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Circadian Rhythm Sleep Disorders
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Circadian rhythm sleep disorders are characterized by an alteration of the phase relationship between the intrinsic circadian system and the extrinsic light- dark cycle that results in complaints of insomnia and excessive sleepiness. Under entrainment to the 24-hour day-night cycle, the sleep-wake pattern may assume various phase relationships to the circadian pacemaker by abnormally long or short intervals between the dim light melatonin onset (DLMO) or the core body temperature (peak time) and wake-up time. Delayed and advanced sleep phase disorders may be associated with shifted circadian rhythms (body clock). Those with ‘weak’ circadian rhythms need a very bright stimulus of light to reset their body clock every day. Treatments 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. This article introduces the clinical approach to the diagnosis and management of the various circadian rhythm sleep disorders, including delayed and advanced sleep phase disorders, shift worker, and jet lag.
Abstract
Circadian rhythm sleep disorders are characterized by an alteration of the phase relationship between the intrinsic circadian system and the extrinsic light- dark cycle that results in complaints of insomnia and excessive sleepiness. Under entrainment to the 24-hour day-night cycle, the sleep-wake pattern may assume various phase relationships to the circadian pacemaker by abnormally long or short intervals between the dim light melatonin onset (DLMO) or the core body temperature (peak time) and wake-up time. Delayed and advanced sleep phase disorders may be associated with shifted circadian rhythms (body clock). Those with ‘weak’ circadian rhythms need a very bright stimulus of light to reset their body clock every day. Treatments 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. This article introduces the clinical approach to the diagnosis and management of the various circadian rhythm sleep disorders, including delayed and advanced sleep phase disorders, shift worker, and jet lag.
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