Circadian rhythm sleep-wake disorders

Circadian Rhythm Sleep Disorders (CRSD) usually arise when there is a discrepancy between the desired sleeping time of an individual and the endogenous circadian rhythm clock system (Lee, 2020) . This results in an individual having difficulties falling asleep or struggling to wake up when the waking time is due and this results in a significant and recurrent sleep disturbance leading to significant functional impairment. A sleep diary of 7 days showing a deranged sleep/wake pattern coupled with abnormal Dim Light Melatonin Onset (DLMO) and core body temperature is enough criteria to diagnose the disease. Disturbance in the Circadian rhythm may result from multiple causes such as environmental factors and social factors as well as disorders of the circadian rhythm itself. 

This disorder can be managed through behavioral therapy and by use of pharmacotherapy. Behavioral therapy is the recommended first line treatment modality. If this fails, pharmacologic agents can then be introduced. Behavioral treatment of this disorder requires that an individual observes strict sleep hygiene (Billiard, 2003). This entails, ensuring that the bedroom as well as the beddings are clean, ensuring that you eliminate any sources of noise in the bedroom and dim the lights before sleeping. In addition, individuals are advised to establish a regular sleep/wake cycle. Chronotherapy is also an effective treatment modality. It involves a progressive delay in sleeping time with about 3 hours every 2 days until the individual attains and maintains an earlier and regular sleeping time (Billiard, 2003). Timed bright light therapy has also been used in the treatment of this disorder. This involves exposing the affected individual to bright light of about 2,000 lux in the biological morning combined with avoidance of light in the biological night time. The disorder can also be managed by administering melatonin in the evening. Melatonin has been shown to improve sleep duration and improve functioning in people with CRSD. Referral to a specialist in sleep/waking disorder can be considered when all the above mechanisms have been explored with no success or when the patient has underlying comorbities that are likely to affect their sleeping pattern. 

References 

Billiard, M. (2003). Circadian rhythm sleep disorders.  Sleep , 469-470. doi:10.1007/978-1-4615-0217-3_36 

Lee, E. K. (2020). Introduction to circadian rhythm disorders.  Circadian Rhythm Sleep-Wake Disorders , 29-43. doi:10.1007/978-3-030-43803-6_3