Managing Jet Lag: Some of the Problems and Possible New Solutions
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Using Bright Light and Melatonin to Reduce Jet Lag Helen J
Chapter 16 Using Bright Light and Melatonin to Reduce Jet Lag Helen J. Burgess Biological Rhythms Research Laboratory, Rush University Medical Center, Chicago, IL PROTOCOL NAME Using bright light and melatonin to reduce jet lag. GROSS INDICATION This is generally applicable to phase shifting the circadian clock in patients with circadian rhythm sleep disorders or winter depression. SPECIFIC INDICATION Bright light and melatonin can be used to reduce jet lag after crossing at least two time zones east or west. CONTRAINDICATIONS Bright light should probably not be used in: l people with existing eye disease; l people using photosensitizing medications. Bright light can induce: l migraines (in about one-third of migraine sufferers); l mania (rare). Melatonin should probably not be used in: l people who are driving or operating heavy machinery (unless they have previously tested their response to melatonin and are taking ,0.5 mg of melatonin); l pregnant or nursing women (melatonin will transfer to the fetus/infant); l women seeking to become pregnant; Behavioral Treatments for Sleep Disorders. DOI: 10.1016/B978-0-12-381522-4.00016-X © 2011 Elsevier Inc. All rights reserved. 151 152 PART I | BSM Treatment Protocols for Insomnia l children (unless they suffer from a neurodevelopmental condition associ- ated with extremely poor sleep); l asthmatics and patients with gastrointestinal disease (melatonin may be inflammatory); l patients using other medications (unless supervised by a physician). RATIONALE FOR INTERVENTION Rapid jet travel across multiple time zones produces a temporary misalign- ment between the timing of the central circadian clock and the desired sleep times in the new time zone. -
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. -
Jet Lag and Shift Work Sleep Disorders: How to Help Reset the Internal Clock
REVIEW CME EDUCATIONAL OBJECTIVE: Readers will suggest strategies to lessen jet lag and shift work disorders CREDIT BHANU P. KOLLA, MBBS R. ROBERT AUGER, MD Mayo Center for Sleep Medicine, Mayo Center for Sleep Medicine, Department of Psychiatry and Psychology, Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Mayo Clinic College of Medicine, Rochester, MN Rochester, MN Jet lag and shift work sleep disorders: How to help reset the internal clock ■■ABSTRACT or people who must travel long dis- F tances east or west by air or who must work Jet lag sleep disorder and shift work sleep disorder are the night shift, some relief is possible for the the result of dyssynchrony between the internal clock and grogginess and disorientation that often ensue. the external light-dark cycle, brought on by rapid travel The problems arise from the body’s internal across time zones or by working a nonstandard schedule. clock being out of sync with the sun. Part of Symptoms can be minimized by optimizing the sleep the solution involves helping reset the inter- nal clock, or sometimes, preventing it from environment, by strategic avoidance of and exposure to resetting itself. light, and also with drug and behavioral therapies. This review will focus on jet lag sleep disor- der and shift work sleep disorder, with an em- ■■KEY POINTS phasis on the causes, the clinical assessment, and evidence-based treatment options. Symptoms include daytime anergia, alternating com- plaints of insomnia and hypersomnia, emotional dis- ■ WHEN THE INTERNAL CLOCK turbances, and gastrointestinal distress. The severity IS OUT OF SYNC WITH THE SUN depends on the degree and the duration of dyssynchrony, as well as on innate factors such as age and whether the Circadian rhythm sleep disorders are the re- patient is an “early bird” or a “night owl.” sult of dyssynchrony between the body’s inter- nal clock and the external 24-hour light-dark cycle. -
Sleep Disorders Preeti Devnani
SPECIAL ISSUE 1: INVITED ARTICLE Sleep Disorders Preeti Devnani ABSTRACT Sleep disorders are an increasingly important and relevant burden faced by society, impacting at the individual, community and global level. Varied presentations and lack of awareness can make accurate and timely diagnosis a challenge. Early recognition and appropriate intervention are a priority. The key characteristics, clinical presentations and management strategies of common sleep disorders such as circadian rhythm disorders, restless legs syndrome, REM behavior disorder, hypersomnia and insomnia are outlined in this review. Keywords: Hypersomnia, Insomnia, REM behavior International Journal of Head and Neck Surgery (2019): 10.5005/jp-journals-10001-1362 INTRODUCTION Department of Neurology and Sleep Disorder, Cleveland Clinic, Abu Sleep disorders are becoming increasingly common in this modern Dhabi, United Arab Emirates era, resulting from several lifestyle changes. These complaints may Corresponding Author: Preeti Devnani, Department of Neurology present excessive daytime sleepiness, lack of sleep or impaired and Sleep Disorder, Cleveland Clinic, Abu Dhabi, United Arab Emirates, quality, sleep related breathing disorders, circadian rhythm disorder e-mail: [email protected] misalignment and abnormal sleep-related movement disorders.1 How to cite this article: Devnani P. Sleep Disorders. Int J Head Neck They are associated with impaired daytime functioning, Surg 2019;10(1):4–8. increased risk of cardiovascular and cerebrovascular disease, poor Source of support: Nil glycemic control, risk of cognitive decline and impaired immunity Conflict of interest: None impacting overall morbidity and mortality. Diagnosis of sleep disorders is clinical in many scenarios, The following circadian rhythm sleep–wake disorders adapted polysomnography is a gold standard for further evaluation of from the ICSD-3: intrinsic sleep disorder such as obstructive sleep apnea (OSA) • Delayed sleep–wake phase disorder and periodic limb movement disorder (PLMD). -
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. -
Assessment and Management of Insomnia 6-8 Carlos H
CONTEMPO UPDATES LINKING EVIDENCE AND EXPERIENCE Assessment and Management of Insomnia 6-8 Carlos H. Schenck, MD pression, and suicidality. Insomnia is plored. The bedpartner’s input can pro- associated with enormous direct and in- vide important information regarding Mark W. Mahowald, MD direct costs, as much as $14 billion in snoring and breathing patterns, un- Robert L. Sack, MD the United States in 1995.7 Physicians usual sleep motor activity, and day- should therefore establish an effective time consequences from suboptimal NSOMNIA IS A COMMON TREATABLE clinical strategy for eliciting and man- sleep. Use of caffeine, alcohol, and drugs disorder of insufficient or poor- aging insomnia complaints.9-11 Use of a (prescription, over-the-counter, herbal quality sleep, with adverse daytime I 1 sleep-trained nurse, psychologist, or products, illicit agents) should also be consequences. Insomnia presents as both on a consultation basis or as a mem- discussed. Reliving a typical day with the trouble falling asleep (long-sleep ber of the physician’s medical practice patient can be helpful. latency), trouble staying asleep (exces- should be considered. One study has re- A sleep log (diary), completed for at sive or prolonged awakenings), or feel- ported on the benefit of behavioral treat- least 7 consecutive days, is important for ing nonrestored from sleep. Insomnia ment of insomnia provided by a trained evaluating an insomnia complaint11 and can be a primary disorder emerging in clinic nurse in a general medical prac- is especially useful in identifying circa- childhood or later, a conditioned (psy- tice.12 However, the cost-effectiveness of dian rhythm disorders as a cause of in- chophysiological) disorder, or comor- incorporating a sleep-trained nurse or somnia. -
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. -
Circadian Rhythm Sleep Disorders and Narcolepsy
TALK FOR NARCOLEPSY NETWORK CONFERENCE 2013: Circadian Rhythm Sleep Disorders and Narcolepsy Note: The slides for this talk may be viewed at http://www.circadiansleepdisorders.org/docs/talks/NNconf2013talkSlides.pdf . Slides with audio of the talk are at http://youtu.be/i70SqjCr-jY . I. Introduction [title slide] A. Hello Hi. I’m Peter Mansbach, and I’m president of Circadian Sleep Disorders Network. I’m really glad for this opportunity to talk about circadian sleep disorders, and also about possible connections with narcolepsy. B. Disclaimer Let me start by saying I am not a medical doctor. I don’t diagnose, and I don’t treat. C. Why should the narcolepsy community care? [Overview slide] The various sleep disorders overlap. I have DSPS, but I have some of the same symptoms as narcolepsy. And many of you have symptoms of DSPS. Diagnoses are fuzzy too, and in some cases another sleep disorder may be secondary or even dominant. I’ll talk more about this later. D. Intro How many of you have trouble waking up in the morning? How many of you like to stay up late? II. Circadian Rhythm Sleep Disorders A. What are circadian rhythms? [slide] 1. General Circadian means "approximately a day". Circadian rhythms are processes in living organisms which cycle daily. They are produced internally in all living things. They are also referred to as the body clock. 2. In Humans Humans have internal cycles lasting on average about 24 hours and 10 minutes, though the length varies from person to person. (Early experiments seemed to show a cycle of about 25 hours, and this still gets quoted, but it is now known to be incorrect. -
Melatonin and Jet Lag Br J Sports Med: First Published As 10.1136/Bjsm.32.2.98 on 1 June 1998
98 Br J Sports Med 1998;32:98–100 Melatonin and jet lag Br J Sports Med: first published as 10.1136/bjsm.32.2.98 on 1 June 1998. Downloaded from World class sportspersons must travel widely for inter- immediately after the flight, and on methods to promote national competitions and sports camps. As a result, they adjustment of the body clock.111 During the flight, will suVer from circadian dyschronism, more popularly dehydration and stiVness should be avoided (by taking known as “jet lag” if they fly across several time zones to the copious amounts of water and fruit juice, and by short east or west. walks and stretching exercises), and the times of taking Normally, humans work in the daytime and sleep at naps and meals should be determined by habits in the new, night. This pattern is due not only to a behavioural rather than the old, time zone. Training programmes response to the rhythmic environment, but also to a “body should be devised with the consideration that some of the clock”. The body clock is situated in the base of the brain new daytime will correspond to night in the time zone just (the hypothalamic suprachiasmatic nuclei) and exerts its left and that the athlete or games player will also be suVer- eVects throughout the body by producing daily rhythms in ing from the eVects of sleep loss. Restricted training sched- core temperature, plasma melatonin and adrenaline, and ules and reduced levels of achievement should be expected the sympathetic nervous system.1 by coach and athlete or player. -
Stabilized NADH As a Countermeasure for Jet Lag
I < Source of Acquisition [ NASA Johnson Space Center NADH & Jet Lag 25 pages 5112 words 29 references o tables 5 figures Stabilized NADH as a Countermeasure for Jet Lag Gary G. Kay, Ph.D. Erik ViilTe M.D ., Ph.D. Jonathan Clark, M.D. Running Head: Stabilized NADH and Jet Lag Please send Correspondence to: Gary G. Kay, Ph.D. Director Washi ngton Neuropsychological Insti tute 4910 Massachusetts Ave., NW Suite 100 Washington, DC 20016 (202) 686 7520 NADH & Jet Lag 2 Abstract Background: Current remedies for jet lag (phototherapy, melatonin, stimulant, and sedative medications) are limited in efficacy and practicality. The efficacy of a stabi lized, sublingual form of reduced nicotinamide adenine dinucleotide (NADH, E NADAlert®, Menuco Corp.) as a countermeasure for jet lag was examined. Hypothesis: Because NADH increases cellular production of ATP and fac ilitates dopamine synthesis, it may counteract the effects of jet lag on cogniti ve fu nction in g and sleepiness. Methods: Thirty-five health y, empl oyed subjects participated in this double- blind, placebo-controlled study. Training and baseline testing were conducted on the West Coast before subj ects flew overnight to the East Coast, where they would experi ence a 3-hour time di fference. Upon aITival, individuals were randoml y assigned to receive either 20 mg of sublingual stabi li zed ADH (n=1 8) or identical placebo tablets (n=17). All participants completed computer-administered tests (including CogScreen7) to assess changes in cognitive functioning, mood, and sleepiness in the morning and afternoon. Results: Jet lag resulted in increased sleepiness for over half the participants and deterioration of cognitive functioning for approxi mately one third.