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Circadian Rhythm Sleep Disorders

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Primary Care Sleep Medicine

Abstract

Nearly all organisms exhibit a near-24 h (circadian) rhythm in physiology and behavior, which in humans is best reflected in the daily pattern of the sleep and wake cycle. These intrinsic rhythms are genetically regulated through a complex transcription–translation feedback loop of specific clock genes. The master pacemaker that generates circadian rhythms is located within the suprachiasmatic nucleus (SCN) in the hypothalamus. The timing and strength of the oscillation of circadian rhythms can be manipulated by strategically timed administration of light and melatonin. Circadian rhythm sleep–wake disorders can result either from endogenous dysfunction of the internal circadian clock, or through exogenous environmental disruption. Treatment of these disorders relies on a combination of specific timing of light and melatonin, along with structured physical and social activity and maintaining a regular sleep–wake schedule.

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Abbreviations

ASPD:

Advanced sleep phase disorder

BMAL:

Brain and muscle ARNT-like protein

CK:

Casein kinase

CLOCK:

Circadian locomotor output cycles kaput

CRSD:

Circadian rhythm sleep disorder

DSPD:

Delayed sleep phase disorder

GSK:

Glycogen synthase kinase

ISWD:

Irregular sleep–wake disorder

MR:

Median raphe

N24SD:

Non-24 sleep–wake disorder

PVN:

Paraventricular nucleus

SAD:

Seasonal affective disorder

SCN:

Suprachiasmatic nucleus

SWD:

Shift work disorder

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Correspondence to Phyllis C. Zee M.D., Ph.D. .

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Abbott, S.M., Soca, R., Zee, P.C. (2014). Circadian Rhythm Sleep Disorders. In: Pagel, J., Pandi-Perumal, S. (eds) Primary Care Sleep Medicine. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1185-1_27

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