Circadian rhythm disorders ashansiam February 27, 2022

Circadian rhythm disorders

  • Circadian rhythm sleep disorders are a group of sleep disorders where the main problem lies in the disruption in the timing of sleep. Circadian rhythm is the name given to your body’s 24-hour “internal clock.” This internal clock controls your body’s sleep-wake cycle.
  • The “internal clock” is kept in line with the 24-hour day by a control system in the brain, in a special area called the hypothalamus. It also gets visual cues from light, especially from sunlight, physical activity, and social behaviors.
  • Circadian rhythm sleep disorders involve problems such as difficulty in falling asleep at socially accepted times, struggle to stay asleep and often wake up several times during the sleep cycle or wake up too early and not being able to go back to sleep.
  • Poor sleep hygiene will make this group of disorders worse and difficult to treat.
  • This group of disorders will lead to insomnia, excessive sleepiness in the daytime, depression, sleep loss, stress in relationships, poor school and work performance and inability to meet social needs.
Types of circadian rhythm disorders
  • Delayed Sleep Phase Disorder
    • If you have this sleep disorder, the body clock has been pushed late and you will find difficulty in falling asleep at times considered normal.
    • The normal sleep time will be late, such as the early hours of the morning. The wake up time will be after the normal hours of sleep and would be in the afternoon.
    • As long as you are allowed to sleep in this pattern you will feel fine. However, as you have to wake up to keep time with the rest of the world, such as for schooling or work, you struggle with falling asleep and waking up on time. This pattern is most commonly seen in adolescents and young adults.
  • Advanced Sleep Phase Disorder
    • In this condition you tend to fall asleep early in the evening and wake up in the very early hours of the morning.
    • You typically complain of early morning awakening or insomnia and are sleepy in the late afternoon or early evening.
    • It is most commonly seen in the middle age and older adults.
  • Jet Lag
    • The internal clock in the body gets disturbed when two or more world time zones are crossed. This causes problems in people who have to fly frequently for work and need to stay alert in the new time zones before the body has had time to adjust to the new times.
    • Eastward travel is more difficult than westward travel because it is easier to delay sleep than to advance sleep.
    • Common features of jet lag are change in appetite, altered bowel habits and indigestion, fatigue, change in mood and feeling of discomfort etc.
  • Shift Work Disorder
    • This is seen in professions where the shift rotates frequently or where there is work at night. These work schedules conflict with your body’s natural circadian rhythm, making it difficult to adjust to the change.
    • Shift work disorder is identified by a constant or recurrent pattern of sleep interruption that results in insomnia or excessive sleepiness. This will result in loss of good quality sleep and inefficiency at work. It may pose a threat to the patient as well to his work.
    • Irregular sleep-wake rhythm
    • People who have this disorder have no regular sleep wake cycle duration. The circadian pattern will be erratic resulting in irregular sleep wake rhythms. This will result in both insomnia and excessive sleepiness.
    • This disorder is more commonly seen in people with neurological conditions such as dementia, in nursing home residents, in children with intellectual disabilities and in those with traumatic injuries to the brain.
  • Non-24-hour sleep-wake syndrome
    • If you have this sleep disorder, you keep your same length of sleep and awake time, but your “internal clock” is longer than 24 hours.
    • The time of sleep onset changes gradually over days and at one time you may end up having your sleep period in the daytime.
    • This irregular sleep pattern can be quite disruptive to a normal lifestyle.
    • This disorder occurs most commonly in blind people but may be seen in some sighted people as well.
How are circadian rhythm sleep disorders diagnosed?
  • The diagnosis of circadian rhythm sleep disorders can be challenging.
  • Tools such sleep diary, actigraphy as well as polysomnography to exclude other sleep disorders will be helpful.
  • Measurement of core body temperature and serial salivary melatonin are done in specialized centers to define a person’s circadian rhythm.
How are circadian rhythm sleep disorders treated?
  • Treatment options for circadian rhythm sleep disorders vary based on the type of disorder and the degree to which it affects your quality of life.
  • Treatment options include,
    • Lifestyle and behavior therapy (to improve sleep habits and to correct malpractices).
    • Bright light therapy (used to advance or delay sleep depending on the timing of light to reset the body clock).
    • Medications (prescribed by a specialist after proper evaluation).
    • Chronotherapy (to progressively advance or delay the sleep cycle).
error: Content is protected !!