Circadian Rhythms and Insomnia

  • Leon C. Lack
  • Helen R. Wright
Part of the Current Clinical Neurology book series (CCNEU)


Because our circadian rhythms have a strong influence on sleepiness/alertness, inappropriate timing of these rhythms with respect to the attempted sleep period can produce insomnia. Relatively delayed circadian rhythms have been associated with sleep-onset insomnia and advanced or early timed rhythms have been associated with early morning awakening insomnia. Therefore, management of these insomnias need to include treatments, such as bright light and melatonin, that will retime the circadian rhythms to be more in synchrony with the timing of sleep.


Circadian rhythms, Delayed sleep phase Advanced sleep phase Insomnia Bright-light therapy Melatonin 


  1. 1.
    American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders, 4th edn. American Psychiatric Association, Washington, DCGoogle Scholar
  2. 2.
    American Academy of Sleep Medicine (2005) International classification of sleep disorders: diagnostic and coding manual, 2nd edn. American Academy of Sleep Medicine, Westchester, ILGoogle Scholar
  3. 3.
    Borbély AA, Achermann P (1999) Sleep homeostasis and models of sleep regulation. J Biol Rhythms 14(6):559–568CrossRefGoogle Scholar
  4. 4.
    Klein DC, Moore RY, Reppert SM (1991) Suprachiasmatic nucleus: the mind’s clock. Oxford University Press, New YorkGoogle Scholar
  5. 5.
    Arendt J (2000) Melatonin, circadian rhythms and sleep. New Engl J Med 343:1114–1116CrossRefPubMedGoogle Scholar
  6. 6.
    Sack R, Lewy A, Hughes R (1998) Use of melatonin for sleep and circadian rhythm disorders. Ann Med 30:115–121CrossRefPubMedGoogle Scholar
  7. 7.
    Dijk DJ, Lockely SW (2001) Functional genomics of sleep and circadian rhythms: invited review: integration of human sleep-wake regulation and circadian rhythmicity. J Appl Physiol 92:852–862CrossRefGoogle Scholar
  8. 8.
    Strogatz SH, Kronauer RE (1985) Circadian wake maintenance zones and insomnia in man. Sleep Res 14:219Google Scholar
  9. 9.
    Strogatz S, Kronauer R, Czeisler CA (1987) Circadian pacemaker interferes with sleep onset at specific times each day: role in insomnia. Am J Physiol 253:R172–R178PubMedGoogle Scholar
  10. 10.
    Dijk D-J, Czeisler CA (1995) Contributions of the circadian pacemaker and the sleep propensity, sleep structure, electroencephalographic slow wave, and sleep spindle activity in humans. J Neurosci 15:3526–3538PubMedGoogle Scholar
  11. 11.
    Strogatz SH, Kronauer RE, Czeisler CA (1986) Circadian regulation dominates homeostatic control of sleep length and prior wake length in humans. Sleep 9:353–364PubMedGoogle Scholar
  12. 12.
    Czeisler CA, Duffy JF, Shanahan TL, Brown EN et al (1999) Stability, precision, and near-24-hour period of the human circadian pacemaker. Science 284:2177–2181CrossRefPubMedGoogle Scholar
  13. 13.
    Campbell SS, Murphy PJ (2007) Delayed sleep phase disorder in temporal isolation. Sleep 30:1225–1228PubMedPubMedCentralGoogle Scholar
  14. 14.
    Morris M, Lack L, Dawson D (1990) Sleep-onset insomniacs have delayed temperature rhythms. Sleep 13:1–14PubMedGoogle Scholar
  15. 15.
    Wright H, Lack L, Bootzin R (2006) Relationship between dim light melatonin onset and the timing of sleep in sleep onset insomniacs. Sleep Biol Rhythms 4:78–80CrossRefGoogle Scholar
  16. 16.
    Lack L, Wright H, Paynter D (2007) The treatment of sleep onset insomnia with bright morning light. Sleep Biol Rhythms 5:173–179CrossRefGoogle Scholar
  17. 17.
    Taylor A, Wright HR, Lack LC (2008) Sleeping-in on the weekend delays circadian phase and increases sleepiness on the following week. Sleep Biol Rhythms 6:172–179CrossRefGoogle Scholar
  18. 18.
    Burgess HJ, Eastman CI (2006) A late wake time phase delays the human dim light melatonin rhythm. Neurosci Lett 395:191–195CrossRefPubMedGoogle Scholar
  19. 19.
    Yang C-M, Spielman A, D’Ambrosio P et al (2001) A single dose of melatonin prevents the phase delay associated with delayed weekend sleep pattern. Sleep 24:272–281PubMedGoogle Scholar
  20. 20.
    Jones CR, Campbell SS, Zone SE, Cooper F, DeSano A, Murphy PJ et al (1999) Familial advanced sleep-phase syndrome: a short-period circadian rhythm variant in humans. Nature 5:1062–1065Google Scholar
  21. 21.
    Lack L, Wright H (1993) The effect of evening bright light in delaying the circadian rhythms and lengthening the sleep or early morning awakening insomniacs. Sleep 16:436–443PubMedGoogle Scholar
  22. 22.
    Lack LC, Mercer JD, Wright HR (1996) Circadian rhythms of early morning awakening insomniacs. J Sleep Res 5:211–219CrossRefPubMedGoogle Scholar
  23. 23.
    Lack L, Wright H, Kemp K, Gibbon S (2005) The treatment of early-morning awakening insomnia with 2 evenings of bright light. Sleep 28:616–623PubMedGoogle Scholar
  24. 24.
    Czeisler CA, Kronauer RE, Allan JS, Duffy JF, Jewett ME, Brown EN et al (1989) Bright light induction of strong (Type 0) resetting of the human circadian pacemaker. Science 244:1328–1333CrossRefPubMedGoogle Scholar
  25. 25.
    Jewett ME, Rimmer DW, Duffy JF, Klerman EB, Kronauer RE, Czeisler CA (1997) Human circadian pacemaker is sensitive to light throughout subjective day without evidence of transients. Am J Physiol 273:R1800–R1809PubMedGoogle Scholar
  26. 26.
    Minors DS, Waterhouse JM, Wirz-Justice A (1991) A human phase-response curve to light. Neurosci Lett 133:36–40CrossRefPubMedGoogle Scholar
  27. 27.
    Khalsa SBS, Jewett ME, Cajochen C, Czeisler CA (2003) A phase response curve to single bright light pulses in human subjects. J Physiol 549:945–952CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Brainard GC, Hanifen JP, Greeson JM, Byrne B, Glickman G, Gerner E et al (2001) Action spectrum for melatonin regulation in humans: evidence for a novel circadian photoreceptor. J Neurosci 21:6405–6412PubMedGoogle Scholar
  29. 29.
    Wright HR, Lack LC (2001) Effect of wavelength on suppression and phase delay of the melatonin rhythm. Chronobiol Int 18:801–808CrossRefPubMedGoogle Scholar
  30. 30.
    Wright HR, Lack LC, Kennaway DJ (2004) Differential effects of light wavelength in phase advancing the melatonin rhythm. J Pineal Res 36:140–144CrossRefPubMedGoogle Scholar
  31. 31.
    Lack L, Bramwell T, Wright H (2007) Morning bright blue light can advance the melatonin rhythm in mild delayed sleep phase syndrome. Sleep Biol Rhythms 5:78–80Google Scholar
  32. 32.
    Lack L, Wright H (1993) The effect of evening bright light in delaying the circadian rhythms and lengthening the sleep or early morning awakening insomniacs. Sleep 16:436–443PubMedGoogle Scholar
  33. 33.
    Lack L, Wright H, Kemp K, Gibbon S (2005) The treatment of early-morning awakening insomnia with 2 evenings of bright light. Sleep 28:616–623PubMedGoogle Scholar
  34. 34.
    Revell VL, Burgess HJ, Gazda CJ et al (2006) Advancing human circadian rhythms with afternoon melatonin and morning intermittent bright light. J Clin Endocrinol Metab 91:54–59CrossRefPubMedGoogle Scholar
  35. 35.
    Lewy AJ, Bauer VK, Ahmed S et al (1998) The human phase response curve (PRC) to melatonin is about 12 hours out of phase with the PRC to light. Chronobiol Int 15:71–83CrossRefPubMedGoogle Scholar
  36. 36.
    Sack R, Lewy A, Hughes R (1998) Use of melatonin for sleep and circadian rhythm disorders. Ann Med 30:115–121CrossRefPubMedGoogle Scholar
  37. 37.
    Burgess HJ, Revell VL, Eastman CI (2008) A three pulse phase response curve to three milligrams of melatonin in humans. J Physiol 586(2):639–647CrossRefPubMedGoogle Scholar
  38. 38.
    Deacon S, English J, Arendt J (1997) Sensitivity of the human circadian pacemaker to melatonin timed to phase delay: a dose dependent study. Chronobiol Int 14:41Google Scholar
  39. 39.
    Buscemi N, Vandermeer B, Hooton N et al (2005) The efficacy and safety of exogenous melatonin for primary sleep disorders a meta-analysis. J Gen Int Med 20:1151–1158CrossRefGoogle Scholar
  40. 40.
    Kräuchi K, Cajochen C, Möri D et al (1997) Early evening melatonin and S-20098 advance circadian phase and nocturnal regulation of core body temperature. Am J Physiol 272:R1178–R1188PubMedGoogle Scholar
  41. 41.
    Leproult R, Van Onderbergen A, L’Hermite-Balériaux M et al (2005) Phase-shifts of 24-h rhythms of hormonal release and body temperature following early evening administration of the melatonin agonist agomelatine in healthy older men. Clin Endocrinol 63:298–304CrossRefGoogle Scholar
  42. 42.
    Nickelsen T, Samel A, Vejvoda M et al (2002) Chronobiotic effects of the melatonin agonist LY 156735 following a simulated 9h time shift: Results of a placebo-controlled trial. Chronobiol Int 19:915–936CrossRefPubMedGoogle Scholar
  43. 43.
    Mini L, Wang-Weigand S, Zhang J (2008) Ramelton 8mg/d versus placebo in patients with chronic insomnia: post hoc analysis of a 5-week trial using 50% or greater reduction in latency to persistent sleep as a measure of treatment effect. Clin Ther 30:1316–1323CrossRefPubMedGoogle Scholar
  44. 44.
    Simpson D, Curran MP (2008) Ramelteon: a review of its use in insomnia. Drugs 68:1901–1919CrossRefPubMedGoogle Scholar
  45. 45.
    Roth T, Seiden D, Sainati S, Wang-Weigand S et al (2006) Effects of ramelteon on patient-reported sleep latency in older adults with chronic insomnia. Sleep Med 7:312–318CrossRefPubMedGoogle Scholar
  46. 46.
    Zammit G, Erman M, Wang-Weigand S et al (2007) Evaluation of the efficacy and safety of ramelteon in subjects with chronic insomnia. J Clin Sleep Med 3:495–504PubMedPubMedCentralGoogle Scholar
  47. 47.
    Zemlan FP, Mulchahey J, Scharf MB et al (2005) The efficacy and safety of the melatonin agonist ß-methyl-6-chloromelatonin in primary insomnia: a randomized, placebo-controlled crossover clinical trial. J Clin Psychiatry 66:384–390CrossRefPubMedGoogle Scholar
  48. 48.
    Bootzin RR (1972) A stimulus control treatment for insomnia. Proc Am Psychol Assoc 7:395–396Google Scholar
  49. 49.
    Bootzin RR, Nicassio P (1978) Behavioral treatments for insomnia. In: Hersen M, Eisler RM, Miller PM (eds) Progress in behavior modification, vol 6. Academic Press, New York, pp 1–45Google Scholar
  50. 50.
    Spielman AJ, Saskin P, Thorpy MJ (1987) Treatment of chronic insomnia by restriction of time in bed. Sleep 10:45–56PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Leon C. Lack
    • 1
  • Helen R. Wright
    • 1
  1. 1.Department of PsychologyFlinders UniversityAdelaideAustralia

Personalised recommendations