Circadian arrhythmias
- Article
- 2021-02-01
You have a biological clock that controls the timing of various activities and functions of your body, including when you go to sleep and wake up. This internal mechanism is called the circadian clock. The circadian clock rotates approximately every 24 hours. These repetitive 24-hour cycles are called the circadian rhythm. The control of your circadian rhythm is a function of certain genes in the DNA called circadian clock genes.
Your body tries to adjust your sleep-wake cycle to signals from the environment, such as when it gets light or dark outside, when you eat and when you are physically active. When your sleep-wake cycle is out of sync with your environment, you may have sleep problems and the quality of your sleep may be poor. Interruptions in your sleep-wake cycle that interfere with your daily activities could mean you have a circadian rhythm disorder.
Disruptions in your sleep pattern can be temporary and caused by external factors such as your sleeping habits, work or travel. Or a circadian rhythm disorder can be long-lasting and caused by internal factors such as your age, your genes, or a medical condition. Symptoms may include extreme daytime sleepiness, insomnia, fatigue, decreased alertness, and problems with memory and decision-making.
To diagnose a circadian rhythm disorder, your doctor may ask about your sleep habits, suggest sleep tests, keep a diary to keep track of when and how long you sleep, and test the levels of certain hormones in your blood or saliva . Your treatment plan will depend on the type and cause of your circadian rhythm disturbance. Treatment may include light therapy, medicines to help you fall asleep or stay awake, or changes to your healthy lifestyle, including steps to improve your sleeping habits. If left untreated, circadian arrhythmias can increase the risk of certain health problems or lead to workplace and road accidents.
Symptoms
Common symptoms of circadian arrhythmias are:
- Persistent difficulty falling asleep, staying asleep, or both
- Excessive daytime sleepiness or sleepiness during shift work
- Fatigue and exhaustion
- Lethargy
- Reduced alertness and concentration problems
- Impaired judgment and difficulty controlling mood and emotions
- Aches and pains, including headaches
- Stomach problems, in people with jet lag
Therapy
Treatments for circadian arrhythmias aim to reset your sleep-wake rhythm to your environment. Your treatment plan will depend on the type and severity of your circadian rhythm disturbance. The most common treatments are healthy lifestyle changes, bright light therapy, and melatonin. Often times, your doctor will recommend a combination of these treatments.
Healthy lifestyle changes
To help reset your sleep-wake cycle, your doctor may recommend that you establish a daily routine of set activities that take place during the day and a different set of activities that take place at night. This can help control the symptoms of circadian arrhythmias caused by internal or external factors. A daily routine is especially important if you are completely blind or cannot tolerate changes in your exposure to light. Your daily routine can include:
- Adopt a regular meal schedule, especially if you work shifts or sleep irregular times during the day or night.
- Adopt a normal bedtime routine. Sleep in a cool, quiet place and follow a relaxing bedtime routine that limits stress. These exercises, along with regular sleep and wake times, can help you fall asleep faster and stay asleep longer.
- Avoid naps during the day, especially in the afternoon. Shift workers, however, may benefit from a short nap before the start of their shift.
- Exercise regularly. Your doctor may recommend that you get regular exercise during the day and avoid exercising right before bed, which can make it difficultto fall asleep.
- Limit your intake of caffeine, alcohol, nicotine and some medications, especially just before going to bed
- Manage your exposure to light. Light is the strongest signal in the area to reset your sleep-wake cycle. You may need more sunlight during the day and less artificial light from TV screens and electronic devices at night. Artificial light can lower your melatonin levels, making it more difficult to fall asleep. Light-blocking glasses, screen filters, or smartphone apps can help dim the light from your electronic devices. Dim lighting for a period of time before bed can also help reduce the symptoms of circadian rhythm disturbance. For shift workers, it can help to wear light-blocking glasses when you are outside during the day.
Light therapy
Your doctor may recommend that you try light therapy to treat certain types of circadian arrhythmias. With this approach, schedule time each day to sit in front of a light box, which produces bright light that resembles sunlight. Light visors and light lenses can also be effective. Light therapy can help adjust the amount of melatonin your body produces to reset your sleep-wake cycle.
- When you wake up in the morning, use the light box to move your sleep and wake times earlier . This can also help reduce daytime sleepiness. This method can be used to treat delayed sleep-wake phase disorder, irregular sleep-wake rhythm disorder, and jet lag disorder when traveling east.
- Use the light box in the late afternoon or early evening to shift your sleep and wake times later . This method can be used to treat advanced sleep-wake phase disorder, shift work disorder, and jet lag disorder when traveling west.
Side effects of light therapy can include agitation, eye strain, headaches, migraines and nausea. Ask your doctor before using light therapy if you have an eye condition or if you are taking medicines that make you sensitive to light.
Melatonin drugs or supplements
Your doctor may recommend melatonin drugs or supplements to tailor your sleep-wake cycle to your environment. The choice will depend on the type and severity of your circadian rhythm disturbance. Possible options are:
- Melatonin receptor agonists are drugs for the treatment of non-24-hour sleep-wake arrhythmias. Side effects can include dizziness and fatigue.
- Melatonin supplements are lab-made versions of the sleep hormone that your doctor can recommend for the treatment of delayed sleep-wake disturbances, irregular sleep-wake arrhythmias, and non-24-hour sleep-wake arrhythmias. These supplements are not regulated by the United States Food and Drug Administration. Thus, the dose and purity of these supplements can vary. Talk to your doctor about how to find safe, effective melatonin supplements, as well as possible side effects or drug interactions. Melatonin side effects can include excessive drowsiness, headache, high blood pressure, low blood pressure, upset stomach, and worsening symptoms of depression.
These drugs may not be recommended for people with dementia or epilepsy, or for people taking the blood-thinning medicine warfarin. Other people who should consult a doctor before taking these drugs include women who are pregnant, trying to conceive, or breastfeeding.
Other drugs that can be used to treat the symptoms of circadian arrhythmias include:
- Beta blockers to lower the amount of melatonin in your body during the day
- Caffeine to help prevent daytime sleepiness. Your doctor may recommend that you avoid caffeine within eight hours of your preferred bedtime.
- Sleep-promoting medicines, such as benzodiazepines and zolpidem, to help you fall asleep faster and stay asleep longer. These drugs can cause side effects and complications that can be more serious in older adults and people with dementia. These complications can include confusion, headaches, bad drug interactions, long-term dependence, muscle weakness, falls, and nausea
Did you not find what you were looking for? Search further in the
