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Jet lag is a physiological condition that results from alterations to the body's circadian rhythms caused by rapid long-distance trans-meridian travel. For example, someone flying from New York to London, i.e. from west to east, feels as if the time were five hours earlier than local time, and someone travelling from London to New York, i.e. from east to west, feels as if the time were five hours later than local time. The phase shift when traveling from east to west is referred to as phase-delay of the circadian circle, whereas going west to east is phase-advance of the circadian circle. Most travelers find that it is harder to timezone adjust when traveling to the east. Jet lag was previously classified as one of the circadian rhythm sleep disorders.
A circadian rhythm, or circadian cycle, is a natural, internal process that regulates the sleep–wake cycle and repeats roughly every 24 hours. It can refer to any process that originates within an organism and responds to the environment. These 24-hour rhythms are driven by a circadian clock, and they have been widely observed in animals, plants, fungi and cyanobacteria.
Seasonal affective disorder (SAD) is a mood disorder subset, in which people who have normal mental health throughout most of the year exhibit depressive symptoms at the same time each year, commonly but not always in the wintertime, with reduced sunlight.
Delayed sleep phase disorder (DSPD), more often known as delayed sleep phase syndrome and also as delayed sleep–wake phase disorder, is the delaying of a person's circadian rhythm compared to those of societal norms. The disorder affects the timing of biological rhythms including sleep, peak period of alertness, core body temperature, and hormonal cycles.
Non-24-hour sleep–wake disorder is one of several chronic circadian rhythm sleep disorders (CRSDs). It is defined as a "chronic steady pattern comprising [...] daily delays in sleep onset and wake times in an individual living in a society". Symptoms result when the non-entrained (free-running) endogenous circadian rhythm drifts out of alignment with the light–dark cycle in nature. Although this sleep disorder is more common in blind people, affecting up to 70% of the totally blind, it can also affect sighted people. Non-24 may also be comorbid with bipolar disorder, depression, and traumatic brain injury. The American Academy of Sleep Medicine (AASM) has provided CRSD guidelines since 2007 with the latest update released in 2015.
A phase response curve (PRC) illustrates the transient change in the cycle period of an oscillation induced by a perturbation as a function of the phase at which it is received. PRCs are used in various fields; examples of biological oscillations are the heartbeat, circadian rhythms, and the regular, repetitive firing observed in some neurons in the absence of noise.
A zeitgeber is any external or environmental cue that entrains or synchronizes an organism's biological rhythms, usually naturally occurring and serving to entrain to the Earth's 24-hour light/dark and 12-month cycles.
Circadian rhythm sleep disorders (CRSD), also known as circadian rhythm sleep-wake disorders (CRSWD), are a family of sleep disorders which affect the timing of sleep. CRSDs arise from a persistent pattern of sleep/wake disturbances that can be caused either by dysfunction in one's biological clock system, or by misalignment between one's endogenous oscillator and externally imposed cues. As a result of this mismatch, those affected by circadian rhythm sleep disorders have a tendency to fall asleep at unconventional time points in the day. These occurrences often lead to recurring instances of disturbed rest, where individuals affected by the disorder are unable to go to sleep and awaken at "normal" times for work, school, and other social obligations. Delayed sleep phase disorder, advanced sleep phase disorder, non-24-hour sleep–wake disorder and irregular sleep–wake rhythm disorder represents the four main types of CRSD.
Shift work sleep disorder (SWSD) is a circadian rhythm sleep disorder characterized by insomnia, excessive sleepiness, or both affecting people whose work hours overlap with the typical sleep period. Insomnia can be the difficulty to fall asleep or to wake up before the individual has slept enough. About 20% of the working population participates in shift work. SWSD commonly goes undiagnosed, so it's estimated that 10–40% of shift workers have SWSD. The excessive sleepiness appears when the individual has to be productive, awake and alert. Both symptoms are predominant in SWSD. There are numerous shift work schedules, and they may be permanent, intermittent, or rotating; consequently, the manifestations of SWSD are quite variable. Most people with different schedules than the ordinary one might have these symptoms but the difference is that SWSD is continual, long-term, and starts to interfere with the individual's life.
Dark therapy is the practice of keeping people in complete darkness for extended periods of time in an attempt to treat psychological conditions. The human body produces the melatonin hormone, which is responsible for supporting the circadian rhythms. Darkness seems to help keep these circadian rhythms stable. Dark therapy was said to be founded by a German anthropologist by the name of Holger Kalweit. A form of dark therapy is to block blue wavelength lights to stop the disintegration of melatonin.
Light effects on circadian rhythm are the effects that light has on circadian rhythm.
Sundowning, or sundown syndrome, is a neurological phenomenon associated with increased confusion and restlessness in people with delirium or some form of dementia. It is most commonly associated with Alzheimer's disease but also found in those with other forms of dementia. The term "sundowning" was coined by nurse Lois K. Evans in 1987 due to the timing of the person's increased confusion beginning in the late afternoon and early evening. For people with sundown syndrome, a multitude of behavioral problems begin to occur and are associated with long term adverse outcomes. Sundowning seems to occur more frequently during the middle stages of Alzheimer's disease and mixed dementia and seems to subside with the progression of the person's dementia. People are generally able to understand that this behavioral pattern is abnormal. Research shows that 20–45% of people with Alzheimer's will experience some variation of sundowning confusion. However, despite lack of an official diagnosis of sundown syndrome in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), there is currently a wide range of reported prevalence.
Tasimelteon, sold under the brand name Hetlioz, is a medication approved by the U.S. Food and Drug Administration (FDA) in January 2014, for the treatment of non-24-hour sleep–wake disorder. In June 2014, the European Medicines Agency (EMA) accepted an EU filing application for tasimelteon and in July 2015, the drug was approved in the European Union for the treatment of non-24-hour sleep-wake rhythm disorder in totally blind adults, but not in the rarer case of non-24 in sighted people.
Designing lighting for the elderly requires special consideration and care from architects and lighting designers. As people age, they experience neurodegeneration in the retina and in the suprachiasmatic nucleus (SCN). Less light reaches the back of the eyes because the pupils decrease in size as you age, the lens inside your eye becomes thicker, and the lens scatters more light, causing objects and colors to appear less vivid. These symptoms are particularly common with persons having alzheimer's disease. Older people also have reduced levels of retinal illuminance, such as having smaller pupils and less transparent crystalline lenses. Furthermore, as an individual ages, they begins to lose retinal neurons, which not only compromises the ability to see but also to register a robust daily pattern of light-dark that is needed to maintain biological rhythms. The 24-hour light-dark cycle is the most important external stimulus for regulating the timing of the circadian cycle.
Irregular sleep–wake rhythm (ISWD) is a rare form of circadian rhythm sleep disorder. It is characterized by numerous naps throughout the 24-hour period, no main nighttime sleep episode, and irregularity from day to day. Affected individuals have no pattern of when they are awake or asleep, may have poor quality sleep, and often may be very sleepy while they are awake. The total time asleep per 24 hours is normal for the person's age. The disorder is serious—an invisible disability. It can create social, familial, and work problems, making it hard for a person to maintain relationships and responsibilities, and may make a person home-bound and isolated.
Robert Leroy Sack is an American physician and researcher specializing in sleep medicine. He is certified by the American Board of Psychiatry and Neurology and the American Board of Sleep Disorders Medicine. On the faculty of the Oregon Health & Science University since 1977, he is the medical director of its Clinical Sleep Disorders Medicine Program which he developed parallel with his research on circadian rhythms.
Michael Terman is an American psychologist best known for his work in applying the biological principles of the circadian timing system to psychiatric treatments for depression and sleep disorders. This subspecialty is known as Chronotherapeutics.
Charmane Eastman is an American academic research scientist whose career has focused on studying circadian rhythms and their relationships to sleep, jet lag, and shift work. She has also studied winter depression, more properly known as seasonal affective disorder (SAD). Of special focus are the effects of bright light and melatonin on circadian rhythms.
Melatonin is a dietary supplement and medication as well as naturally occurring hormone. As a hormone, melatonin is released by the pineal gland and is involved in sleep–wake cycles. As a supplement, it is often used for the short-term treatment of insomnia, such as from jet lag or shift work, and is typically taken orally. Evidence of its benefit for this use, however, is not strong. A 2017 review found that sleep onset occurred six minutes faster with use, but found no change in total time asleep. A prolonged-release form of melatonin is also approved for use as a medication in Europe for the treatment of insomnia in certain people.
Elizabeth Klerman is an assistant professor of neurology at Harvard Medical School whose research focuses on applying circadian and sleep research principles. She also uses mathematical analysis to model human circadian, sleep, and neurobehavioral mood and performance rhythms.
References
- ↑ Bhattacharjee, Yudhijit (14 September 2007). "Is Internal Timing Key to Mental Health?" (PDF). Science. AAAS. 317 (5844): 1488–90. doi:10.1126/science.317.5844.1488. PMID 17872420. Archived from the original (PDF) on 28 February 2008. Retrieved 2008-02-18.
(incl. photo of A.J.Lewy)
- ↑ "The Sleep and Mood Disorders Laboratory". Oregon Health & Science University. Archived from the original on 2012-08-05. Retrieved 2008-05-30.
- ↑ "Graduate Studies Programs Faculty". Oregon Health & Science University School of Medicine. 2008. Retrieved 2008-05-30.[ dead link ]
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