Circadian Rhythm Sleep Disorders Clinical Trials, Diagnosis, and Treatment

Browse All Available Clinical Trials

Join Now to be Notified of New Clinical Trials

View Information and Clinical Trials for Other Conditions

Circadian Rhythm Sleep Disorders

Circadian rhythm sleep disorders are a family of sleep disorders affecting the timing of sleep. People with circadian rhythm sleep disorders are unable to sleep and wake at the times required for normal work, school, and social needs. They are generally able to get enough sleep if allowed to sleep and wake at the times dictated by their body clocks. Unless they have another sleep disorder, their sleep is of normal quality.

Humans have biological rhythms, known as circadian rhythms, which are controlled by a biological clock and work on a daily time scale. Due to the circadian clock, sleepiness does not continuously increase as time passes. A person's desire and ability to fall asleep is influenced by both the length of time since the person woke from an adequate sleep (homeostasis), and by internal circadian rhythms. Thus, the body is ready for sleep and for wakefulness at different times of the day.

Current Research

For current research articles click - here

Types of Circadian Rhythm Sleep Disorders

The circadian rhythm sleep disorders are:

Extrinsic Type:

Jet lag, which affects people who travel across several time zones.
Shift work sleep disorder, which affects people who work nights or rotating shifts.

Intrinsic Type:

Delayed sleep phase syndrome (DSPS), which causes a much later than normal timing of sleep onset and offset and a period of peak alertness in the middle of the night.
Advanced sleep phase syndrome (ASPS), which causes difficulty staying awake in the evening and staying asleep in the morning.
Non-24-hour sleep-wake syndrome (Non-24), which causes the affected individual's sleep to occur later and later each day, with the period of peak alertness also continuously moving around the clock from day to day.
Irregular sleep-wake pattern, which presents as sleeping at very irregular times, and usually more than once per day (waking frequently during the night and taking naps during the day) but with total time asleep typical for the person's age.

Normal Circadian Rhythms

Among people with healthy circadian clocks, there is a continuum of chronotypes from "larks" or "morning people" who prefer to sleep and wake early, to "owls" who prefer to sleep and wake at late times. Whether they are larks or owls, people with normal circadian systems:

Can wake in time for what they need to do in the morning, and fall asleep at night in time to get enough sleep before having to get up.
Can sleep and wake up at the same time every day, if they want to.
Will, after starting a new routine which requires they get up earlier than usual, start to fall asleep at night earlier within a few days. For example, someone who is used to sleeping at 1 am and waking up at 9 a.m. begins a new job on a Monday, and must get up at 6 a.m. to get ready for work. By the following Friday, the person has begun to fall asleep at around 10 p.m., and can wake up at 6 a.m. feeling well-rested. This adaptation to earlier sleep/wake times is known as "advancing the sleep phase." Healthy people can advance their sleep phase by about one hour each day.

Researchers have placed volunteers in caves or special apartments for several weeks without clocks or other time cues. Without time cues, the volunteers tended to go to bed an hour later and to get up about an hour later each day. These experiments appeared to demonstrate that the "free-running" circadian rhythm in humans was about 25 hours long. However, these volunteers were allowed to control artificial lighting and the light in the evening caused a phase delay. More recent research shows that adults of all ages free-run at an average of 24 hours and 11 minutes. To maintain a 24 hour day/night cycle, the biological clock needs regular environmental time cues, e.g. sunrise, sunset, and daily routine. Time cues keep the normal human circadian clock aligned with the rest of the world.

Circadian Rhythm Abnormalities

Persistent circadian rhythm sleep disorders such as Non-24-hour sleep-wake syndrome are believed to be caused by a reduced ability to reset the sleep/wake cycle in response to environmental time cues. For example, these individuals' circadian clocks might have an unusually long cycle, or might not be sensitive enough to time cues. People with DSPS, which is more common, do entrain to nature's 24 hours, but are unable to sleep and awaken at socially acceptable times, sleeping instead, for example, from 4 a.m. to noon.

(adapted from Wikipedia, the free encyclopedia http://en.wikipedia.org/wiki/Circadian_rhythm_sleep_disorder)

Findings From Current Research

Circadian Rhythm Sleep Disorders: Part I, Basic Principles, Shift Work and Jet Lag Disorders. An American Academy of Sleep Medicine Review

Authors: Sack RL, Auckley D, Auger RR, Carskadon MA, Wright KP Jr, Vitiello MV, Zhdanova IV; American Academy of Sleep Medicine.

Department of Psychiatry, Oregon Health Sciences University, Portland, OR, USA.

OBJECTIVE: This the first of two articles reviewing the scientific literature on the evaluation and treatment of circadian rhythm sleep disorders (CRSDs), employing the methodology of evidence-based medicine. In this first part of this paper, the general principles of circadian biology that underlie clinical evaluation and treatment are reviewed. We then report on the accumulated evidence regarding the evaluation and treatment of shift work disorder (SWD) and jet lag disorder (JLD). METHODS: A set of specific questions relevant to clinical practice were formulated, a systematic literature search was performed, and relevant articles were abstracted and graded. RESULTS: A substantial body of literature has accumulated that provides a rational basis the evaluation and treatment of SWD and JLD. Physiological assessment has involved determination of circadian phase using core body temperature and the timing of melatonin secretion. Behavioral assessment has involved sleep logs, actigraphy and the Morningness-Eveningness Questionnaire (MEQ). Treatment interventions fall into three broad categories: 1) prescribed sleep scheduling, 2) circadian phase shifting ("resetting the clock"), and 3) symptomatic treatment using hypnotic and stimulant medications. CONCLUSION: Circadian rhythm science has also pointed the way to rational interventions for the SWD and JLD, and these treatments have been introduced into the practice of sleep medicine with varying degrees of success. More translational research is needed using subjects who meet current diagnostic criteria.

Journal: Sleep. 2007 Nov 1;30(11):1460-83.
Adapted from PubMed; click here to access full journal article.

Circadian Rhythm Sleep Disorders: Part II, Advanced Sleep Phase Disorder, Delayed Sleep Phase Syndrome, Free-Running Disorder, and Irregular Sleep-Wake Rhythm. An American Academy of Sleep Medicine Review

OBJECTIVE: This the second of two articles reviewing the scientific literature on the evaluation and treatment of circadian rhythm sleep disorders (CRSDs), employing the methodology of evidence-based medicine. We herein report on the accumulated evidence regarding the evaluation and treatment of Advamced Sleep Phase Disorder (ASPD), Delayed Sleep Phase Syndrome (DSPD), Free-Running Disorder (FRD) and Irregular Sleep-Wake Rhythm ISWR). METHODS: A set of specific questions relevant to clinical practice were formulated, a systematic literature search was performed, and relevant articles were abstracted and graded. RESULTS: A substantial body of literature has accumulated that provides a rational basis the evaluation and treatment of CRSDs. Physiological assessment has involved determination of circadian phase using core body temperature and the timing of melatonin secretion. Behavioral assessment has involved sleep logs, actigraphy and the Morningness-Eveningness Questionnaire (MEQ). Treatment interventions fall into three broad categories: 1) prescribed sleep scheduling, 2) circadian phase shifting ("resetting the clock"), and 3) symptomatic treatment using hypnotic and stimulant medications. CONCLUSION: Circadian rhythm science has also pointed the way to rational interventions for CRSDs and these treatments have been introduced into the practice of sleep medicine with varying degrees of success. More translational research is needed using subjects who meet current diagnostic criteria.

Journal: Sleep. 2007 Nov 1;30(11):1484-501.
Adapted from PubMed; click here to access full journal article.

Practice Parameters for the Clinical Evaluation and Treatment of Circadian Rhythm Sleep Disorders. An American Academy of Sleep Medicine Report

Authors: Morgenthaler TI, Lee-Chiong T, Alessi C, Friedman L, Aurora RN, Boehlecke B, Brown T, Chesson AL Jr, Kapur V, Maganti R, Owens J, Pancer J, Swick TJ, Zak R; Standards of Practice Committee of the American Academy of Sleep Medicine.

Mayo Sleep Disorders Center, Mayo Clinic, Rochester, MN, USA.

The expanding science of circadian rhythm biology and a growing literature in human clinical research on circadian rhythm sleep disorders (CRSDs) prompted the American Academy of Sleep Medicine (AASM) to convene a task force of experts to write a review of this important topic. Due to the extensive nature of the disorders covered, the review was written in two sections. The first review paper, in addition to providing a general introduction to circadian biology, addresses "exogenous" circadian rhythm sleep disorders, including shift work disorder (SWD) and jet lag disorder (JLD). The second review paper addresses the "endogenous" circadian rhythm sleep disorders, including advanced sleep phase disorder (ASPD), delayed sleep phase disorder (DSPD), irregular sleep-wake rhythm (ISWR), and the non-24-hour sleep-wake syndrome (nonentrained type) or free-running disorder (FRD). These practice parameters were developed by the Standards of Practice Committee and reviewed and approved by the Board of Directors of the AASM to present recommendations for the assessment and treatment of CRSDs based on the two accompanying comprehensive reviews. The main diagnostic tools considered include sleep logs, actigraphy, the Morningness-Eveningness Questionnaire (MEQ), circadian phase markers, and polysomnography. Use of a sleep log or diary is indicated in the assessment of patients with a suspected circadian rhythm sleep disorder (Guideline). Actigraphy is indicated to assist in evaluation of patients suspected of circadian rhythm disorders (strength of recommendation varies from "Option" to "Guideline," depending on the suspected CRSD). Polysomnography is not routinely indicated for the diagnosis of CRSDs, but may be indicated to rule out another primary sleep disorder (Standard). There is insufficient evidence to justify the use of MEQ for the routine clinical evaluation of CRSDs (Option). Circadian phase markers are useful to determine circadian phase and confirm the diagnosis of FRD in sighted and unsighted patients but there is insufficient evidence to recommend their routine use in the diagnosis of SWD, JLD, ASPD, DSPD, or ISWR (Option). Additionally, actigraphy is useful as an outcome measure in evaluating the response to treatment for CRSDs (Guideline). A range of therapeutic interventions were considered including planned sleep schedules, timed light exposure, timed melatonin doses, hypnotics, stimulants, and alerting agents. Planned or prescribed sleep schedules are indicated in SWD (Standard) and in JLD, DSPD, ASPD, ISWR (excluding elderly-demented/nursing home residents), and FRD (Option). Specifically dosed and timed light exposure is indicated for each of the circadian disorders with variable success (Option). Timed melatonin administration is indicated for JLD (Standard); SWD, DSPD, and FRD in unsighted persons (Guideline); and for ASPD, FRD in sighted individuals, and for ISWR in children with moderate to severe psychomotor retardation (Option). Hypnotic medications may be indicated to promote or improve daytime sleep among night shift workers (Guideline) and to treat jet lag-induced insomnia (Option). Stimulants may be indicated to improve alertness in JLD and SWD (Option) but may have risks that must be weighed prior to use. Modafinil may be indicated to improve alertness during the night shift for patients with SWD (Guideline).

Journal: Sleep. 2007 Nov 1;30(11):1445-59.
Adapted from PubMed; click here to access full journal article.

Circadian Rhythm Sleep Disorders Following Mild Traumatic Brain Injury

Authors: Ayalon L, Borodkin K, Dishon L, Kanety H, Dagan Y.

Department of Psychiatry, University of California San Diego and Veterans Affairs San Diego Healthcare System, San Diego, CA 92161, USA. layalon@ucsd.edu

OBJECTIVE: To describe the physiologic and behavioral characteristics of circadian rhythm sleep disorders (CRSDs) following minor traumatic brain injury (mTBI) in patients complaining of insomnia. METHODS: Forty two patients with insomnia complaints following mTBI were screened. Those suspected of having CRSD underwent actigraphy, saliva melatonin and oral temperature measurement, and polysomnography. All patients also filled out a self-reported questionnaire to determine their circadian preference. RESULTS: Fifteen of the 42 patients (36%) with complaints of insomnia following mTBI were diagnosed with CRSD. Eight patients displayed a delayed sleep phase syndrome (DSPS), whereas seven displayed an irregular sleep-wake pattern (ISWP). Whereas all patients with DSPS exhibited a 24-hour periodicity of oral temperature rhythm, three of seven patients with ISWP lacked such a daily rhythm. In addition, ISWP patients exhibited smaller amplitude of oral temperature rhythm vs the DSPS group. Subjective Morningness-Eveningness Questionnaire scores were in accordance with the clinical diagnosis of DSPS or ISWP based on actigraphy. CONCLUSIONS: Minor traumatic brain injury might contribute to the emergence of circadian rhythm sleep disorders. Two types of these disorders were observed: delayed sleep phase syndrome and irregular sleep-wake pattern. The types differed in the subjective questionnaire scores and had distinct profiles of melatonin and temperature circadian rhythms.

Journal: Neurology. 2007 Apr 3;68(14):1136-40.
Adapted from PubMed; click here to access full journal article.

A Clinical Approach to Circadian Rhythm Sleep Disorders

Authors: Barion A, Zee PC.

Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.

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.

Journal: Sleep Med. 2007 Sep;8(6):566-77. Epub 2007 Mar 28.
Adapted from PubMed; click here to access full journal article.

Join Now - Become a free member and get notified about studies in your area when they become available.

Browse Our Current Studies - Look over all of our current studies being conducted throughout the United States.

View Information and Clinical Trials for Other Conditions - Access all of our health-related content.