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Sleep-Wake Disorders JAMA PATIENT PAGE | Neurology Sleep-Wake Disorders Sleep-wake disorders occur when the body’s internal clock does not work properly or is out of sync with the surrounding environment. The Circadian System sleep-wake phase disorder, non–24-hour sleep-wake rhythm dis- The body has an internal timing system called the circadian system order, and irregular sleep-wake rhythm disorder. that regulates daily behavior and bodily functions through cycles called circadian rhythms. Circadian rhythms influence things such Diagnosis as sleeping and eating patterns, body temperature, and the produc- Diagnosis of sleep-wake disorders is based on the type of sleep prob- tion of certain hormones. These rhythms repeat approximately ev- lems present and the timing and setting in which they occur. To bet- ery 24 hours. ter understand your sleep patterns, a health care practitioner may Aparticularpartofthebraincalledthesuprachiasmaticnucleus ask you to fill out a sleep diary and wear a motion sensor for up to generates circadian rhythms. Exposure to light also affects the tim- 14 days. Keeping a sleep diary means writing down the timing of your ing of the rhythms. Normally,circadian rhythms are in sync with the sleep and the amount of sleep you obtain each day. Actigraphy in- surrounding environment, which helps people stay awake during the volves wearing a motion sensor on your wrist to track your sleep and daytime and fall asleep at night. Circadian rhythm sleep-wake dis- activity patterns throughout the day. Usually, a sleep study is not orders occur when the synchronization between circadian rhythms needed to diagnose sleep-wake disorders, but it is sometimes used and the external environment is lost or when the circadian system to make sure you do not have additional sleep problems. itself is dysfunctional. Treatment Types of Sleep-Wake Disorders The specific treatment of sleep-wake disorders depends on the type There are several different types of sleep-wake disorders. All ofsleep-wakedisorder.Ingeneral,strategicallytimedexposuretolight involve problems falling asleep or staying awake at desired or and following a sleep schedule are behavioral changes that may be socially appropriate times. Jet lag disorder and shift work disorder helpful. Melatonin is a hormone produced by the body that regu- are the 2 most common sleep-wake disorders, and they are lates sleep-wake cycles, and melatonin supplements may be used in caused by misalignment of circadian rhythms with the surround- some situations to help align the body’s circadian rhythms with the ing environment. Jet lag disorder involves excessive sleepi- outside environment. Other medications may also be used, depend- ness or difficulty falling asleep that is due to quickly crossing mul- ing on the scenario, to either promote wakefulness or facilitate sleep. tiple time zones. Shift work disorder involves problems with sleepiness or alertness related to an irregular or untraditional FOR MORE INFORMATION work schedule. The other types of sleep-wake disorders are char- American Academy of Sleep Medicine acterized by abnormalities of the circadian system itself, and www.sleepeducation.org these disorders are delayed sleep-wake phase disorder, advanced Author: Christopher C. Muth, MD The JAMA Patient Page is a public service of JAMA. The information and Sources: American Academy of Sleep Medicine recommendations appearing on this page are appropriate in most instances, but they Zee PC, Attarian H, Videnovic A. Circadian rhythm abnormalities. Continuum (Minneap are not a substitute for medical diagnosis. For specific information concerning your Minn). 2013;19(1):132-147. personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 312/464-0776. 2322 JAMA December 6, 2016 Volume 316, Number 21 (Reprinted) jama.com Copyright 2016 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/23/2021.
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