Classification of sleep disorders
S.R. Pandi-Perumal, Meera Narasimhan, Milton Kramer in Sleep and Psychosomatic Medicine, 2017
Delayed sleep–wake phase disorder occurs when there is a significant delay in the phase of the major sleep episode in relation to the desired sleep and wake-up time. When allowed to sleep as desired, sleep duration and quality are age appropriate. Advanced sleep–wake phase disorder occurs when there is a significant advance in the phase of the major sleep episode in relation to the desired sleep and wake-up time. When allowed to sleep as desired, sleep duration and quality are age appropriate. Irregular sleep–wake rhythm disorder is a recurrent or chronic pattern of irregular sleep and wake episodes throughout the 24-hour period, with symptoms of insomnia and daytime sleepiness. Non-24-hour sleep–wake rhythm disorder is due to a progressively delayed sleep– wake pattern. Shift work disorder is insomnia or excessive sleepiness associated with a recurring work schedule that overlaps with the usual time for sleep. Sleep logs and actigraphy monitoring for at least 7 days is recommended for all of the above CRSWDs. Jet lag disorder is insomnia or sleepiness accompanied by transmeridian jet travel across at least two time zones.
The travelling athlete
R. C. Richard Davison, Paul M. Smith, James Hopker, Michael J. Price, Florentina Hettinga, Garry Tew, Lindsay Bottoms in Sport and Exercise Physiology Testing Guidelines: Volume I – Sport Testing, 2022
It is important to note that these assumptions are limited in that they are considered to apply equally across all individuals, e.g., rate of adjustment. However, we know that jet lag is experienced differently between individuals, and therefore the earlier text provides an incomplete assessment of jet lag. As a result, symptoms of jet lag are typically assessed. While symptoms do not allow for circadian phase to be precisely pinpointed and circadian misalignment quantified, they do provide an indication of jet lag experience at a given time of day (Waterhouse et al., 2003). Standardised questionnaires have been employed previously to character-ise athlete experiences over the course of a day and include the Liverpool John Moore’s Jet Lag Questionnaire (see Waterhouse et al., 2005). Overall, capturing the subjective experience of jet lag coupled with an estimation of circadian phase realignment based off assumptions can help assess jet lag and therefore target management, such as light therapy, meal timing and exercise (see Roach and Sargent, 2019).
Melatonin
Linda M. Castell, Samantha J. Stear (Nottingham), Louise M. Burke in Nutritional Supplements in Sport, Exercise and Health, 2015
With increasing levels of international travel, optimizing recovery from jet lag may offer a significant performance advantage. Jet lag occurs in response to a minimum of a 3-zone change at a rate faster than one zone per day and has been suggested to cause decreased performance and increased injury risk, though direct evidence is limited (Paul et al., 2010). Supplemental melatonin appears to reduce both subjective and objective symptoms of jetlag (Atkinson et al., 2003). It is unclear at this point whether the main action is hypnotic, i.e. inducing sleepiness, or chronobiotic, i.e. helping to ‘reset’ the body clock to the new time zone. Rest–activity schedules and physical exercise potentiate entrainment of the circadian system (Escames et al., 2012). However, they are weak Zeitgebers compared to the light–dark cycle. Night-time exercise of moderate or high intensity may cause a phase delay in dim light melatonin onset. A melatonin phase response curve for exercise needs to be clarified. There does not appear to be a performance ‘hangover’ from supplementation taken the night before exercise (Atkinson et al., 2001). However, the use of daytime exogenous melatonin may be more likely to diminish cognitive performance variables than to enhance physical performance (Atkinson et al., 2003, 2005).
Effects of long-haul transmeridian travel on physiological, sleep, perceptual and mood markers in Olympic team support staff
Published in Chronobiology International, 2022
Antonia Rossiter, Thomas M. Comyns, Ian Sherwin, Alan M. Nevill, Mark J. Campbell, Giles D. Warrington
A recent consensus statement has defined jet lag as a “temporary impairment of sleep and wakefulness, as well as other biological functions, associated with rapid eastward or westward travel across 3 or more time-zones” (Janse van Rensburg et al. 2021, 2032). Jet lag can cause an array of symptoms (Simmons et al. 2015), including poor sleep, gastrointestinal disturbance, negative mood disturbances, and impaired physical and cognitive performance (Forbes-Robertson et al. 2012; Sack 2009; Simmons et al. 2015; Waterhouse et al. 2007, 2004). Symptoms of jet lag are generally more severe and last longer following an eastward flight in comparison to a westward flight (Reilly et al. 1997; Roach and Sargent 2019; Simmons et al. 2015) and when greater number of time-zones are crossed (Reilly et al. 1997; Sack 2009). The human body clock needs time to gradually adjust and consequently the symptoms of jet lag will persist until circadian rhythms shift to a new environment (Sack 2009; Simmons et al. 2015; Waterhouse et al. 2004).
Understanding the role of chronopharmacology for drug optimization: what do we know?
Published in Expert Review of Clinical Pharmacology, 2023
Akio Fujimura, Kentaro Ushijima
Disruption of the circadian clock by travel across time zones can cause jet lag, which is one of the exogenous circadian rhythm sleep-wake disorders. Melatonin agonists are available for the treatment of insomnia characterized by difficulty with sleep onset in patients with jet lag [101]. In one study, subjects with a history of jet lag-induced sleep difficulty were allocated to receive ramelteon, a MT1, MT2, and MT3 agonist, at doses of 1, 4 or 8 mg or to receive placebo [102]. Ramelteon 1 mg was found to reduce sleep latency in comparison with placebo. In another study, healthy subjects with experimentally induced jet lag were allocated to receive tasimelteon, a MT1 and MT2 agonist, at a dose of 20, 50 or 100 mg or to receive placebo [103]. All doses of the drug significantly reduced sleep latency and improved sleep efficiency. Therefore, melatonin agonists are effective for the treatment of sleep problems in subjects with jet lag.
Recent advances in modulators of circadian rhythms: an update and perspective
Published in Journal of Enzyme Inhibition and Medicinal Chemistry, 2020
Shenzhen Huang, Xinwei Jiao, Dingli Lu, Xiaoting Pei, Di Qi, Zhijie Li
Circadian rhythm plays a very important role in the normal maintenance of organisms, but physical and psychological influences including jet lag, shift work, and diseases can cause a misalignment of the intrinsic oscillators. Jet lag occurs in individuals travelling across multiple time zones, who may suffer from some symptoms including disruption of sleep, gastrointestinal disturbances, decreased vigilance and attention span, a general feeling of malaise, and an increased risk of cancer and heart disease133,134. Shift work is apparent among people employed in factories or social event firms and work from 7 pm to 9 am135. Shift work has become a common phenomenon in society, and was found to be involved in cancer, cardiovascular disease, depression, and infertility. Jet lag and shift work induce rhythm disorder, which can cause a mass of psychological, nervous system, mental health, and physical health problems135. Beyond all that, diseases are closely related to circadian rhythms. Diseases can cause disturbances in circadian rhythms, and disorder in circadian rhythms, in turn, further aggravate the severity of the disease136,137. This section will focus on the relationship between disease and circadian rhythm disorders (Figure 9).
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