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Mental Health Friday 2022-01-21 – Circadian Rhythm Disorders

Today’s Topic: Circadian Rhythm Disorders

On Mental Health Friday, we post, in alphabetical order, one per week, information on mental health disorders. Mental Health Friday is for informational purposes only, and is in no way meant to diagnose, treat or cure any disease. Please do not self diagnose and seek professional help for what ails you.

Circadian Rhythm Disorders

Also known as Sleep-Wake Cycle Disorders

Circadian rhythm disorders are problems that occur when your sleep-wake cycle is not properly aligned with your environment and interferes with your daily activities. 

You have a biological clock that controls the timing of several activities and functions of your body, including when you go to sleep and wake up. This internal mechanism is called the circadian clock. The circadian clock cycles about every 24 hours. These repeating 24-hour cycles are called the circadian rhythm. The control of your circadian rhythm is a function of certain genes in the DNA called circadian clock genes. 

Your body tries to align your sleep-wake cycle to cues from the environment, for example, when it gets light or dark outside, when you eat, and when you are physically active. When your sleep-wake cycle is out of sync with your environment, you may have difficulty sleeping, and the quality of your sleep may be poor. Disruptions of your sleep-wake cycle that interfere with daily activities may mean that you have a circadian rhythm disorder. 

Disruptions in your sleep patterns can be temporary and caused by external factors such as your sleep habits, job, or travel. Or a circadian rhythm disorder can be long-term and caused by internal factors such as your age, your genes, or a medical condition. Symptoms may include extreme daytime sleepiness, insomnia, tiredness, decreased alertness, and problems with memory and decision-making. 

To diagnose a circadian rhythm disorder, your doctor may ask about your sleep habits, suggest sleep tests, a diary to track when and how long you sleep, and test the levels of certain hormones in your blood or saliva. Your treatment plan will depend on the type and cause of your circadian rhythm disorder. Treatment may include light therapy, medicines to help you fall asleep or stay awake, or healthy lifestyle changes including steps to improve your sleep habits. If left untreated, circadian rhythm disorders may increase the risk of certain health problems or lead to workplace and road accidents.

Circadian rhythm disorders occur when your sleep-wake cycle is out of sync with your environment. Many factors, both internal and external, can cause you to have problems sleeping and raise your risk for a circadian rhythm disorder.

Genetic conditions that affect your brain or hormone can cause circadian rhythm disorders. For example, Smith-Magenis syndrome is a genetic condition that may affect how much or how often your body makes the hormone melatonin, which helps you sleep. Sleep patterns may be completely reversed, causing daytime sleepiness and wakeful nights.

Did you know that your natural circadian rhythm and your risk for disorders may be different from someone else’s?

The rhythm and timing of your sleep-wake cycle can change with age because of changes in your brain. Teens may naturally have a later bedtime than adults, which raises their risk for delayed sleep-wake phase disorder. Older adults, on the other hand, usually sleep and wake up early. This raises their risk for advanced sleep-wake phase disorder. Older adults are also at higher risk for shift work disorder and jet lag disorder.

You may have a higher risk for circadian rhythm disorders because of internal factors such as your age, your sex, family history and genetics, and certain medical conditions that affect your brain or vision. External factors such as your lifestyle habits, environment, and occupation can also increase your risk.

People who work during the night have a higher risk for shift work disorder. Jet lag disorder is more common in pilots, flight attendants, athletes, and people who travel often for business.

Your genes may play a role in whether you naturally wake up early in the morning or go to sleep later at night. This genetic preference of an early or late bedtime can raise your risk for advanced or delayed sleep-wake phase disorder if your rhythm is out of sync with your environment or social responsibilities.

mutations in certain genes can also raise your risk for circadian rhythm disorders. These include the genes that control your body’s circadian clocks and certain genes that affect brain development or health.

Lifestyle habits can raise your risk for circadian rhythm disorders. These include:

  • Alcohol use
  • chronic caffeine use
  • Frequent air travel
  • Illegal drug use
  • Lack of exposure to natural light during the day
  • Unhealthy sleep habits such as regularly staying up late and nighttime exposure to artificial light, including light from a TV screen, a smartphone, or a very bright alarm clock.

Several medical conditions can increase your risk for circadian rhythm disorders, including:

  • Autism spectrum disorders
  • Certain genetic conditions, such as Smith-Magenis syndrome, Angelman syndrome, and Huntington’s disease
  • Conditions that affect eyesight, such as blindness and macular degeneration. This raises the risk for non-24-hour sleep-wake rhythm disorder.
  • Conditions that cause damage to the brain, such as traumatic brain injuries, strokes, and brain tumor
  • Mental health conditions, such as bipolar disorder, major depression, obsessive-compulsive disorder, and schizophrenia. This raises the risk of delayed sleep-wake phase disorder.
  • Neurodegenerative diseases, such as Alzheimer’s disease, dementia, and Parkinson’s disease. These conditions are more common in older adults and can increase your risk for irregular sleep-wake phase disorder.

How do neurodegenerative conditions lead to circadian rhythm disorders?

Neurodegenerative diseases such as Alzheimer’s disease and dementia can damage brain cells that process light and other signals from the environment. Without correct information, your body makes less melatonin and at different times of the day than expected. This can lead to irregular sleep-wake rhythm disorder or a complete reversal of the normal sleep-wake cycle.

People who have neurodegenerative conditions and are living in nursing homes may not have a clear pattern of day and night. They may have few social interactions during the day and be awakened for medicine and care throughout the day and night. This can lead to a disrupted sleep-wake cycle, which may cause circadian rhythm disorders.

Men are more likely to have advanced sleep-wake phase disorder than women.

Women may be more likely to experience circadian rhythm disorders at certain stages of life.

  • Hormonal changes that happen during pregnancy, after childbirth, and at menopause can cause problems with sleep.
  • Discomfort during pregnancy may also prevent good-quality sleep.
  • After childbirth, sleep interruptions and nighttime exposure to light while caring for a newborn can increase your risk for circadian rhythm disorders.

Currently, there are no screening methods to determine who will develop circadian rhythm disorders. Your doctor may ask you about your sleep habits in childhood and the last several years, and if you have performed shift-work. If you are at risk for circadian rhythm disorders, your doctor may recommend certain lifestyle changes to help prevent a circadian rhythm disorder.

Sign and symptoms of circadian rhythm disorders can vary depending on the type of circadian rhythm disorder you have and how severe your condition is. Many of the symptoms of circadian rhythm disorders occur because you are not getting enough good-quality sleep when your body needs it. Undiagnosed and untreated circadian rhythm disorders may increase your risk of certain health conditions or cause workplace or road accidents.

To diagnose a circadian rhythm disorder, your doctor may review your medical history; ask about your symptoms, sleep patterns, and environment; do a physical exam; and order diagnostic tests.

Treatments for circadian rhythm disorders aim to reset your sleep-wake rhythm to align with your environment. Your treatment plan will depend on the type and severity of your circadian rhythm disorder. The most common treatments are healthy lifestyle changes, bright light therapy, and melatonin. Often, your doctor will recommend a combination of these treatments.

If you have been diagnosed with a circadian rhythm disorder, it is important that you continue your treatment. Follow-up care can vary depending on your response to treatment and whether your condition is caused by internal factors, such as a medical condition, or external factors, such as your environment.

The NHLBI is part of the U.S. Department of Health and Human Services’ National Institutes of Health (NIH)—the Nation’s biomedical research agency that makes important scientific discoveries to improve health and save lives. We are committed to advancing science and translating discoveries into clinical practice to promote the prevention and treatment of heart, lung, blood, and sleep disorders, including circadian rhythm disorders. Learn about current and future NHLBI efforts to improve health through research and scientific discovery.

We lead or sponsor many studies relevant to circadian rhythm disorders. See if you or someone you know is eligible to participate in our clinical trials.

Source: National Heart, Lung, and Blood Institute; National Institutes of Health; U.S. Department of Health and Human Services.

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