Circadian Rhythm Sleep-Wake Disorders : An Evidence-Based Guide for Clinicians and Investigators

This book resolves to bridge the communication gap between research and clinical practice for circadian rhythm sleep-wake disorders. Beginning with a scientific background on biological timekeeping, opening chapters describe the crucial nature of maintaining delicate temporal organization of physiological and molecular events within the body. Following this are discussions on circadian physiology and methods of circadian assessments. Subsequent chapters then relay comprehensive information regarding the International Classification of Sleep Disorders-defined circadian rhythm sleep-wake disorders (CRSWDs), specifically discussing etiology and epidemiology, but focusing on evidence-based treatment data. Concluding discussions provide guidance for the application of light therapy and discuss future roles for optimized lighting environments. Nuanced and market-demanded, __Circadian Rhythm Sleep-Wake Disorders: An Evidence-Based Guide for Clinicians and Investigators__ is an invaluable resource for Sleep Medicine clinicians, circadian researchers, and other interested parties. Preface 5 Acknowledgments 6 Contents 7 Contributors 9 Chapter 1: Biological Timekeeping: Scientific Background 11 Introduction 11 History of Chronobiology 12 Measurement and Assessment of Circadian Rhythms 13 Properties of Circadian Rhythms 14 Circadian Rhythms Persist Under Constant Conditions 15 Rhythmic Environmental Stimuli Can Entrain Circadian Rhythms 15 Free-Running Periods Are Temperature Compensated 16 Organization and Entrainment of the Circadian System 17 Light Is Encoded at the Master Timekeeper by a Specialized Detection Mechanism 17 Organization of the Suprachiasmatic Nucleus (SCN): The Master Timekeeper 18 SCN-Dependent Outputs Entrain Peripheral Oscillators 19 Non-photic Entrainment of Peripheral Oscillators 20 Molecular Basis for Circadian Rhythms 21 Organization of the Mammalian Molecular Clock 21 Entrainment of the Molecular Clock 22 Conclusion 23 References 24 Chapter 2: Review of Protocols and Terminology to Enhance Understanding of Circadian-Based Literature 31 Protocols 34 References 37 Chapter 3: Introduction to Circadian Rhythm Disorders 38 Definition 38 Phase Response Curves of Light, Melatonin 43 Chronotype (Circadian Typology) and Phase Tolerance 44 Circadian Changes with Age 45 Epidemiology of Circadian Rhythm Sleep/Wake Disorders 46 Diagnosis of Circadian Rhythm Sleep/Wake Disorders 46 Questionnaires 47 Actigraphy 47 Treatment Options 48 Light Therapy 48 Melatonin 49 Summary 49 References 49 Chapter 4: Physiologic Methods of Assessment Relevant to Circadian Rhythm Sleep-Wake Disorders 53 Introduction 53 Actigraphy 54 Ambulatory Light Monitoring 55 Melatonin Rhythm Measurement 56 Core Body Temperature 58 Circadian Gene Expression in Peripheral Cells 59 Polysomnography 60 Multiple Channel Ambulatory Monitoring 60 Heart Rate and Electrocardiographic Monitoring 61 References 61 Chapter 5: Non-physiologic Methods of Assessment Relevant to Circadian Rhythm Sleep-Wake Disorders 64 Introduction 64 Sleep Diaries 64 Questionnaires 66 Horne-Östberg Morningness-Eveningness Questionnaire (MEQ) 66 Torsvall and Akerstedt Diurnal Scale 67 Composite Scale of Morningness 68 Preferences Scale 68 Munich Chronotype Questionnaire 68 Children’s Chronotype Questionnaire 69 Internet/Twitter/Apps 69 References 70 Chapter 6: Delayed Sleep-Wake Phase Disorder 73 Introduction 73 Clinical Features 74 Differential Diagnosis 75 Comorbidities 75 Epidemiology 77 Pathophysiology 78 Genetic Factors 78 Treatment 80 Combination Light Therapy Studies 80 Adverse Effects Associated with Light Therapy 81 Melatonin 82 Adverse Effects Associated with Melatonin 84 Less Explored Interventions 85 Conclusions and Future Directions 86 References 89 Chapter 7: Circadian Rhythms and School Start Times: The Indivisible Link Between Medicine and Education 97 Introduction 97 Early Research 98 Circadian Rhythms 98 Adolescent Sleep Patterns 98 Consequences of Unmet Sleep Needs 99 Early Studies in Educational Settings 99 1996: The First Comprehensive Study of Later Start Times 100 1997: Later Starts for Minneapolis Public High Schools 101 The Middle Years: 2002–2014 102 Emerging National Interest 102 Additional Outcomes Studied 104 The CDC Call for a Comprehensive Study 105 Continuing Questions/Dilemmas: 2015 to Present 106 Persistent Dilemmas 106 Current and Emerging Issues 108 Conclusion 110 References 111 Chapter 8: Advanced Sleep-Wake Rhythm Disorder 115 Advance-Related Sleep Complaints and Advanced Sleep-Wake Phase Disorder (ASWPD) 115 Advance-Related Sleep Complaints 115 Epidemiology 117 Etiology and Risk Factors 117 Genetics 117 Risk Factors 119 Age 119 Diagnosis 119 Treatment Options 120 Behavioral Options 120 Hypnotic and Stimulant Medications 121 Melatonin 122 Light Therapy 122 Morningness and Resilience 123 Summary 124 References 125 Chapter 9: Non-24-Hour Sleep-Wake Rhythm Disorder 129 Introduction 129 Basic Concepts 129 Circadian Period and Non-entrainment 130 Circadian Phase 132 Etiology 132 Blind Individuals 132 Sighted Individuals 133 Epidemiology 135 Presentation and Diagnosis 135 Morbidity 136 Treatment 136 Treatment: Blind 137 Dose of Administration: Demonstration of Entrainment 137 Time of Administration: Demonstration of Entrainment at the Correct Time 138 Treatment: Sighted 138 References 139 Chapter 10: Irregular Sleep-Wake Rhythm Disorder 143 Introduction 143 Pathophysiology 143 Clinical Features, Epidemiology, and Diagnosis 146 Management 148 Conclusion 150 References 151 Chapter 11: Shift Work Sleep Disorder 155 Introduction 155 Epidemiology 156 Physiology and Pathophysiology 157 Clinical Features 159 Insomnia 159 Excessive Sleepiness, Work Dysfunction, and Accidents 160 Adverse Health Consequences 161 Cardiovascular Disease 162 Metabolic Abnormalities 163 Neoplastic 164 Gastrointestinal Dysfunction 165 Reproduction 166 Psychiatric Disorders 166 Other 166 Diagnostic Criteria and Differential Diagnosis 166 Evaluation 168 History 168 Questionnaires 169 Sleep Log and Actigraphy 169 Dim Light Melatonin Onset 170 Other Laboratory Studies 171 Polysomnography and Multiple Sleep Latency Test (MSLT) 171 Treatment: Shift Work Disorder and Symptoms Associated with Shift Work 171 Overview 171 Sleep/Wake Scheduling and Naps 172 Circadian Phase Shifting 173 Hypnotic (Sleep-Promoting) Medications 175 Stimulant (Wake-Promoting) Medications 175 Conclusion 177 References 177 Chapter 12: Duty Hour Regulations of Physicians in Training and Circadian Considerations 189 Definitions 189 Introduction 190 Sleep/Wake Regulation and Medical Trainees 191 Impact of Sleep Loss and Circadian Disruptions on the Personal and Professional Lives of Trainees 192 History of Resident Work Hour Reforms (Table 12.1) 194 Effect of Resident Duty Hour Limitations on Resident Wellbeing, Resident Education, and Patient Safety 199 Conclusion 201 References 202 Chapter 13: Jet Lag Sleep Disorder 205 Introduction 205 Pathophysiology 206 Diagnosis 206 Treatment 207 Light/Dark Exposure for Jet Lag 207 Pharmacologic Treatments 209 Melatonin 209 Sedative Hypnotics 209 Stimulants 210 Conclusion 210 References 210 Chapter 14: A Guide for Characterizing and Prescribing Light Therapy Devices 212 Introduction 212 What Is Light? 213 Retinal Physiology 214 Presumed Underlying Mechanism 215 Discussion 219 References 222 Chapter 15: Future Directions for Lighting Environments 225 Introduction 225 What Is Light and How Do We Characterize It? 226 Current Trends in Lighted Environments 228 Research on the Impact of Current Lighted Environments on Health and Well-being 231 The Need for Proposing a 24-h Lighting Scheme in our Lighted Environments 232 Future Trends in Lighted Environments 235 Workplace Lighting 235 Healthcare Facility Lighting 235 Home Lighting 238 Conclusion 239 References 241 Index 245 Front Matter ....Pages i-xii Biological Timekeeping: Scientific Background (Matthew R. Brown, Aleksey V. Matveyenko)....Pages 1-20 Review of Protocols and Terminology to Enhance Understanding of Circadian-Based Literature (Vincent A. LaBarbera, Katherine M. Sharkey)....Pages 21-27 Introduction to Circadian Rhythm Disorders (Elliott Kyung Lee)....Pages 29-43 Physiologic Methods of Assessment Relevant to Circadian Rhythm Sleep-Wake Disorders (Vincent A. LaBarbera, Katherine M. Sharkey)....Pages 45-55 Non-physiologic Methods of Assessment Relevant to Circadian Rhythm Sleep-Wake Disorders (Vincent A. LaBarbera, Katherine M. Sharkey)....Pages 57-65 Delayed Sleep-Wake Phase Disorder (Gregory S. Carter, R. Robert Auger)....Pages 67-90 Circadian Rhythms and School Start Times: The Indivisible Link Between Medicine and Education (Kyla L. Wahlstrom)....Pages 91-108 Advanced Sleep-Wake Rhythm Disorder (Elliott Kyung Lee)....Pages 109-122 Non-24-Hour Sleep-Wake Rhythm Disorder (Jonathan Emens)....Pages 123-136 Irregular Sleep-Wake Rhythm Disorder (Danielle Goldfarb, Katherine M. Sharkey)....Pages 137-148 Shift Work Sleep Disorder (Alok Sachdeva, Cathy Goldstein)....Pages 149-182 Duty Hour Regulations of Physicians in Training and Circadian Considerations (Eric J. Olson)....Pages 183-198 Jet Lag Sleep Disorder (Cinthya Pena-Orbea, Bhanu Prakash Kolla, Meghna P. Mansukhani)....Pages 199-205 A Guide for Characterizing and Prescribing Light Therapy Devices (Mark S. Rea)....Pages 207-219 Future Directions for Lighting Environments (Mariana G. Figueiro)....Pages 221-240 Back Matter ....Pages 241-247