Circadian rhythm sleep disorders are caused by a de-synchronization of the endogenous circadian rhythm and the light-dark cycle. Patients usually suffer from insomnia, excessive daytime sleepiness, or both, then what are usually again when the internal clock reoriented again. The diagnosis is made clinically. Treatment depends on the cause.
In disorders of circadian rhythm of endogenous sleep-wake rhythm running (internal clock) and the external light-dark cycle offset from (Desynchronisiation). The cause may be endogenously (z. B. delayed sleep phase syndrome or vorverlagertes) or topically (e. As jet lag, shift work).
Circadian rhythm sleep disorders are caused by a de-synchronization of the endogenous circadian rhythm and the light-dark cycle. Patients usually suffer from insomnia, excessive daytime sleepiness, or both, then what are usually again when the internal clock reoriented again. The diagnosis is made clinically. Treatment depends on the cause. In disorders of circadian rhythm of endogenous sleep-wake rhythm running (internal clock) and the external light-dark cycle offset from (Desynchronisiation). The cause may be endogenously (z. B. delayed sleep phase syndrome or vorverlagertes) or topically (e. As jet lag, shift work). If the cause is externally, other circadian rhythms in the body, including temperature and hormone release, asynchronous with the light-dark cycle (external desynchronization) and each other (internal desynchronization). in addition to insomnia and excessive sleepiness these changes nausea, malaise, irritability and depression can result. The risk of cardiovascular disease and metabolic disorders may also be increased. It is particularly difficult to adapt to repeated circadian shifts (z. B. due to frequent long-distance travel or rotating shift work), in particular if the layers in the direction of change in the counterclockwise direction. Shifts counterclockwise are those which the wake-up and sleep times to the front lay (z. B. when flying east, in layers, on the night rotate from day to night). The symptoms can be after a few days or, in some patients (eg. As the elderly), after a few weeks or months, while the rhythms to adapt again. Because light is a strong synchronizer of circadian rhythms, accelerate the exposure in bright light (sunlight or artificial light with an intensity of 5,000-10,000 lux) of the desired wake-up time and use of a pair of sunglasses before the desired bedtime the re-adjustment. Melatonin administration before bedtime can help (other sedatives). Patients with circadian rhythm disorders often abuse alcohol, hypnotics and stimulants. Among the disorders of the circadian rhythm include the following: Circadian rhythm sleep disorders type jet lag (jet lag disorder) Circadian rhythm sleep disorders, type of shift work (shift worker syndrome) Circadian rhythm sleep disorders, type sleep phase shift Circadian rhythm sleep disorders type jet lag (jet lag disorder) This syndrome is caused by rapid travel by> 2 time zones. Travel to the east (forward displacement of the sleep cycle) causes more discomfort than traveling in a westerly direction (delayed sleep). If possible, travelers should change their sleep-wake rhythm gradually before the trip so that it approaches the destination, and after arriving at your destination daylight exposure days (v. A. The morning) and reinforce the dark exposure before bedtime. Short-acting hypnotics or vigilanzverstärkende drugs (eg. As modafinil) can be used after arriving for a short time. Circadian rhythm sleep disorders, type shift work (shift worker syndrome) severity of symptoms is proportional to the frequency of the shift change magnitude of each change in number of consecutive nights, is carried out in which the length of the layers frequency of changes in the counterclockwise direction (advancing sleep) Fixed shift work ( ie full-time) is desirable at night or in the evening. In rotating layers (i.e.,.. From day to night to night) should be changed in a clockwise direction. However, shift workers have fixed layers trouble sleeping because of the daily noise and the lights disturb the sleep quality. Shift workers often shorten the sleep time to participate in the social and family life. Shift workers should be times when they should be awake, bright a light as possible stay (sunlight or at night workers, specially designed light boxes with bright artificial light) care and for a dark and quiet as possible bedroom. Wearing sunglasses while driving home in the morning in anticipation of sleep is also helpful. Sleep masks and devices that emit white noise are useful. Melatonin at bedtime can also help. If symptoms persist and interfere with the ability to work, a reasonable use of hypnotics with short half-life and alertness promoting drugs is appropriate. Circadian rhythm sleep disorders, sleep phase type shift patients with these syndromes have a normal sleep quality and duration in a circadian 24-hour rhythm, but the rhythm is not harmonized with the desired or necessary waking hours. More rarely the daily cycle is not 24 hours, and the patient awake or sleep every day sooner or later. If they are allowed to follow their natural rhythm, patients show no symptoms. Delayed sleep phase syndrome: Patients go consistently to bed late and wake late (for example, at 3 am and at 10 am.). This pattern is more common in adolescence. If it is necessary for school or work, get up earlier, results in an excessive daytime sleepiness. Patients are presented often because school performance is poor or they miss school hours in the morning. Of people who go voluntarily to bed late, it is different, that they, even if they try, can not go to sleep earlier. A slight phase shift (<3 h) is treated by gradually getting up earlier and morning light therapy, possibly h with melatonin administration 4-5 before the desired sleep time. An alternative method is to delay the Schlafens- and the wake-up time to 1-3 hours / day steps until the right sleeping and waking times are achieved. Vorverlagertes sleep phase syndrome: This syndrome (go to bed early and get up early) is more common in older people and is responsive to treatment with bright light in the evening and with an opaque glasses in the morning. Non-24-hour sleep-wake syndrome: This syndrome is much less common and is characterized by a free-running sleep-wake rhythm. The sleep-wake cycle usually remains in its length constant, but this is> 24 h, resulting in a delay of sleep onset and wake-up time of 1-2 h / d. This disorder is more common in blind people. Tasimelteon, a melatonin receptor agonist, may increase nightly sleep duration and daytime reduce sleep duration with completely blindne patients who have this disease. The dose is 20 mg 1 time / day at bedtime, at the same time every night.