Disrupted Circadian Rhythm: A Common Factor in Mental Health Disorders and Sleep Issues

Circadian rhythm sleep disorder is a condition that affects the timing and quality of sleep due to disruptions or misalignments of the body’s internal clock.

In this article, you will learn about:

  • What is Circadian Rhythm?
  • Circadian Rhythm as a Common Pathological Factor in Mental Disorders
  • Effects of Circadian Rhythm on Gender and Age
  • Types and Causes of Circadian Rhythm Sleep Disorders
  • Diagnosis and Treatment of Circadian Rhythm Sleep Disorders
  • Frequently Asked Questions
    • What are the symptoms of circadian rhythm sleep disorders?
    • How can I prevent or cope with circadian rhythm sleep disorders?

Table of Contents

What is Circadian Rhythm?

The human “circadian rhythm” is the natural cycle of biological processes that occurs over approximately 24 hours, synchronized with the day and night. The main regulator of this cycle is the brain’s internal clock, which responds to light signals from the environment. When it is dark, the clock signals the body to produce melatonin, a hormone that induces sleepiness. When it is light, the clock inhibits melatonin and promotes alertness. Thus, the intensity and timing of light exposure are the primary cues for adjusting our sleep and wake patterns.

However, the circadian rhythm does more than just control sleep. It also regulates daily fluctuations in various physiological functions and behaviors, such as hormone secretion, body temperature, metabolism, mood, and memory. Therefore, maintaining a stable and consistent circadian rhythm is essential for health and well-being. However, many factors can disrupt or shift the rhythm, such as irregular schedules, jet lag, shift work, aging, and exposure to artificial light at night.

Circadian Rhythm as a Common Pathological Factor in Mental Disorders

A growing body of research suggests that circadian rhythm disruption is a common and causal factor in many mental disorders. In a recent study published in “Translational Psychiatry,” scientists from the University of California, Irvine, reviewed the literature on the link between circadian rhythm and several psychiatric conditions, including Autism Spectrum Disorder (ASD), Attention Deficit Hyperactivity Disorder (ADHD), and Bipolar Disorder.

Dr. Amal Alachkar, the lead author of the study and a professor of pharmacological sciences and neuroscientist at the University of California, Irvine, states that the evidence shows that circadian rhythm abnormalities are not only a symptom but also a core feature of these disorders. She argues that understanding the role of circadian rhythm in mental health could lead to better diagnosis and treatment strategies.

She notes that one of the most obvious signs of circadian rhythm disturbance is sleep problems, which are prevalent in many psychiatric diseases. However, she also points out that circadian rhythm affects other aspects of mental health, such as mood, cognition, social behavior, and response to stress. She suggests that the hypothesis that circadian rhythm is a psychopathological factor could be extended to other mental disorders, such as Obsessive-Compulsive Disorder (OCD), eating disorders, substance abuse, and Parkinson’s disease.

Effects of Circadian Rhythm on Gender and Age

The circadian rhythm is not the same for everyone. It can vary depending on individual factors, such as gender and age. For example, studies have shown that women tend to have shorter circadian cycles than men, meaning that they may prefer earlier bedtimes and wake times. Women are also more likely to experience changes in their circadian rhythm due to hormonal fluctuations, such as during menstruation, pregnancy, and menopause. These changes can affect their sleep quality, mood, and energy levels.

Age is another factor that influences the circadian rhythm. As people get older, their circadian rhythm tends to advance, meaning that they tend to feel sleepy earlier in the evening and wake up earlier in the morning. However, older adults also face challenges in maintaining a regular circadian rhythm, such as reduced exposure to natural light, decreased melatonin production, increased sensitivity to noise and temperature, and more frequent naps. These factors can contribute to insomnia, daytime sleepiness, and cognitive impairment in older adults.

Types and Causes of Circadian Rhythm Sleep Disorders

Circadian rhythm sleep disorders are a group of conditions that result from a mismatch between the body’s internal clock and the external environment. This mismatch can cause difficulty falling asleep, staying asleep, or waking up at the desired or required time. It can also cause excessive daytime sleepiness, impaired performance, and reduced quality of life. Some of the common types and causes of circadian rhythm sleep disorders are:

  • Delayed Sleep-Wake Phase Disorder (DSWPD): This disorder is characterized by a delayed sleep onset and wake up time, typically more than two hours later than the conventional or socially acceptable time. People with DSWPD have trouble falling asleep at night and waking up in the morning. They often feel more alert and productive in the evening and night. DSWPD is more common in adolescents and young adults, and may be influenced by genetic, environmental, and behavioral factors, such as exposure to blue light from electronic devices, caffeine intake, and lack of morning light.
  • Advanced Sleep-Wake Phase Disorder (ASWPD): This disorder is characterized by an advanced sleep onset and wake up time, typically more than two hours earlier than the conventional or socially acceptable time. People with ASWPD fall asleep in the early evening and wake up in the early morning. They often feel sleepy and tired in the evening and alert and energetic in the morning. ASWPD is more common in older adults, and may be influenced by genetic, environmental, and behavioral factors, such as exposure to bright light in the morning, reduced melatonin production, and early social or work obligations.
  • Irregular Sleep-Wake Rhythm Disorder (ISWRD): This disorder is characterized by a lack of a clear sleep-wake pattern, resulting in variable and unpredictable sleep and wake times throughout the 24-hour period. People with ISWRD have difficulty maintaining a consolidated sleep episode at night, and often take multiple naps during the day. They may experience insomnia, daytime sleepiness, and mood disturbances. ISWRD is more common in people with neurological disorders, such as Alzheimer’s disease, dementia, or brain injury, and may be influenced by environmental factors, such as lack of exposure to natural light or social cues.
  • Non-24-Hour Sleep-Wake Rhythm Disorder (N24SWD): This disorder is characterized by a sleep-wake cycle that is longer or shorter than 24 hours, resulting in a gradual shift of sleep and wake times across the 24-hour period. People with N24SWD have difficulty synchronizing their sleep-wake cycle with the day-night cycle, and often experience insomnia, daytime sleepiness, and social and occupational impairment. N24SWD is more common in people who are totally blind, as they lack the light cues that entrain the circadian rhythm. However, it can also occur in sighted people, and may be influenced by genetic, environmental, and behavioral factors, such as irregular schedules, medication use, and isolation.
  • Shift Work Disorder (SWD): This disorder is characterized by a misalignment between the sleep-wake cycle and the work schedule, resulting in insufficient or poor-quality sleep and excessive sleepiness during work hours. People with SWD have trouble adjusting to changing or rotating work shifts, especially night or early morning shifts. They often experience insomnia, daytime sleepiness, fatigue, mood problems, and reduced performance and productivity. SWD is more common in people who work in industries that require 24-hour operations, such as health care, transportation, manufacturing, or security.
  • Jet Lag Disorder (JLD): This disorder is characterized by a temporary misalignment between the sleep-wake cycle and the new time zone, resulting from rapid travel across multiple time zones. People with JLD have difficulty adapting to the local time, and often experience insomnia, daytime sleepiness, fatigue, mood changes, and gastrointestinal problems. JLD is more common in people who travel frequently for work or leisure, and may be influenced by the direction and number of time zones crossed, the individual’s age and chronotype, and the exposure to light and social activities at the destination.

Diagnosis and Treatment of Circadian Rhythm Sleep Disorders

The diagnosis of circadian rhythm sleep disorders is based on a combination of clinical history, sleep diaries, actigraphy, and polysomnography. Clinical history involves obtaining information about the patient’s sleep habits, work and social schedules, medical conditions, and medication use. Sleep diaries are records of the patient’s daily sleep and wake times, as well as the quality and quantity of sleep. Actigraphy is a method of measuring the patient’s activity and rest cycles using a device worn on the wrist. Polysomnography is a comprehensive test that monitors the patient’s brain waves, eye movements, muscle activity, heart rate, breathing, and oxygen levels during sleep.

The treatment of circadian rhythm sleep disorders depends on the type and cause of the disorder, as well as the patient’s preferences and goals. Some of the common treatment options are:

  • Bright Light Therapy: This therapy involves exposing the patient to bright light at specific times of the day, depending on the direction of the circadian rhythm shift. The aim is to advance or delay the circadian rhythm to align with the desired or required sleep-wake schedule. Bright light therapy can be delivered using natural sunlight or artificial light sources, such as light boxes, lamps, or goggles.
  • Melatonin Supplementation: This therapy involves taking melatonin, a hormone that regulates the circadian rhythm, at appropriate times before bedtime. Melatonin can help the patient fall asleep faster and improve the quality of sleep. However, melatonin should be used with caution, as it may have side effects or interact with other medications.
  • Chronotherapy: This therapy involves gradually shifting the patient’s sleep-wake schedule by one or two hours per day, until the desired or required schedule is reached. Chronotherapy can be useful for patients with delayed or advanced sleep phase disorders, but it requires a lot of time and commitment.
  • Pharmacotherapy: This therapy involves using medications to induce or maintain sleep, or to promote alertness. Some of the medications that can be used for circadian rhythm sleep disorders are benzodiazepines, non-benzodiazepine hypnotics, antidepressants, stimulants, and modafinil. Pharmacotherapy should be prescribed by a doctor, as it may have side effects or dependency issues.

In addition to these therapies, the patient may also benefit from behavioral and lifestyle modifications, such as maintaining a regular sleep-wake schedule, avoiding caffeine, alcohol, and nicotine, exercising regularly, and creating a comfortable and dark sleeping environment.

Frequently Asked Questions

What are the symptoms of circadian rhythm sleep disorders?

The symptoms of circadian rhythm sleep disorders vary depending on the type and severity of the disorder, but they generally include:

  • Difficulty falling asleep or staying asleep: The patient may have trouble initiating or maintaining sleep, resulting in insufficient or poor-quality sleep.
  • Excessive daytime sleepiness or fatigue: The patient may feel drowsy, tired, or lethargic during the day, affecting their performance, mood, and health.
  • Impaired cognitive and emotional functioning: The patient may experience problems with memory, concentration, decision-making, learning, and mood regulation, leading to impaired academic, occupational, and social functioning.
  • Other physical and mental health problems: The patient may develop or worsen other conditions, such as headaches, gastrointestinal disorders, cardiovascular diseases, diabetes, obesity, immune system dysfunction, depression, anxiety, and substance abuse.

How can I prevent or cope with circadian rhythm sleep disorders?

The prevention and management of circadian rhythm sleep disorders depend on the type and cause of the disorder, as well as the patient’s preferences and goals. However, some general tips that may help are:

  • Seek professional help: The patient should consult a doctor or a sleep specialist if they suspect they have a circadian rhythm sleep disorder, as they may need a proper diagnosis and treatment plan.
  • Follow the treatment plan: The patient should adhere to the treatment plan prescribed by their doctor or sleep specialist, which may include one or more of the therapies mentioned above.
  • Practice good sleep hygiene: The patient should maintain a regular sleep-wake schedule, avoid caffeine, alcohol, and nicotine, exercise regularly, and create a comfortable and dark sleeping environment.
  • Adjust to environmental changes: The patient should try to adapt to changes in their external cues, such as daylight, temperature, and social activities, that may affect their circadian rhythm. For example, if they travel across time zones, they should expose themselves to bright light or take melatonin at appropriate times to reduce jet lag.
  • Seek support and education: The patient should seek support from their family, friends, or peers who may understand their condition and provide emotional and practical assistance. They should also educate themselves and others about circadian rhythm sleep disorders and their impact on health and well-being.

Reference

  • American Academy of Sleep Medicine. (2014). International classification of sleep disorders (3rd ed.). Darien, IL: American Academy of Sleep Medicine.
  • Auger, R. R., Burgess, H. J., Emens, J. S., Deriy, L. V., Thomas, S. M., & Sharkey, K. M. (2015). Clinical practice guideline for the treatment of intrinsic circadian rhythm sleep-wake disorders: advanced sleep-wake phase disorder (ASWPD), delayed sleep-wake phase disorder (DSWPD), non-24-hour sleep-wake rhythm disorder (N24SWD), and irregular sleep-wake rhythm disorder (ISWRD). An update for 2015: an American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine, 11(10), 1199-1236.
  • Foster, R. G., & Roenneberg, T. (2008). Human responses to the geophysical daily, annual and lunar cycles. Current Biology, 18(17), R784-R794.
  • Lewy, A. J., Emens, J. S., Sack, R. L., Hasler, B. P., & Bernert, R. A. (2006). Low, but not high, doses of melatonin entrained a free-running blind person with a long circadian period. Chronobiology International, 23(3), 709-715.
  • Roenneberg, T., & Merrow, M. (2016). The circadian clock and human health. Current Biology, 26(10), R432-R443.

You may be interested in these articles:

Unlocking the Impact of Neurological Diseases on Sleep

Late-Night Care: Nourishing Your Body After Staying Up

The Hidden Dangers of Staying Up Late: Impact on Health and Well-Being

Sleep Quality and COPD Risk: Unveiling the Connection

Master the 4-7-8 Breathing Technique for Instant Sleep

Managing Post-Stroke Sleep Disorders

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