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. 2016 Sep;2(3):158-165.
doi: 10.1007/s40675-016-0052-1. Epub 2016 Jul 2.

Circadian-Based Therapies for Circadian Rhythm Sleep-Wake Disorders

Helen J Burgess  1 , Jonathan S Emens  2
Affiliations

Circadian-Based Therapies for Circadian Rhythm Sleep-Wake Disorders

Helen J Burgess et al. Curr Sleep Med Rep. 2016 Sep.

Abstract

This review summarizes recent developments relevant to the treatment of circadian rhythm sleep-wake disorders. The clinical practice guidelines for the treatment of intrinsic circadian rhythm sleep-wake disorders is described, followed by recent treatment studies for delayed sleep-wake phase disorder, non-24 hour sleep-wake disorder, irregular sleep-wake disorder and shift work. New methods to estimate circadian phase, including home saliva collection to estimate the dim light melatonin onset, circadian questionnaires and general rules to guide light and exogenous melatonin treatments are described. New developments in light treatment are detailed, including light flashes during sleep and wearable light devices. Substances such as caffeine and alcohol, and devices such as electronic tablets are also considered for their potential to shift circadian timing. Finally, an update on melatonin supplements in the US is discussed, along with the controversy surrounding the use of melatonin supplements in patients with prediabetes or diabetes.

Keywords: advance; agonist; alcohol; caffeine; delay; diabetes; light; melatonin.

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Conflict of interest statement

Compliance with Ethics Guidelines Conflict of Interest Helen J. Burgess and Jonathan S. Emens declare that they have no conflict of interest Human and Animal Rights and Informed Consent This article does not contain any studies with human or animal subjects performed by any of the authors.

Figures

Figure 1
Figure 1
A pictorial representation of the most recent clinical practice guideline recommendations for treatment of the treatment of intrinsic circadian rhythm sleep-wake disorders. From top down is Advanced Sleep-Wake Phase Disorder, Delayed Sleep-Wake Phase Disorder, Non-24 Hour Sleep-Wake Disorder in the blind with circadian period >24 hours, Non-24 Hour Sleep-Wake Disorder in the blind with circadian period <24 hours, Irregular Sleep-Wake Disorder for the elderly, and Irregular Sleep-Wake Disorder for children. The times in red indicate the range in typical fall asleep or wake times seen in patients prior to treatment, and the red arrow represents the direction of desired phase shifts. The light bulb symbol represents light therapy. The circles represent melatonin pills with doses suggested by the authors to either minimize or maximize melatonin’s soporific effect as needed.
See this image and copyright information in PMC

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