Overview of circadian sleep-wake rhythm disorders
- James K Wyatt, PhD
James K Wyatt, PhD
- Associate Professor of Behavioral Sciences
- Rush Medical College
The intrinsic circadian timekeeping system influences consolidation of sleep and wake episodes and is critical for sleep health as well as optimal functioning of other organ systems.
Desynchrony between the internal circadian timing system and desired sleep-wake times can result in one of six circadian sleep-wake rhythm disorders and is also an important factor to consider for most of the other sleep disorders. For example, persistent excessive daytime sleepiness in a patient with treated obstructive sleep apnea may be due to an underlying circadian rhythm sleep-wake disorder as opposed to refractory symptoms despite positive airway pressure therapy.
This topic provides an overview of the pathophysiology, clinical features, and diagnostic criteria of the circadian sleep-wake rhythm disorders. The classification and diagnosis of other types of sleep disorders are presented separately. (See "Classification of sleep disorders".)
FUNCTIONS OF THE CIRCADIAN SYSTEM
The intrinsic circadian timekeeping system modulates many physiological systems, including daily rhythms in core body temperature, cortisol, and appetite [1-3]. The circadian system also actively drives wakefulness during the habitual waking day, helping to offset the progressive increase in sleepiness from the sleep homeostatic system, which accumulates sleep pressure across extended wakefulness [4-6].
Sleep homeostatic drive accumulates during wakefulness and promotes the initiation of sleep. After the first half of the sleep episode, this sleep drive rapidly diminishes. A properly-aligned circadian system increases drive for sleep at night, particularly in the latter half of the night, helping to maintain sleep consolidation until normal wake-up time (figure 1) .
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- FUNCTIONS OF THE CIRCADIAN SYSTEM
- ORIGINS OF CIRCADIAN DISORDERS
- Intrinsic circadian pathophysiology
- Environmentally imposed misalignment
- CLINICAL MANIFESTATIONS
- Disrupted sleep-wake pattern
- - Delayed sleep-wake phase disorder
- - Advanced sleep-wake phase disorder
- - Non-24-hour sleep-wake rhythm disorder
- - Irregular sleep-wake rhythm disorder
- - Jet lag disorder
- - Shift work disorder
- Functional impairment
- DIFFERENTIAL DIAGNOSIS
- DIAGNOSTIC TOOLS
- Sleep diary
- Wrist actigraphy
- Melatonin sampling
- Core body temperature measurements
- DIAGNOSTIC CRITERIA