Sherry Roberts

/in /by

Circadian Rhythm Sleep/Wake Disorder

A person’s circadian rhythm is about the sleep cycle running along with the day light. I think of it as the internal wake sleep clock. Our bodies run on a 24- hour cycle that regulates our behavioral and physiological functions, including our level of arousal, or sleep/wake cycle.  According to Huan et al, “Our circadian rhythms are regulated by external cues, such as availability of sunlight, but also are intrinsically hardwired into us, and regulated by the suprachiasmatic nuclei in the hypothalamus. Availability of light is the primary signal to the SCN” (Huang, Ramsey, Marcheva, & Bass, 2011).

DSM-5 Criteria

The DSM-5 gives a list of criteria for this diagnosis. The disorder has to have a persistent or recurrent pattern of sleep disturbance due to the circadian mechanism. It can be related to a person working schedule or environment. The disruption in sleep must lead to tiredness, insomnia or both. These issues must lead to problems in a person’s job, social life or other important aspects of functioning. These symptoms should be for 1 month for episodic and more than 3 months for persistent while recurrent is two or more episodes in the span of a 1 year (Psychiatry online, 2020). There are specifiers to this diagnosis as well. Those are delayed sleep phase, Irregular sleep-wake type, shift work type, Non-24- hour sleep-wake type just to name a few (Psychiatry online, 2020).

Psychotherapy and Psychopharmacology

Some therapies that are indicated for Circadian Rhythm sleep disorder is bright broad spectrum light therapy but only in the morning, good sleep hygiene, avoidance of light in the evening and chronotherapy. CBT is also the recommended therapy of choice to help with behavioral changes. Some medications that can be used is melatonin, but must be careful in the elderly. For shift workers, it’s all about a non-pharmacological approach by making sure the environment is conducive to sleeping during the day. Hypnotics such as temazepam may be used for short term (Dodson & Zee, 2011).

Referral

Having sleep issues can be detrimental to a person’s physical health. I would refer a patient to seek medical help if the disorder causes metabolic issues, experiencing chronic fatigue, or mood changes. Sleep apnea is a medical condition that would need to have a sleep study done. Neurologist should be consulted if any sleeping disorder is accompanied by epilepsy or any movement disorders (“Penn Medicine,” 2020). A neurologist will be able to use diagnostic tools such as the EEG to look at the electrical workings in the brain. They can also use other machines to look at the blood flow of the brain and determine how much energy the brain uses and how the brain utilizes glucose -PET an SPECT machines are good for this. One more reason to be sent to a medical specialist is if there is chest pain. Myocardial infarction has a long-established connection to the circadian rhythm (Brainard, Gobel, Scott, Koeppen, & Eckle, 2015).

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