Circadian Rhythm Sleep Disorders: Part I, Basic Principles, Shift Work and Jet Lag Disorders
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OBJECTIVE: This the first of two articles reviewing the scientific literature on the evaluation and treatment of circadian rhythm sleep disorders (CRSDs), employing the methodology of evidence-based medicine. In this first part of this paper, the general principles of circadian biology that underlie clinical evaluation and treatment are reviewed. We then report on the accumulated evidence regarding the evaluation and treatment of shift work disorder (SWD) and jet lag disorder (JLD). METHODS: A set of specific questions relevant to clinical practice were formulated, a systematic literature search was performed, and relevant articles were abstracted and graded. RESULTS: A substantial body of literature has accumulated that provides a rational basis the evaluation and treatment of SWD and JLD. Physiological assessment has involved determination of circadian phase using core body temperature and the timing of melatonin secretion. Behavioral assessment has involved sleep logs, actigraphy and the Morningness-Eveningness Questionnaire (MEQ). Treatment interventions fall into three broad categories: 1) prescribed sleep scheduling, 2) circadian phase shifting ("resetting the clock"), and 3) symptomatic treatment using hypnotic and stimulant medications. CONCLUSION: Circadian rhythm science has also pointed the way to rational interventions for the SWD and JLD, and these treatments have been introduced into the practice of sleep medicine with varying degrees of success. More translational research is needed using subjects who meet current diagnostic criteria.
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Light, often in combination with exogenous melatonin, is commonly used in sleep medicine for the treatment of specific circadian rhythm sleep-wake disorders (CRSWD), including advanced and delayed sleep-wake phase disorder, jet lag, shift work, sighted non-24 and irregular sleep-wake phase disorder.
“Finally, one of the most common applications of light, often in combination with exogenous melatonin, is found in sleep medicine [70, 71] for the treatment of specific circadian rhythm sleep–wake disorders (CRSWD), including advanced and delayed sleep–wake phase disorder, jet lag, shift work, sighted non-24 and irregular sleep–wake phase disorder”
From Effects of light on human circadian rhythms, sleep and mood (2019) · cites this paper as [70]
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- Authors
- Sack, R. L., Auckley, D., Auger, R. R., Carskadon, M. A., Wright, K. P., Vitiello, M. V., & Zhdanova, I. V.
- Affiliations
- Oregon Health & Science University (US)
- Mayo Clinic (US)
- Brown University (US)
- University of Colorado Boulder (US)
- University of Washington (US)
- Boston University (US)
- ORCID
- Venue
- Sleep
- Publisher
- Oxford University Press (OUP)
- Published
- 2007-11
- Volume
- 30
- Issue
- 11
- Pages
- 1460-1483
- ISSN
- 0161-8105 (ISSN-L)
- 1550-9109
- PMC
- PMC2082105
- OpenAlex
- W2606013951
- Cited by
- 650
- References
- 205
- Citations by year
- 2026: 18 · 2025: 32 · 2024: 32 · 2023: 24 · 2022: 30 · 2021: 37 · 2020: 40 · 2019: 33 · 2018: 31 · 2017: 30 · 2016: 31 · 2015: 31 · 2014: 35 · 2013: 64 · 2012: 43
- FWCI
- 2.98
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- SLEEP (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- GlaxoSmithKline
- Topics
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Circadian rhythm and melatonin
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Keywords
- circadian rhythm sleep disorders, shift work disorder, circadian phase, core body temperature, melatonin secretion, actigraphy, Morningness-Eveningness Questionnaire, sleep scheduling, circadian phase shifting, hypnotics, stimulant medication, sleep medicine
- MeSH terms
- Adult, Aged, Aged, 80 and over, Employment, Female, Humans, Disorders of Excessive Somnolence, Male, Middle Aged, Phototherapy, Surveys and Questionnaires, Risk Factors, Severity of Illness Index, Prevalence, Polysomnography, Sleep Disorders, Circadian Rhythm, Jet Lag Syndrome
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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