Treating chronobiological components of chronic insomnia

Lack, Leon C.; Wright, Helen R.

doi:10.1016/j.sleep.2006.10.003

Cited by 74Sleep and related disordersCircadian rhythm and melatoninSleep and Work-Related Fatigue

Treating chronobiological components of chronic insomnia

Lack, Leon C., Wright, Helen R.·2007·Sleep Medicine

DOI 10.1016/j.sleep.2006.10.003

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Abstract

Circadian rhythms have a strong effect on the ability to sleep across the 24-h period. Maximum sleepiness occurs at the phase of lower endogenous core body temperature. This period is bracketed by two periods of alertness: a "wake-maintenance zone" occurring 6-10h before the time of core temperature minimum, and a "wake-up zone" occurring 4-7h after the minimum. Therefore, if the circadian rhythm drifts earlier with respect to the attempted sleep period, the wake-up zone can impinge on the end of the normal sleep period resulting in premature awakening and the development of early morning awakening insomnia. Similarly, a delay of the circadian rhythm can impose the wake-maintenance zone on the attempted bedtime and lead to sleep onset insomnia. Therefore, these two types of insomnia should be treatable with chronobiologic effects such as bright light and, possibly, melatonin administration. Bright light stimulation at normal wake-up time and melatonin administration 4-8h before normal bedtime can phase advance circadian rhythms to an earlier time. While morning bright light has been efficacious for sleep onset insomnia, evening melatonin administration has yet to be tested. Early morning awakening insomnia has been treated with phase delays imposed by evening bright light but not yet with morning melatonin administration. There is now sufficient evidence to warrant the consideration of chronobiologic manipulations such as bright light therapy for the treatment of chronic sleep onset and early morning awakening insomnia that show evidence of circadian delay or advance, respectively.

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SOI may have a significant circadian component in its aetiology.
“Likewise, sleep-onset insomnia (SOI) may have a significant circadian component in its aetiology (Lack and Wright 2007).”
From A systematic review of circadian function, chronotype and chronotherapy in attention deficit hyperactivity disorder (2017) · cites this paper as Lack and Wright 2007

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Authors: Lack, L. C., & Wright, H. R.
Affiliations: Flinders University (AU)
Corresponding author: Lack, Leon C.
ORCID: Lack, Leon C.
Venue: Sleep Medicine
Publisher: Elsevier BV
Published: 2007-09
Volume: 8
Issue: 6
Pages: 637-644
ISSN: 1389-9457 (ISSN-L)
DOI: 10.1016/j.sleep.2006.10.003
OpenAlex: W2135493222
Cited by: 74
References: 65
Citations by year: 2025: 3 · 2024: 3 · 2023: 2 · 2022: 2 · 2021: 4 · 2020: 2 · 2019: 4 · 2018: 3 · 2017: 4 · 2016: 9 · 2015: 5 · 2014: 4 · 2013: 5 · 2012: 3
FWCI: 6.42
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Sleep Medicine (publishedVersion)
PubMed (publishedVersion)
Flinders Academic Commons (Flinders University) (submittedVersion)
Topics: Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Circadian rhythm and melatonin
Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
Keywords: chronic insomnia, circadian rhythm, chronobiology, sleep onset insomnia, bright light therapy, melatonin, core body temperature, circadian phase advance, circadian phase delay
MeSH terms: Behavior Therapy, Biological Clocks, Body Temperature, Chronic Disease, Circadian Rhythm, Humans, Light, Melatonin, Phototherapy, Chronotherapy, Sleep Disorders, Circadian Rhythm

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Treating chronobiological components of chronic insomnia

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