, CA. Sleep-facilitating effect of exogenous melatonin in healthy young men and women is circadian-phase dependent. Sleep 2006; 29:609–18.CrossRefGoogle Scholar
Zee, PC, Manthena, P. The brain's master circadian clock: implications and opportunities for therapy of sleep disorders. Sleep Med Rev 2007; 11:59–70.CrossRefGoogle ScholarPubMed

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