Normal and Delayed Sleep Phases
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No Evidence for a Phase Delay in Human Circadian Rhythms After a Single Morning Melatonin Administration
J. Pineal Res. 2002; 32:1±5 Copyright ã Munksgaard, 2002 Journal of Pineal Research ISSN 0742-3098 No evidence for a phase delay in human circadian rhythms after a single morning melatonin administration Wirz-Justice A, Werth E, Renz C, MuÈ ller S, KraÈ uchi K. No evidence for a Anna Wirz-Justice, Esther Werth, phase delay in human circadian rhythms after a single morning melatonin Claudia Renz, Simon MuÈ ller and administration. J. Pineal Res. 2002; 32: 1±5. ã Munksgaard, 2002 Kurt KraÈuchi Abstract: Although there is good consensus that a single administration of Centre for Chronobiology, Psychiatric University Clinic, Basel, Switzerland melatonin in the early evening can phase advance human circadian rhythms, the evidence for phase delay shifts to a single melatonin stimulus given in the early morning is sparse. We therefore carried out a double-blind randomized- order placebo-controlled study under modi®ed constant routine (CR) conditions (58 hr bedrest under 8 lux with sleep 23:00±07:00 hr) in nine healthy young men. A single (pharmacological) dose of melatonin (5 mg p.o.) or a placebo was administered at 07:00 hr on the ®rst morning. Core body temperature (CBT) and heart rate (HR) were continuously recorded, and saliva was collected half-hourly for assay of melatonin. Neither the timing of the mid-range crossing times of temperature (MRCT) and HR rhythms, nor dim light melatonin onset (DLMOn) or oset (DLMO) were phase shifted the day after melatonin administration compared with placebo. Key words: human circadian rhythms, morning The only change was an altered wave form of the CBT rhythm: longer melatonin, phase delay duration of higher-than-average temperature after melatonin administration. -
Normal and Delayed Sleep Phases
1 Overview • Introduction • Circadian Rhythm Sleep Disorders – DSPS – Non-24 • Diagnosis • Treatment • Research Issues • Circadian Sleep Disorders Network © 2014 Circadian Sleep Disorders Network 2 Circadian Rhythms • 24 hours 10 minutes on average • Entrained to 24 hours (zeitgebers) • Suprachiasmatic nucleus (SCN) – the master clock • ipRGC cells (intrinsically photosensitive Retinal Ganglion Cells) © 2014 Circadian Sleep Disorders Network 3 Circadian Rhythm Sleep Disorders • Definition – A circadian rhythm sleep disorder is an abnormality of the body’s internal clock, in which a person is unable to fall asleep at a normal evening bedtime, although he is able to sleep reasonably well at other times dictated by his internal rhythm. • Complaints – Insomnia – Excessive daytime sleepiness • Inflexibility • Coordination with other circadian rhythms © 2014 Circadian Sleep Disorders Network 4 Circadian Sleep Disorder Subtypes* • Delayed Sleep-Phase Syndrome (G47.21**) • Non-24-Hour Sleep-Wake Disorder (G47.24) • Advanced Sleep-Phase Syndrome (G47.22) • Irregular Sleep-Wake Pattern (G47.23) • Shift Work Sleep Disorder (G47.26) • Jet Lag Syndrome * From The International Classification of Sleep Disorders, Revised (ICSD-R) ** ICD-10-CM diagnostic codes in parentheses © 2014 Circadian Sleep Disorders Network 5 Definition of DSPS from The International Classification of Sleep Disorders, Revised (ICSD-R): • Sleep-onset and wake times that are intractably later than desired • Actual sleep-onset times at nearly the same daily clock hour • Little or no reported difficulty in maintaining sleep once sleep has begun • Extreme difficulty awakening at the desired time in the morning, and • A relatively severe to absolute inability to advance the sleep phase to earlier hours by enforcing conventional sleep and wake times. -
The Use of Bright Light in the Treatment of Insomnia
Chapter e39 The Use of Bright Light in the Treatment of Insomnia Leon Lack and Helen Wright Department of Psychology, Flinders University, Adelaide, South Australia PROTOCOL NAME The use of bright light in the treatment of insomnia. GROSS INDICATION Certain types of insomnia that are associated with abnormal timing of circa- dian rhythms may be treated with bright light therapy. SPECIFIC INDICATION Some individuals with sleep onset insomnia experience difficulty falling asleep at a “normal time” but no difficulty maintaining sleep once it is initi- ated. Individuals with this type of insomnia may have a delayed or later timed circadian rhythm. Bright light therapy timed in the morning after arising can advance or time circadian rhythms earlier and thus would be indicated for sleep onset or initial insomnia. Morning bright light therapy is also indicated for the related problem of delayed sleep phase disorder. Individuals experiencing early morning awakening insomnia have no diffi- culty initiating sleep but their predominant difficulty is waking before intended and not being able to resume sleep. These individuals may have an advanced or early timed circadian rhythm. Bright light therapy in the evening before sleep would be indicated for this type of insomnia as well as for the more extreme version, advanced sleep phase disorder. CONTRAINDICATIONS Bright light therapy would not be recommended in the following cases: ● Insomnia in which there is no indication of abnormal timing of circadian rhythms (e.g. combined problem initiating and maintaining sleep, having no strong morning or evening activity preferences) Behavioral Treatments for Sleep Disorders. DOI: 10.1016/B978-0-12-381522-4.00053-5 © 2011 Elsevier Inc. -
Circadian Rhythm Sleep Disorders
Circadian Rhythm Sleep Disorders Circadian Rhythm Sleep Disorders By Yolanda Smith, BPharm Circadian rhythm sleep disorders are a type of sleep disorder that involve abnormalities in the timing of sleep. The circadian rhythm, also sometimes referred to as the body clock, is the natural pattern of sleep in the body, including feelings of sleepiness and wakefulness during the day. It naturally affects the body temperature, appetite, hormone secretion and alertness of the individual, which influence the timing of sleep. A patient affected by a circadian rhythm sleep disorder is unable to sleep and wake up at the times according to their circadian rhythm, due to work, study or lifestyle commitments. In most cases, they are able to get enough sleep throughout the day if they are able to sleep according to the cues of their body clock, but their daily commitments are out of sync with their circadian rhythm, increasing the difficulty in falling asleep when they have time to sleep. Delayed Sleep Phase Disorder Delayed sleep phase disorder refers to when the body clock of an individual is two or more hours later than what is considered normal, resulting in delayed feelings of sleepiness and wakefulness with respect to the external environment. This typically means that they fall asleep after 1 a.m. in the night and would not naturally wake until the late morning or afternoon. However, most people with this disorder have work or study commitments in the morning that shorten the duration of the sleep, which may lead to sleep deprivation and daytime sleepiness. Light therapy and melatonin treatment may be useful in helping to advance the sleep phase by up to two hours, but it may not be possible for all individuals to advance their sleep phase to the normal schedule. -
Psychopathology-Madjirova.Pdf
NADEJDA PETROVA MADJIROVA PSYCHOPATHOLOGY psychophysiological and clinical aspects PLOVDIV 2005 I devote this book to all my patients that shared with me their intimate problems. © Nadejda Petrova Madjirova, 2015 PSYCHOPATHOLOGY: PSYCHOPHYSIOLOGICAL AND CLINICAL ASPECTS Prof. Dr. Nadejda Petrova Madjirova, MD, PhD, DMSs Reviewer: Prof. Rumen Ivandv Stamatov, PhD, DPS Prof. Drozdstoj Stoyanov Stoyanov, PhD, MD Design: Nadejda P. Madjirova, MD, PhD, DMSc. Prepress: Galya Gerasimova Printed by ISBN I. COMMON ASPECTS IN PSYCHOPHYSIOLOGY “A wise man ought to realize that health is his most valuable possession” Hippocrates C O N T E N T S I. Common aspects in psychophysiology. ..................................................1 1. Some aspects on brain structure. ....................................................5 2. Lateralisation of the brain hemispheres. ..........................................7 II. Experimental Psychology. ..................................................................... 11 1. Ivan Petrovich Pavlov. .................................................................... 11 2. John Watson’s experiments with little Albert. .................................15 III. Psychic spheres. ...................................................................................20 1. Perception – disturbances..............................................................21 2. Disturbances of Will .......................................................................40 3. Emotions ........................................................................................49 -
Circadian Phase Sleep and Mood Disorders (PDF)
129 CIRCADIAN PHASE SLEEP AND MOOD DISORDERS ALFRED J. LEWY CIRCADIAN ANATOMY AND PHYSIOLOGY SCN Efferent Pathways Anatomy Not much is known about how the SCN entrains overt circadian rhythms. We know that the SCN is the master The Suprachiasmatic Nucleus: Locus of the pacemaker, but regarding its regulation of the rest/activity Biological Clock cycle, core body temperature rhythm and cortisol rhythm, Much is known about the neuroanatomic connections of among others, it is not clear if there is a humoral factor or the circadian system. In vertebrates, the locus of the biologi- neural connection that transmits the SCN’s efferent signal; cal clock (the endogenous circadian pacemaker, or ECP) however, a great deal is known about the efferent neural pathway between the SCN and pineal gland. that drives all circadian rhythms is in the hypothalamus, specifically, the suprachiasmatic nucleus (SCN)(1,2).This paired structure derives its name because it lies just above The Pineal Gland the optic chiasm. It contains about 10,000 neurons. The In mammals, the pineal gland is located in the center of molecular mechanisms of the SCN are an active area of the brain; however, it lies outside the blood–brain barrier. research. There is also a great deal of interest in clock genes Postganglionic sympathetic nerves (called the nervi conarii) and clock components of cells in general, not just in the from the superior cervical ganglion innervate the pineal (4). SCN. The journal Science designated clock genes as the The preganglionic neurons originate in the spinal cord, spe- second most important breakthrough for the recent year; cifically in the thoracic intermediolateral column. -
Non-24-Hour Sleep-Wake Disorder Revisited – a Case Study
CASE REPORT published: 29 February 2016 doi: 10.3389/fneur.2016.00017 Non-24-Hour Sleep-Wake Disorder Revisited – a Case study Corrado Garbazza1,2† , Vivien Bromundt3† , Anne Eckert2,4 , Daniel P. Brunner5 , Fides Meier2,4 , Sandra Hackethal6 and Christian Cajochen1,2* 1 Centre for Chronobiology, Psychiatric Hospital of the University of Basel, Basel, Switzerland, 2 Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland, 3 Sleep-Wake-Epilepsy-Centre, Department of Neurology, Inselspital, Bern University Hospital, Bern, Switzerland, 4 Neurobiology Laboratory for Brain Aging and Mental Health, Psychiatric Hospital of the University of Basel, Basel, Switzerland, 5 Center for Sleep Medicine, Hirslanden Clinic Zurich, Zurich, Switzerland, 6 Charité – Universitaetsmedizin Berlin, Berlin, Germany The human sleep-wake cycle is governed by two major factors: a homeostatic hourglass process (process S), which rises linearly during the day, and a circadian process C, which determines the timing of sleep in a ~24-h rhythm in accordance to the external Edited by: Ahmed S. BaHammam, light–dark (LD) cycle. While both individual processes are fairly well characterized, the King Saud University, Saudi Arabia exact nature of their interaction remains unclear. The circadian rhythm is generated by Reviewed by: the suprachiasmatic nucleus (“master clock”) of the anterior hypothalamus, through Axel Steiger, cell-autonomous feedback loops of DNA transcription and translation. While the phase Max Planck Institute of Psychiatry, Germany length (tau) of the cycle is relatively stable and genetically determined, the phase of Timo Partonen, the clock is reset by external stimuli (“zeitgebers”), the most important being the LD National Institute for Health and Welfare, Finland cycle. -
An Integrative Chronobiological-Cognitive Approach to Seasonal Affective Disorder Jennifer Nicole Rough University of Vermont
University of Vermont ScholarWorks @ UVM Graduate College Dissertations and Theses Dissertations and Theses 2016 An integrative chronobiological-cognitive approach to seasonal affective disorder Jennifer Nicole Rough University of Vermont Follow this and additional works at: https://scholarworks.uvm.edu/graddis Part of the Clinical Psychology Commons Recommended Citation Rough, Jennifer Nicole, "An integrative chronobiological-cognitive approach to seasonal affective disorder" (2016). Graduate College Dissertations and Theses. 483. https://scholarworks.uvm.edu/graddis/483 This Dissertation is brought to you for free and open access by the Dissertations and Theses at ScholarWorks @ UVM. It has been accepted for inclusion in Graduate College Dissertations and Theses by an authorized administrator of ScholarWorks @ UVM. For more information, please contact [email protected]. AN INTEGRATIVE CHRONOBIOLOGICAL-COGNITIVE APPROACH TO SEASONAL AFFECTIVE DISORDER A Dissertation Presented by Jennifer Nicole Rough to the Faculty of the Graduate College of the University of Vermont In Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Specializing in Clinical Psychology January, 2016 Defense Date: September, 17, 2015 Dissertation Examination Committee: Kelly Rohan, Ph.D., Advisor Terry Rabinowitz, M.D., Chairperson Timothy Stickle, Ph.D. Mark Bouton, Ph.D. Donna Toufexis, Ph.D. Cynthia J. Forehand, Ph.D., Dean of the Graduate College ABSTRACT Seasonal affective disorder (SAD) is characterized by annual recurrence of clinical depression in the fall and winter months. The importance of SAD as a public health problem is underscored by its high prevalence (an estimated 5%) and by the large amount of time individuals with SAD are impaired (on average, 5 months each year). -
A Three Pulse Phase Response Curve to Three Milligrams of Melatonin in Humans
J Physiol 586.2 (2008) pp 639–647 639 A three pulse phase response curve to three milligrams of melatonin in humans Helen J. Burgess1,VictoriaL.Revell2 and Charmane I. Eastman1 1Biological Rhythms Research Laboratory, Department of Behavioural Sciences, Rush University Medical Center, Chicago, IL, USA 2Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey GU2 7XH, UK Exogenousmelatoninisincreasinglyusedforitsphaseshiftingandsoporificeffects.Wegenerated a three pulse phase response curve (PRC) to exogenous melatonin (3 mg) by administering it to free-running subjects. Young healthy subjects (n = 27) participated in two 5 day laboratory sessions,eachprecededbyatleastaweekofhabitual,butfixedsleep.Each5 daylaboratorysession started and ended with a phase assessment to measure the circadian rhythm of endogenous melatonin in dim light using 30 min saliva samples. In between were three days in an ultradian dim light (< 150 lux)–dark cycle (LD 2.5 : 1.5) during which each subject took one pill per day at the same clock time (3 mg melatonin or placebo, double blind, counterbalanced). Each individual’s phase shift to exogenous melatonin was corrected by subtracting their phase shift to placebo (a free-run). The resulting PRC has a phase advance portion peaking about 5 h before the dim light melatonin onset, in the afternoon. The phase delay portion peaks about 11 h after the dim light melatonin onset, shortly after the usual time of morning awakening. A dead zone of minimal phase shifts occurred around the first half of habitual sleep. The fitted maximum advance and delay shifts were 1.8 h and 1.3 h, respectively. This new PRC will aid in determining the optimal time to administer exogenous melatonin to achieve desired phase shifts and demonstrates that using exogenous melatonin as a sleep aid at night has minimal phase shifting effects. -
Circadian Rhythm Phase Shifts Caused by Timed Exercise Vary with Chronotype
Circadian rhythm phase shifts caused by timed exercise vary with chronotype J. Matthew Thomas, … , Jody L. Clasey, Julie S. Pendergast JCI Insight. 2020. https://doi.org/10.1172/jci.insight.134270. Clinical Medicine In-Press Preview Clinical trials Graphical abstract Find the latest version: https://jci.me/134270/pdf Circadian rhythm phase shifts caused by timed exercise vary with chronotype J. Matthew Thomas1,2, Philip A. Kern2,3,4, Heather M. Bush2,5, Kristen J. McQuerry5, W. Scott Black6, Jody L. Clasey1,2,4, Julie S. Pendergast2,4,7,8 1Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, Kentucky, USA 2Center for Clinical and Translational Science, University of Kentucky, Lexington, Kentucky, USA 3The Department of Internal Medicine, Division of Endocrinology, University of Kentucky, Lexington, Kentucky, USA 4Barnstable Brown Diabetes and Obesity Center, University of Kentucky, Lexington, Kentucky, USA 5Department of Biostatistics, University of Kentucky, Lexington, Kentucky, USA 6Department of Clinical Sciences, University of Kentucky, Lexington, Kentucky, USA 7Department of Biology, University of Kentucky, Lexington, Kentucky, USA 8Saha Cardiovascular Research Center, University of Kentucky, Lexington, Kentucky, USA JL Clasey and JS Pendergast contributed equally to this work. Address for Correspondence: Julie S. Pendergast 316 Thomas Hunt Morgan Building Department of Biology University of Kentucky Lexington, KY 40502 (859) 218-6770 [email protected] The authors have declared that no conflict of interest exists. Submission Category: Clinical Medicine 1 ABSTRACT BACKGROUND. The circadian system entrains behavioral and physiological rhythms to environmental cycles and modern lifestyles disrupt this entrainment. We investigated a timed exercise intervention to phase shift the internal circadian rhythm. -
The Implications of Chronobiology for Psychiatry
56 CASPONSOREDT BY CMEE LLC • PSYCHIATRICG TIMESO • OCTOBER 2011RY The Implications of Chronobiology for Psychiatry by Anna Wirz-Justice, PhD vides the temporal organization necessary for uli that act on biological rhythms (eg, light) or optimum behavior—the right function at the right direct manipulations of sleep to treat psychiatric hronobiology—the science of daily time. disorders. (circadian), monthly, tidal, and season- The field of chronobiology is exemplary in Biological rhythms are not new to psychiatry. al rhythms—has undergone exponen- its bench-to-bedside translational approach. The 19th century German psychiatrists, in par- C tial growth in the past decade, with Groundbreaking research into the genetic clock- ticular, collected enormous numbers of case stud- major discoveries at the molecular and neuroana- work covers all phyla, from cyanobacteria to the ies that demonstrated periodicity in psycho- tomic level. The most ubiquitous rhythms are weed Arabidopsis, utilizing the rich mutant pos- pathology. In 1960, Menninger-Lerchenthal1 those linked to the 24-hour day-night cycle. sibilities in fruit flies and mice and scanning for proposed a hypothalamic neuroendocrine mecha- These circadian rhythms manifest themselves at polymorphisms of clock genes in clinical disor- nism to underlie the astonishing precision of every hierarchical level: from the general popula- ders. On the basis of this research, novel, non- daily and seasonal rhythms in clinical symptoms tion (eg, more traffic accidents late at night) to the pharmacological treatments for chronobiological and behavior—a very prescient prediction that individual (eg, the sleep-wake cycle), in each disorders have been developed. Chronothera- has been characterized in detail by modern re- organ, cell, and molecule. -
Chronobiological Strategies for Unmet Needs in the Treatment of Depression – Wirz-Justice MEDICOGRAPHIA, VOL 27, No
U NMET N EEDS IN THE T REATMENT OF D EPRESSION he field of chronobiology studies 24-hour bio- logical clocks (the circadian system) and their Tsynchronizers (“zeitgebers”) such as light, the pineal hormone melatonin, food, activity, as well as the factors regulating sleep.1 Light therapy has arisen out of this basic research in circadian rhythms, Anna WIRZ-JUSTICE, PhD whereas, in contrast, sleep deprivation (“wake ther- Center for Chronobiology apy”) was established by astutely following up clin- University Psychiatric Hospitals Basel ical observations.2 Chronotherapeutics can be de- Basel, SWITZERLAND fined as translating basic chronobiology research into valid treatments. The term is broad, and the treatments subsumed under this heading will grow as the field grows, and are of course not limited to affective disorders (there is an important body of evidence, for example, that the correct timing of cancer treatments augments survival and dimin- ishes the often potent side effects). The theme of meeting unmet needs in the treat- Chronobiological ment of depression is important and timely. The onset of action of antidepressants is still not rapid enough, a proportion of patients do not respond, strategies for unmet others have residual symptoms that predict relapse. Although medication based on classic neurotrans- mitter systems is still a prime focus, drug targets other than monoamines are under intensive inves- needs in the treatment 3 tigation. Strategies promoting adjuvant therapy are on the increase, whether they encompass com- bination with other medications (eg, addition of of depression pindolol, of thyroid hormone) or psychological in- terventions (eg, cognitive behavioral therapy). Main- stream psychiatry is becoming more and more by A.