Practice Parameters for the Clinical Evaluation and Treatment of Circadian Rhythm Sleep Disorders

Morgenthaler, Timothy I.; Lee‐Chiong, Teofilo; Alessi, Cathy A.; Friedman, Leah; Aurora, R. Nisha; Boehlecke, Brian; Brown, Terry M.; Chesson, Andrew L.; Kapur, Vishesh K.; Maganti, Rama; Owens, Judith; Pancer, Jeffrey; Swick, Todd J.; R, Zák

doi:10.1093/sleep/30.11.1445

Cited by 559 publications

(406 citation statements)

References 125 publications

(159 reference statements)

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“…Another treatment that is becoming more popular because of its noninvasive nature is that of DLMO therapy. This therapy uses exposure to a dim light to activate the suprachiasmatic nucleus (SCN) in the brain to secrete melatonin, thus inducing sleepiness in the patient at the desired time [43].…”

Section: Diagnosis Of Circadian Rhythm Sleep Disordersmentioning

confidence: 99%

Circadian Rhythm Sleep Disorders

Wells

Overton²

2014

Primary Health Care

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Though the theories on the reasons why humans need to sleep vary, there is no disagreement that sleep is essential to our wellbeing and survival. External and internal physiological parameters dictate our own individual body "clocks," or circadian rhythms. Typically, this clock runs very close to a 24-hour cycle of sleep and wakefulness. However, for some individuals, this clock can be slightly "off." This article will discuss what creates internal circadian rhythms and the major types of circadian rhythm disorders, with an overview of diagnosis and treatment options.

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Section: Diagnosis Of Circadian Rhythm Sleep Disordersmentioning

confidence: 99%

Circadian Rhythm Sleep Disorders

Wells

Overton²

2014

Primary Health Care

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“…O uso da melatonina no tratamento dos distúrbios do ritmo circadiano já tem seu papel estabelecido conforme dados da American Academy of Sleep Medicine 24 . No entanto, no caso da insônia crônica primária, os resultados ainda não são tão consistentes na questão manutenção do sono, exceto em populações específicas, como, por exemplo, em pacientes acima de 55 anos 25 .…”

Section: Melatoninérgicos 1) Ramelteonunclassified

Novos sedativos hipnóticos

Sukys-Claudino

Moraes

Tufik

et al. 2010

Rev. Bras. Psiquiatr.

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ResumoNas últimas décadas houve um esforço para o desenvolvimento de hipnóticos mais seguros e eficazes. Zolpidem, zaleplona, zopiclona, eszopiclona (drogas-z) e indiplona são moduladores do receptor GABA-A, os quais agem de forma seletiva na subunidade α1, exibindo, desta forma, mecanismos similares de ação, embora evidências recentes sugiram que a eszopiclona não seja tão seletiva para a subunidade α1 quanto o zolpidem. Ramelteon e tasimelteon são novos agentes crono-hipnóticos seletivos para os receptores de melatonina MT1 e MT2. Por outro lado, nos últimos anos, o consumo de drogas antidepressivas sedativas tem aumentado significativamente no tratamento da insônia. Como droga experimental, a eplivanserina tem sido testada como um potente agonista inverso do subtipo 5-HT 2A da serotonina, com um uso potencial na dificuldade da manutenção do sono. Outro agente farmacológico para o tratamento da insônia é o almorexant, o qual apresenta um novo mecanismo de ação envolvendo antagonismo do sistema hipocretinérgico, desta forma levando à indução do sono. Finalmente, também discutiremos o potencial papel de outras drogas gabaérgicas no tratamento da insônia.Descritores: Hipnóticos e sedativos; Efeitos fisiológicos de drogas; Receptores de melatonina; Antidepressivos; Distúrbios do início e da manutenção do sono AbstractThere has been a search for more effective and safe hypnotic drugs in the last decades. Zolpidem, zaleplon, zopiclone, eszopiclone (the z-drugs) and indiplon are GABA-A modulators which bind selectively α1 subunits, thus, exhibiting similar mechanisms of action, although recent evidence suggests that eszopiclone is not as selective for α1 subunit as zolpidem is. Ramelteon and tasimelteon are new chrono-hypnotic agents, selective for melatonin MT1 and MT2 receptors. On the other hand, the consumption of sedative antidepressant drugs is significantly increasing for the treatment of insomnia, in the last years. As an experimental drug, eplivanserin is being tested as a potent antagonist of serotonin 2-A receptors (ASTAR) with a potential use in sleep maintenance difficulty. Another recent pharmacological agent for insomnia is almorexant, which new mechanism of action involves antagonism of hypocretinergic system, thus inducing sleep. Finally we also discuss the potential role of other gabaergic drugs for insomnia. Descriptors: Hypnotics and sedatives; Physiological effects of drugs; Receptors, melatonin; Antidepressive agents; Sleep initiation and maintenance disordersIntrodução A insônia é, sem dúvida, na atualidade, o distúrbio do sono mais comum, afetando de 10 a 50% da população 1,2 . As conclusões de um consenso do National Institutes of Health (NHI) indicam que quando utilizamos como critério diagnóstico a necessidade de comprometimento ou impacto nas atividades diurnas, a prevalência da insônia cai para cerca de 10% 3 . Estima-se que cerca de 40% dos indivíduos insones apresentem comorbidade psiquiátrica 4 .Desde a década de 50, a psicofarmacologia vem evoluindo no tratamento da insônia em busca ...

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“…Since light is a potent Zeitgeber, the use of light therapy to treat circadian rhythm sleep disorders is a potentially effective treatment [3][4][5]. However, most studies have tested the phase shifting effects of light in highly controlled laboratory conditions.…”

Section: Introductionmentioning

confidence: 99%

“…A large number of people may therefore benefit from a correction of their clock and sleep timing. Because light is so effective in phase shifting the clock, it is often proposed as the most effective method to advance a late sleep phase [3][4][5]. However there is no general accepted protocol for the optimization of light therapy.…”

Section: Introductionmentioning

confidence: 99%

Short Blue Light Pulses (30 Min.) in the Morning are Able to Phase Advance the Rhythm of Melatonin in a Home Setting

Geerdink¹,

Beersma²

2016

J Sleep Disord Ther

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It is known that light in the morning is able to induce phase advances of the endogenous clock, however most studies have tested the phase advances in highly controlled laboratory conditions. At home the environmental lighting is more variable. In theory, a high intensity short morning-light pulse in the short-wavelengths-range (blue light) should be capable of inducing phase advances. If this is also true in a home setting, this could be a firm basis supporting light treatment in late chronotypes who suffer from a late sleep phase. In a study carried out in summer, 11 normal to relatively late (habitual midsleep 4:15-6:09 hours) chronotypes (age range 23-27 years, 4f/7m) participated in two conditions: (1) 1 baseline day followed by 3 consecutive days of 30 min. blue morning-light pulses, (2) 1 baseline day followed by 3 consecutive days of 60 min. blue light pulses. Blue light was applied by use of the Philips GoLite BLU (HF3320, blue leds, intensity at the cornea 2306 melanopic-lux, 300 lux, 3.65 W/m 2 ). During all four evenings, subjects were asked to protect themselves from light exposure (<10 lux). The response of the melatonin rhythm, calculated as a shift in dim light melatonin onset (DLMO), to a single 30 min. light pulse varied between subjects and resulted in a non-significant phase advance of 15 (±48) min. (t10 = 1.04; P = 0.33), and a significant advance of 30 (±41) min. to a single 60 min. light pulse. (t10 = 2.40; P < 0.05). After 3 days of light exposure both in the 30-and in the 60 min. light pulses condition significant phase advances of DLMO were observed; 49 (±58) min. (t10 = 2.80; P < 0.05) and 59 (±29) min. (t10 = 6.9; P < 0.001) respectively. No significant differences were found in the DLMO shifts between conditions. In addition there was a trend for a lower sleepiness score directly after waking up after using light for 3 days in both conditions (t10 = 3.38; P = 0.096, 60 min. and (t10 = 4.10; P = 0.070, 30 min.). A prelimin.ary analysis of actimetry data indicated some support for an effect on sleep timin.g. The data support the conclusion that light pulses of 30 min. in the morning on three consecutive days, in a home setting, in combination with dim light during the evenings, can be part of an efficient phase advancing chronotherapy protocol.

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Practice Parameters for the Clinical Evaluation and Treatment of Circadian Rhythm Sleep Disorders

Cited by 559 publications

References 125 publications

Circadian Rhythm Sleep Disorders

Circadian Rhythm Sleep Disorders

Novos sedativos hipnóticos

Short Blue Light Pulses (30 Min.) in the Morning are Able to Phase Advance the Rhythm of Melatonin in a Home Setting

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