Management of insomnia and circadian rhythm sleep–wake disorders

2020 ◽  
pp. 1167-1178
Author(s):  
Simon D. Kyle ◽  
Alasdair L. Henry ◽  
Colin A. Espie
Keyword(s):  
Circadian Rhythm ◽  
Evidence Based ◽  
Sleep Wake Disorders ◽  
Insomnia Disorder ◽  
Cognitive Behavioural ◽  
Melatonin Administration ◽  
Evidence Based Treatments ◽  
Rhythm Disorder ◽  
Delayed Sleep ◽  
Behavioural Therapies

Insomnia disorder and circadian rhythm sleep–wake disorders (CRSWDs) are prevalent and impairing sleep disorders and often co-present with psychiatric disorder. Insomnia is characterized by difficulty with initiation and/or maintenance of sleep, driven primarily by cognitive behavioural processes. CRSWDs manifest because of alterations to the endogenous circadian clock (intrinsic) or as a consequence of environmental circumstances (extrinsic). This chapter reviews evidence-based treatments for the management of insomnia and intrinsic CRSWDs (delayed sleep–wake phase disorder, advanced sleep–wake phase disorder, non-24-hour sleep–wake disorder, irregular sleep–wake rhythm disorder). The chapter covers cognitive behavioural therapies, sleep-promoting hypnotics, phototherapy, and exogenous melatonin administration. The chapter also highlight gaps in the existing clinical science and reflects on emergent therapeutic approaches.

scholarly journals Do Evidence-Based Treatments for Circadian Rhythm Sleep-Wake Disorders Make the GRADE? Updated Guidelines Point to Need for More Clinical Research

2015 ◽  
Vol 11 (10) ◽  
pp. 1079-1080 ◽  
Author(s):  
R. Robert Auger ◽  
Helen J. Burgess ◽  
Jonathan S. Emens ◽  
Ludmila V. Deriy ◽  
Katherine M. Sharkey
Keyword(s):  
Circadian Rhythm ◽  
Clinical Research ◽  
Evidence Based ◽  
Sleep Wake Disorders ◽  
Evidence Based Treatments

Future research directions in children and hoarding

2020 ◽  
Vol 45 (3) ◽  
pp. 175-181
Author(s):  
Andrew G. Guzick ◽  
Sophie C. Schneider ◽  
Eric A. Storch
Keyword(s):  
Childhood Development ◽  
Future Research ◽  
Systematic Research ◽  
Evidence Based ◽  
Research Directions ◽  
Hoarding Disorder ◽  
Cognitive Behavioural ◽  
Evidence Based Treatments ◽  
Future Research Directions ◽  
The Impact

Abstract Despite a rapidly growing understanding of hoarding disorder (HD), there has been relatively limited systematic research into the impact of hoarding on children and adolescents. The goal of this paper is to suggest future research directions, both for children with hoarding behaviours and children living in a cluttered home. Key areas reviewed in this paper include (1) the need for prospective studies of children with hoarding behaviours and those who grow up with a parent with HD; (2) downward extensions of cognitive-behavioural models of adult HD that emphasise different information processing and behavioural biases in youth HD; (3) developmental research into the presentation of emerging HD in childhood compared with adulthood presentations of the disorder, with consideration of typical childhood development and unique motivators for childhood saving behaviours; (4) developmentally sensitive screening and assessment; and (5) the development of evidence-based treatments for this population. The paper concludes with a discussion of methodological suggestions to meet these aims.

scholarly journals Circadian tau differences and rhythm associations in delayed sleep–wake phase disorder and sighted non-24-hour sleep–wake rhythm disorder

SLEEP ◽  
2020 ◽  
Author(s):  
Gorica Micic ◽  
Nicole Lovato ◽  
Sally A Ferguson ◽  
Helen J Burgess ◽  
Leon Lack
Keyword(s):  
Circadian Rhythm ◽  
Core Body Temperature ◽  
Sleep Onset ◽  
Phase Relationship ◽  
Biological Rhythms ◽  
Circadian Phase ◽  
Behavioral Rhythm ◽  
Rhythm Disorder ◽  
Dim Light ◽  
Delayed Sleep

Abstract Study Objectives We investigated biological and behavioral rhythm period lengths (i.e. taus) of delayed sleep–wake phase disorder (DSWPD) and non-24-hour sleep–wake rhythm disorder (N24SWD). Based on circadian phase timing (temperature and dim light melatonin onset), DSWPD participants were dichotomized into a circadian-delayed and a circadian non-delayed group to investigate etiological differences. Methods Participants with DSWPD (n = 26, 17 m, age: 21.85 ± 4.97 years), full-sighted N24SWD (n = 4, 3 m, age: 25.75 ± 4.99 years) and 18 controls (10 m, age: 23.72 ± 5.10 years) participated in an 80-h modified constant routine. An ultradian protocol of 1-h “days” in dim light, controlled conditions alternated 20-min sleep/dark periods with 40-min enforced wakefulness/light. Subjective sleepiness ratings were recorded prior to every sleep/dark opportunity and median reaction time (vigilance) was measured hourly. Obtained sleep (sleep propensity) was derived from 20-min sleep/dark opportunities to quantify hourly objective sleepiness. Hourly core body temperature was recorded, and salivary melatonin assayed to measure endogenous circadian rhythms. Rhythm data were curved using the two-component cosine model. Results Patients with DSWPD and N24SWD had significantly longer melatonin and temperature taus compared to controls. Circadian non-delayed DSWPD had normally timed temperature and melatonin rhythms but were typically sleeping at relatively late circadian phases compared to those with circadian-delayed DSWPD. Conclusions People with DSWPD and N24SWD exhibit significantly longer biological circadian rhythm period lengths compared to controls. Approximately half of those diagnosed with DSWPD do not have abnormally delayed circadian rhythm timings suggesting abnormal phase relationship between biological rhythms and behavioral sleep period or potentially conditioned sleep-onset insomnia.

scholarly journals The Intersection of Cultural Characteristics and Genetics on the Prevalence of Delayed Sleep Phase Syndrome in Brazilian and Japanese Adults

2020 ◽  
Vol 1 (4) ◽  
pp. 1-6
Author(s):  
Abram Estafanous ◽  
Karim Sedky
Keyword(s):  
Circadian Rhythm ◽  
Environmental Changes ◽  
Clock Genes ◽  
Cultural Characteristics ◽  
Sleep Phase ◽  
Delayed Sleep Phase Syndrome ◽  
Japanese Adults ◽  
Delayed Sleep Phase ◽  
Rhythm Disorder ◽  
Delayed Sleep

Delayed sleep phase syndrome (DSPS) is a circadian rhythm disorder where individuals experience difficulty modifying the time they go to sleep and wake up in response to environmental changes. The circadian rhythm itself is regulated by a variety of clock genes, and various other genes (e.g., AA-NAT gene, CKIϵ gene) code for proteins that regulate clock genes. Various polymorphisms of the clock gene influencers have been shown to increase susceptibility to DSPS. This paper seeks to examine how certain cultural characteristics (e.g., napping, timing of meals, exposure to artificial light) and the presence of the AA-NAT gene (G619A polymorphism) and the CKIϵ gene (S408N polymorphism) influence the prevalence of DSPS amongst Japanese and Brazilian populations.

Treating the Client Rather Than the Symptoms: Moving Beyond Manualised Treatments in Psychotherapy

2006 ◽  
Vol 16 (2) ◽  
pp. 159-175 ◽  
Author(s):  
Vicki Bitsika ◽  
Christopher F. Sharpley
Keyword(s):  
Evidence Based ◽  
Controlled Clinical Trials ◽  
Outcomes Analysis ◽  
Evidence Based Treatments ◽  
Behavioural Therapies ◽  
Randomised Controlled ◽  
Treatment Manuals ◽  
Environmental Demands ◽  
Evidence Based Psychotherapy ◽  
Better Than

AbstractThere have been some challenges to the reliance upon data from randomised controlled clinical trials when identifying ‘evidence-based’ psychotherapy treatments. Similarly, data show that use of treatment manuals does not result in uniform and beneficial outcomes, that some evidence-based treatments are little better than non-specific counselling and that the search for those therapies or components that are effective has been largely fruitless. In an attempt to extend the debate about evidence-based treatments and drawing upon those aspects of cognitive and behavioural therapies that have been shown to be effective in most settings, this article describes valued outcomes analysis and therapy as a means of assisting clients to understand their own behaviour as (sometimes unwanted) adaptations to environmental demands and then to learn alternative ways of achieving the goals they pursue. A case illustration is provided.

scholarly journals Prevalence and associated factors of circadian rhythm sleep-wake disorders and insomnia among visually impaired Japanese individuals

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Norihisa Tamura ◽  
Taeko Sasai-Sakuma ◽  
Yuko Morita ◽  
Masako Okawa ◽  
Shigeru Inoue ◽  
...  
Keyword(s):  
Circadian Rhythm ◽  
Visually Impaired ◽  
Light Perception ◽  
Sleep Wake Disorders ◽  
Cross Sectional ◽  
Telephone Interviews ◽  
Phase Type ◽  
Delayed Sleep ◽  
Actual Prevalence

Abstract Background Although earlier studies have demonstrated that circadian rhythm sleep-wake disorders (CRSWD) are more prevalent in visually impaired individuals, the actual prevalence of CRSWD and insomnia among the visually impaired Japanese population remains unclear. The aim of this cross-sectional, telephone-based study was to estimate the prevalence of CRSWD and insomnia, and explore factors associated with CRSWD and insomnia among visually impaired Japanese individuals. Methods A nationwide telephone survey was conducted among visually-impaired individuals through local branches of the Japan Federation of the Blind. In total, 157 visually impaired individuals were eligible for this study. Demographic information and information about visual impairments, lifestyle, and sleep patterns were assessed using questionnaires and subsequent telephone interviews. CRSWD and insomnia were defined according to the International Classification of Sleep Disorders-Third Edition criteria. Results The prevalence of CRSWD in visually impaired individuals was 33.1%. Among those with CRSWD, a non-24-h/irregular sleep-wake rhythm type was the most frequently observed (26.8%), followed by an advanced sleep-wake phase type and a delayed sleep-wake phase type (3.8 and 2.5%, respectively). Furthermore, 28.7% of the visually impaired individuals were found to have insomnia. In the visually impaired individuals, the absence of light perception, unemployment, living alone, and use of hypnotics were significantly associated with CRSWD, whereas only the use of hypnotics was extracted as a marginally associated factor of insomnia. Conclusions CRSWD and insomnia were highly prevalent in visually impaired Japanese individuals. The presence of CRSWD among the visually impaired individuals was associated with a lack of light perception and/or social zeitgebers.

scholarly journals Hacia la recuperación: Enfoques terapéuticos para potenciar el tratamiento del trastorno por uso del alcohol

2021 ◽  
Author(s):  
Rosa Jurado ◽  
Ana Sion ◽  
Laura Esteban-Rodríguez ◽  
Andrés Martinez-Maldonado ◽  
Gabriel Rubio-Valladolid
Keyword(s):  
Alcohol Dependence ◽  
Behavioural Change ◽  
Evidence Based ◽  
Life Purpose ◽  
Long Term Outcomes ◽  
Process Of Change ◽  
Behavioural Approach ◽  
Cognitive Behavioural ◽  
Evidence Based Treatments

Currently, the best evidence-based treatments for alcohol dependence are those developed in multidisciplinary programmes based on a cognitive-behavioural approach, including psychological, sociological, and medical dimensions. However, recovery is not always achieved. The percentage of individuals who abandon and relapse is high throughout the process and an adequate state of wellbeing is not always found. This paper outlines some of the complements or techniques that could be incorporated to the most common treatments to enhance behavioural change, taking into account long-term outcomes. Thus, the text highlights the importance of considering recovery as the culmination of the process of change towards improved health, wellbeing, and self-directed life purpose, rather than just abstinence.

Melatonin in the treatment of Circadian Rhythm Sleep-Wake Disorders – the principles of choosing the right time and dose of administration

2019 ◽  
Vol 34 (4) ◽  
pp. 263-283
Author(s):  
Adam Wichniak ◽  
Aleksandra Wierzbicka ◽  
Katarzyna Gustavsson ◽  
Joanna Szmyd ◽  
Wojciech Jernajczyk
Keyword(s):  
Circadian Rhythm ◽  
Therapeutic Effect ◽  
Social Activity ◽  
Sleep Time ◽  
Prolonged Release ◽  
Sleep Wake Disorders ◽  
Release Formulation ◽  
Wide Range ◽  
Rhythm Disorder ◽  
The Right

Aim. Circadian Rhythm Sleep-Wake Disorders (CRSWD) are a common group of sleep disorders. The aim of this article is to present the principles for treatment of CRSWD with melatonin. Methods. Review of data from randomised, placebo-controlled clinical trials. Results. The main indication for the use of melatonin is a treatment of Delayed Sleep-Wake Phase Disorder (DSWPD). Melatonin is also recommended for the treatment of Irregular Sleep-Wake Rhythm Disorder and Non-24-Hour Sleep-Wake Rhythm Disorder. However, in the treatment of Advanced Sleep-Wake Phase Disorder melatonin plays a secondary role. The therapeutic effect of melatonin primarily depends on the appropriate time of its administration. In DSWPD it should be administered even 6–8 hours before the scheduled sleep time. The available data does not indicate that the melatonin’s therapeutic effect is strongly correlated with the used dose and the recommended doses fall within a wide range of 0.5 to 10 mg. However, usually higher doses, e.g. 5 mg, are beneficial in the first 3–6 weeks of treatment. In neuropsychiatric disorders in children, dosage even up to 10 mg is recommended. Melatonin is also an effective form for relieving symptoms of exogenous CRSWD: shift work disorder and jet lag disorder. Prolonged-release formulation of melatonin in a 2 mg dose is registered for the treatment of insomnia patients aged 55 years and older. Conclusions. Treatment of CRSWD is based primarily on chronotherapeutic interventions. They include phototherapy, light avoidance, melatonin treatment and behavioural interventions that influence, among other things, the rhythm of meals, physical and social activity.

Sign in / Sign up

Export Citation Format

Share Document