Ramelteon for Delayed Sleep-wake Phase Disorder: A Case Report

Takeshima, Masahiro; Shimizu, Tetsuo; Ishikawa, Hiroyasu; Kanbayashi, Takashi

doi:10.9758/cpn.2020.18.1.167

Cited by 5 publications

(4 citation statements)

References 18 publications

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“…A 0.5 mg of melatonin 10 to 12 hours before the midpoint of sleep achieves the greatest amount of phase advance 50 . Also, it has been reported that a prescription of 1, 2, or 4 mg of ramelteon or ramelteon and 15 mg of suvorexant improve symptoms of DSPD 51 …”

Section: Resultsmentioning

confidence: 99%

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Delayed sleep phase disorder during the COVID-19 pandemic and its health implications

et al. 2023

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Circadian rhythm sleep disorders are alterations that are characterized by a shift in the sleep-wake cycle relative to day and night, such as the delayed sleep phase disorder (DSPD), which is a retard of at least 2 hours in the sleep start. Typically, the patient falls asleep after 2 a.m. and wakes up after 10 a.m. and with symptom of sleep onset insomnia. The prevalence of DSPD in young adults is 0.48%, increasing to 3.3% in adolescents. Interestingly, patients with COVID-19 infection report anxiety due to the intensive care unit lockdown and constant exposure to bright light. In addition, post-COVID patients have an increased risk of developing DSPD. For example, in adolescent post-COVID patients, the prevalence of DSPD increases to 63.3%. Patients with DSPD also have alterations in metabolic health, poor school performance, cognitive impairment, and a higher risk of developing other diseases. The objective of the present review is therefore to describe the characteristics of DSPD during the COVID-19 pandemic and to outline its possible implications for physical health (eg, metabolism) and mental health (eg, anxiety or depression).

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Section: Resultsmentioning

confidence: 99%

“…50 Also, it has been reported that a prescription of 1, 2, or 4 mg of ramelteon or ramelteon and 15 mg of suvorexant improve symptoms of DSPD. 51…”

Section: Melatoninmentioning

confidence: 99%

Delayed sleep phase disorder during the COVID-19 pandemic and its health implications

et al. 2023

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“…Administration of 1-4 mg of ramelteon at 30 min before bedtime produces a phase advance. However, no difference in the effect was found between a dose of 8 mg and a placebo (180), suggesting that a small drug dose would be preferable for the treatment of DSWPD (181,182). However, clinical evidence regarding the optimal timing of ramelteon administration for the treatment of DSWPD remains scarce.…”

Section: Chronobiological Approachesmentioning

confidence: 99%

Delayed sleep–wake phase disorder and its related sleep behaviors in the young generation

et al. 2023

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Delayed sleep–wake phase disorder (DSWPD) is a sleep disorder in which the habitual sleep–wake timing is delayed, resulting in difficulty in falling asleep and waking up at the desired time. Patients with DSWPD frequently experience fatigue, impaired concentration, sleep deprivation during weekdays, and problems of absenteeism, which may be further complicated by depressive symptoms. DSWPD is typically prevalent during adolescence and young adulthood. Although there are no studies comparing internationally, the prevalence of DSWPD is estimated to be approximately 3% with little racial differences between Caucasians and Asians. The presence of this disorder is associated with various physiological, genetic and psychological as well as behavioral factors. Furthermore, social factors are also involved in the mechanism of DSWPD. Recently, delayed sleep phase and prolonged sleep duration in the young generation have been reported during the period of COVID-19 pandemic-related behavioral restrictions. This phenomenon raises a concern about the risk of a mismatch between their sleep–wake phase and social life that may lead to the development of DSWPD after the removal of these restrictions. Although the typical feature of DSWPD is a delay in circadian rhythms, individuals with DSWPD without having misalignment of objectively measured circadian rhythm markers account for approximately 40% of the cases, wherein the psychological and behavioral characteristics of young people, such as truancy and academic or social troubles, are largely involved in the mechanism of this disorder. Recent studies have shown that DSWPD is frequently comorbid with psychiatric disorders, particularly mood and neurodevelopmental disorders, both of which have a bidirectional association with the pathophysiology of DSWPD. Additionally, patients with DSWPD have a strong tendency toward neuroticism and anxiety, which may result in the aggravation of insomnia symptoms. Therefore, future studies should address the effectiveness of cognitive-behavioral approaches in addition to chronobiological approaches in the treatment of DSWPD.

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“…MRAs have also been clinically shown to decrease SOL [ 86 – 89 ] and shift the circadian phase [ 90 – 92 ]. However this is largely in healthy populations and therapeutic use in DSWPD has yet to be demonstrated save for two recent successful case reports using ramelteon [ 93 , 94 ]. Of these, Shimura et al in particular [ 94 ] suggest that ramelteon should be administered at very low doses for DSWPD.…”

Section: Preamblementioning

confidence: 99%

Updates and confounding factors in delayed sleep–wake phase disorder

2023

Sleep Biol. Rhythms

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Delayed sleep–wake phase disorder (DSWPD) is a circadian rhythm sleep disorder characterised by a delay in the main sleep period, with patients experiencing difficulty getting to sleep and waking up at socially appropriate times. This often causes insomnia and compromised sleep, results in impairment to daytime function and is associated with a range of comorbidities. Besides interventions aimed at ameliorating symptoms, there is good evidence supporting successful phase advancement with bright light therapy or melatonin administration. However, no treatment to date addresses the tendency to phase delay, which is a common factor amongst the various contributing causes of DSWPD. Circadian phase markers such as core body temperature and circulating melatonin typically correlate well with sleep timing in healthy patients, but numerous variations exist in DSWPD patients that can make these unpredictable for use in diagnostics. There is also increasing evidence that, on top of problems with the circadian cycle, sleep homeostatic processes actually differ in DSWPD patients compared to controls. This naturally has ramifications for management but also for the current approach to the pathogenesis itself in which DSWPD is considered a purely circadian disorder. This review collates what is known on the causes and treatments of DSWPD, addresses the pitfalls in diagnosis and discusses the implications of current data on modified sleep homeostasis, making clinical recommendations and directing future research.

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Ramelteon for Delayed Sleep-wake Phase Disorder: A Case Report

Cited by 5 publications

References 18 publications

Delayed sleep phase disorder during the COVID-19 pandemic and its health implications

Delayed sleep phase disorder during the COVID-19 pandemic and its health implications

Delayed sleep–wake phase disorder and its related sleep behaviors in the young generation

Updates and confounding factors in delayed sleep–wake phase disorder

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