Doctor's Notes on Sleeplessness and Circadian Rhythm Disorders
A person's circadian rhythm (“biological clock”) regulates several biological processes according to an approximate 24-hour period. The malfunctioning of the circadian system causes circadian rhythm disorders. The body systems with the most prominent circadian variations are the sleep-wake cycle, the temperature regulation system, and the endocrine system. The sleep-wake cycle is a type of circadian rhythm disorder and can be categorized into transient disorders (short-term) and chronic disorders. Transient disorders include jet lag, altered sleep schedule due to work hours or social responsibilities, and illness. Chronic biological clock disorders include irregular sleep-wake cycles, delayed sleep-phase syndrome (DSPS), and advanced sleep-phase syndrome (ASPS).
Symptoms of a biological clock sleep disorder include
- poor concentration,
- difficulty concentrating,
- daytime sleepiness,
- problems falling asleep and staying asleep,
- non-restorative or poor quality sleep,
- problems with school or work performance,
- decreased cognitive skills,
- problems with coordination, and
- digestive problems.
What Is the Treatment for Sleeplessness and Circadian Rhythm Disorder?
Treatments for circadian rhythm disorders depend on the cause and severity of the problem. The most common treatments consist of a combination of lifestyle changes including sleep hygiene strategies, light therapy, and medications.
Part of the treatment of sleeplessness and circadian rhythm disorders includes good sleep hygiene. This includes:
- A consistent sleep routine
- Go to bed and wake up at the same time each day, even on weekends
- Keep the room cool
- Use blackout curtains to make the room as dark as possible
- Stimulus control
- Only use the bed for sleep and sex
- If you are awake more than 20 minutes after getting into bed, get out of bed and do something non-strenuous until you are sleepy
- Avoid daytime napping
- Avoid caffeine and alcohol
- Avoid exercise before bed
- Calm yourself before bedtime
- Breathing exercises
- Take a hot bath or shower
- Practice yoga or light stretching before bed
Light therapy with bright light treatments at certain times of the day may help reset the body's circadian rhythm.
Medications that might be used for sleeplessness and circadian rhythm disorders may include:
- Sleep medications, both over-the-counter (OTC) and prescription
- Antihistamines such as doxylamine or diphenhydramine (Benadryl, Nytol)
- Prescription sleep medications
- Benzodiazepines: quazepam (Doral), triazolam (Halcion), estazolam (ProSom), temazepam (Restoril), and flurazepam (Dalmane)
- Nonbenzodiazepines: zaleplon (Sonata), eszopiclone (Lunesta), zolpidem (Ambien), zolpidem extended release (Ambien CR), zolpidem dissolving tablet (Edluar), zolpidem oral liquid spray (Zolpimist), and zolpidem dissolving tablet at a lower dose for middle of the night use (Intermezzo)
- Dual orexin receptor antagonists (DORAs): lemborexant (DayVigo), suvorexant (Belsomra), and daridorexant (Quviviq)
- Histamine receptor antagonist: low-dose doxepin (Silenor)
- Melatonin receptor agonist: ramelteon (Rozerem)
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Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.