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Normal Sleep
Published in Ravi Gupta, S. R. Pandi Perumal, Ahmed S. BaHammam, Clinical Atlas of Polysomnography, 2018
Ravi Gupta, S. R. Pandi Perumal, Ahmed S. BaHammam
To fall asleep, it is important that both the homeostatic and circadian processes are in the same phase. If they are not synchronized, then we may feel difficulty in falling asleep or staying awake. Such a condition leads to the generation of circadian rhythm sleep disorders (Figure 1.3).
Botanicals and Dietary Supplements
Published in Hilary McClafferty, Integrative Pediatrics, 2017
The best evidence to date for melatonin use in children is in insomnia caused by circadian rhythm sleep disorders. Other conditions such as poor sleep hygiene, depression, anxiety, or other mental health or social issues should not be treated with melatonin as a primary agent. Lack of clear evidence regarding efficacy, dose, and long-term safety remains a relevant concern. Theoretical risk of hypothalamic-gonadal axis suppression and delayed puberty exists, although this was not shown in a follow-up study of 57 Dutch adolescents who had used melatonin for a mean of 3 years (range 1–4.6 years) at a mean dose of 2.69 mg (0.3–10 mg). Recurring headache was reported in 38% of this study population as a primary adverse effect (van Geijlswijk et al. 2011).
Fatigue and Sleep Disturbance following TBI
Published in Tom M. McMillan, Rodger Ll. Wood, Neurobehavioural Disability and Social Handicap following Traumatic Brain Injury, 2017
Similar to fatigue, the aetiology of sleep disturbances following TBI has not been established and is likely multi-factorial. Injury to brain regions, pathways, and neurotransmitter systems associated with sleep regulation, including the suprachiasmatic nucleus, hypothalamus, midbrain and ascending reticular activating system may occur (Baumann et al., 2009). Circadian Rhythm Sleep Disorders and delayed circadian timing have been reported in patients with mild TBI and insomnia (Ayalon, Borodkin, Dishon, Kanety & Dagan, 2007). The timing of sleep is regulated by the circadian (~24-h) pacemaker in the hypothalamic suprachiasmatic nuclei, which generate and maintain circadian rhythms, including pineal melatonin synthesis. Melatonin plays a role in the circadian regulation of sleep-wakefulness. Shekleton et al. (2010) found lower levels of evening melatonin production in individuals with TBI, associated with REM sleep, but not sleep efficiency or night-time awakenings. This finding suggests the circadian regulation of melatonin synthesis may be disrupted following TBI.
Actigraphic and melatonin alignment in older adults with varying dementia risk
Published in Chronobiology International, 2023
Zoe Menczel Schrire, Christopher J Gordon, Jake R Palmer, Jade Murray, Ian Hickie, Naomi L. Rogers, Simon JG Lewis, Zoe Terpening, Jonathon E Pye, Sharon L Naismith, Camilla M Hoyos
While previous findings on the relationship between habitual sleep onset and DLMO are diverse and demonstrate considerable individual variability (Sletten et al. 2010; Wright et al. 2005), the current study provides evidence for the relationship in a sample of older adults with varying risks of dementia. Sleep onset has been shown to be associated with DLMO in young people with a sleep schedule minimally influenced by employment, school and family obligations (Burgess and Eastman 2005; Crowley et al. 2006; Martin and Eastman 2002) and on work-free days in adults in a rural town in Brazil (Ruiz et al. 2020). This association has also been demonstrated in individuals with possible sleep-wake rhythm disorders (Keijzer et al. 2011) and insomnia (Wright et al. 2006). In contrast, desired sleep time and DLMO have been shown to be unrelated to shift workers (Cheng et al. 2020), and one study recommended that the timing of the ingestion of exogenous melatonin for the treatment of circadian rhythm sleep disorders be timed according to DLMO, not habitual sleep onset (Keijzer et al. 2014). Thus, the association between DLMO and sleep time is complex and has been shown to differ between populations. As sleep onset is significantly easier to capture than DLMO time, this relationship could help identify individuals at risk of circadian misalignment who could then be referred on to a DLMO assessment. Based on this assessment, circadian treatment options to reduce dementia risk will be able to be tailored to the individual for optimal efficacy.
Sleep complaints in former and current night shift workers: findings from two cross-sectional studies in Austria
Published in Chronobiology International, 2021
Jakob Weitzer, Isabel Santonja, Jürgen Degenfellner, Lin Yang, Galateja Jordakieva, Richard Crevenna, Stefan Seidel, Gerhard Klösch, Eva Schernhammer, Kyriaki Papantoniou
Chronic insomnia was defined by four criteria, established by the International Classification of Sleep Disorders, 3rd edition (Sateia 2014): 1. Report of difficulty initiating sleep and/or difficulty maintaining sleep and/or waking up earlier than desired without being able to fall back to sleep. 2. Sleep disturbance and associated daytime symptoms (of sleepiness) occurring at least three times/week. 3. Symptoms have been present for at least 3 months. 4. Report of daytime impairment related to nighttime sleep difficulties. Chronic insomnia was present if all four criteria applied (Weitzer et al. 2020). Doctor-diagnosed sleep disorder was defined as a self-report of having been diagnosed with chronic insomnia or a circadian rhythm sleep disorder by a physician. Other diagnoses of sleep problems, for example, sleep apnea, movement disorders, hypersomnia, and parasomnia, were excluded from the case definition in the main analysis. In sensitivity analysis, these diagnoses of other sleep disorders were also excluded from the analysis. Having ever asked for medical help or for treatment for a sleep problem [Yes; No] was also reported. Subjective sleepiness was assessed using the Karolinska Sleepiness Scale (KSS) (Åkerstedt et al. 2014). Participants were classified as sleepy (score ≥7) or alert (score <7). Average sleep duration was calculated based on self-reported sleep duration on workdays and days off. [Average sleep duration = (Sleep duration on workdays*5) + (Sleep duration on days off*2)/7.]
Advances in the pharmacological management of non-24-h sleep-wake disorder
Published in Expert Opinion on Pharmacotherapy, 2021
Shohei Nishimon, Naoya Nishino, Seiji Nishino
With regards to pharmacological therapy, melatonin receptor agonists to resynchronize the circadian phase shift are recommended [52–54]. Melatonin can activate the MT1 and MT2 receptors in the SCN [25], and as previously mentioned, the MT1 and MT2 receptors are also expressed in other brain regions and peripheral tissues. Endogenous melatonin regulates various functions, including circadian rhythm and sleep-wake cycle, body temperature, endocrine function, vascular system, immunomodulation, anticancer activity, skin pigmentation, hair growth, and aging [31,55]. Exogenous melatonin, including melatonin receptor agonists, is available for the treatment of insomnia, mood disorder, and circadian rhythm sleep disorder, and is likely to be effective in treating non-24 [56–58]. Of note, tasimelteon is the only approved medication by the US Food and Drug Administration (FDA) and the European Medicines Agency (EMA) for the treatment of non-24 [53]. Available melatonin receptor agonists bind to the MT1 and MT2 receptors, and each agonist has a different binding affinity [59], thereby resulting in several significant pharmacodynamic and pharmacokinetic differences in the mediation of melatonin agonistic effects (Tables 2 and Tables 3).