Insomnia associated with circadian rhythm disturbances. Treatment of circadian rhythm disturbances

The course of circadian rhythm disturbance . The human biological rhythm driver (the so-called biological clock) is located in the suprachiasmal nucleus of the hypothalamus. The failure of the biological clock leads to circadian rhythm disturbances, which is most often manifested by insomnia. Violations of circadian rhythms are clinically characterized by normal duration and quality of sleep, which, however, occurs independently of the time of day, i.e., does not depend on the change of dark and light time. The diagnosis of such disorders is rather complicated. The patient should keep a sleep diary for a long time and tell the doctor in detail about the nature of his disorders.

If circadian rhythms are disturbed , phase sleep syndromes are most often observed. Syndrome of delayed sleep phase (SOFS) is the patient’s inability to fall asleep until the morning (most often until 1-3, but sometimes later). With such a violation, if possible, the patient sleeps in the afternoon up to 10-14. If he is forced to get up at 7-8, he feels sleepy during the day, because the patient does not get enough sleep. But even with this regimen, by the evening the patient feels awake and again cannot fall asleep until the morning. The premature sleep phase syndrome (SPFS) is characterized by the need for early falling asleep (no later than 20-21) and early awakening (3-5). 

SOFS is more common in young people, and SPFS in older people. Both syndromes can occur chronically throughout life. Since many of the symptoms of the premature sleep phase syndrome resemble those of depression (e.g., early awakening), depressive disorders must be excluded in all patients with SPS. 

Another type of circadian rhythm disturbance is the irregularity of periods of sleep and wakefulness. The circadian rhythms of patients are disturbed, which leads to the inability to maintain sleep of normal duration. Thus, patients are forced to sleep several times during the day in order to gain the necessary duration of sleep. Such a violation is often found in the framework of Alzheimer’s disease and other diseases in the elderly. B. Treatment and prognosis. The classic treatment method is chronotherapy – this is a behavioral technique that provides for a systematic three-hour increase in the delay in the sleep phase (with the syndrome of delayed sleep phase) or in advance of the sleep phase (with the syndrome of premature sleep phase).  

This is carried out until the desired sleep phase is reached . Then the patient must strictly observe the selected regimen and go to bed at the selected time. Usually this method of treatment provides good short-term results, but soon the patients, as a rule, again lose their established rhythms. A new treatment for phase sleep disturbances is bright light therapy. Bright lighting is considered an intensity of more than 2,500 lux. Staying in bright light usually effectively helps in the fight against SOFS and SPFS. Finding a patient in bright light in the morning leads to a lengthening of the circadian phase, the evening procedure helps to delay circadian rhythms. Therefore, for the treatment of SOFS, stay in bright light in the morning (at 6-8) is prescribed, SPFS in the evening, 2-4 hours before bedtime. This method also gives good short-term results, but soon after its termination, patients usually stop observing the necessary regimen. 

For some, the duration of normalized circadian rhythms is several months, for others, a relapse of the disease develops after a few days. Patients with circadian rhythm disturbances may need psychological support. In nursing homes, where many patients suffering from this pathology, sleeping pills are usually used. However, drugs in this group have many side effects that are poorly tolerated by older people. Optimistic data from recent studies showing the effectiveness of programs for structuring daily activity of patients in combination with bright light treatment. Before starting treatment with bright light, it is necessary to appoint a consultation of a specialist in sleep disorders and an ophthalmologist. The cost of a full course of therapy with bright light is 150-300 US dollars.  

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