Circadian Sleep-Wake Rhythm Disorders: Latest Guidance and Treatment

The profound effect of circadian timing and sleep on physical and mental health is well-known, including adverse metabolic and cardiovascular effects, depression, and learning impairment, according to a report from Neurology Advisor.

Circadian rhythm sleep-wake disorders may develop when wakefulness and sleep patterns conflict with the timing of one’s biological clock. Melatonin and other melatonin receptor agonists have demonstrated efficacy in the treatment of these disorders in both pediatric and adult populations. In a review published in July 2020 in Sleep Medicine Clinics, the authors discussed the use of these agents in patients with intrinsic circadian rhythm sleep-wake disorders.

While other drugs such as hypnotics and alerting medications may also be used as “chronobiotics”  (ie, agents that can shift central circadian timing and improve sleep), they are not discussed in the current review because of the lack of clinical trials investigating their use for these indications.

Based on available evidence, the American Academy of Sleep Medicine (AASM) clinical guidelines recommend strategically timed melatonin or other melatonin receptor agonists for delayed sleep-wake phase disorder(DSWPD) in children and adults, irregular sleep-wake rhythm disorder (ISWRD) in children and adolescents with neurologic disorders, and non-24 sleep-wake disorder in blind adults.

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