RESUMEN
CME: Jet Lag Jetlag Abstract. Crossing several time zones by air travel leads to a temporary desynchronization of the internal clock with the external light/dark cycle. In the following jet lag occurs typically including difficulties falling asleep or waking up early as well as day-time sleepiness and significant reduction of wellbeing and fitness. To provide optimal medical advice, it is necessary to understand the human circadian rhythm and sleep-wake regulation. In consideration with additional information on travel plans, an approach to alleviate jet lag symptoms can be developed. This article addresses different supportive measures and advice on how to adjust to a new time zone and reduce jet lag symptoms.
Asunto(s)
Ritmo Circadiano/fisiología , Síndrome Jet Lag/fisiopatología , Diagnóstico Diferencial , Disomnias/diagnóstico , Disomnias/terapia , Humanos , Individualidad , Síndrome Jet Lag/diagnóstico , Síndrome Jet Lag/psicología , Síndrome Jet Lag/terapia , Masculino , Melatonina/sangre , Persona de Mediana Edad , Fototerapia , Glándula Pineal/fisiopatología , Fases del Sueño/fisiologíaRESUMEN
The timing, duration, and consolidation of sleep result from the interaction of the circadian timing system with a sleep-wake homeostatic process. When aligned and functioning optimally, this allows wakefulness throughout the day and a long consolidated sleep episode at night. Mismatch between the desired timing of sleep and the ability to fall and remain asleep is a hallmark of the circadian rhythm sleep-wake disorders. This article discusses changes in circadian regulation of sleep with aging; how age influences the prevalence, diagnosis, and treatment of circadian rhythm sleep-wake disorders; and how neurologic diseases in older patients affect circadian rhythms and sleep.
Asunto(s)
Relojes Circadianos/fisiología , Trastornos del Sueño del Ritmo Circadiano/fisiopatología , Anciano , Depresores del Sistema Nervioso Central/uso terapéutico , Ritmo Circadiano/fisiología , Humanos , Síndrome Jet Lag/diagnóstico , Síndrome Jet Lag/epidemiología , Síndrome Jet Lag/fisiopatología , Síndrome Jet Lag/terapia , Melatonina/uso terapéutico , Fototerapia , Sueño/fisiología , Trastornos del Sueño del Ritmo Circadiano/diagnóstico , Trastornos del Sueño del Ritmo Circadiano/epidemiología , Trastornos del Sueño del Ritmo Circadiano/terapia , Vigilia/fisiologíaRESUMEN
In recent decades, the hectic lifestyle of industrialized societies has wrought its effects on the quality of sleep, and these effects are evidenced by a profusion of sleep-related disorders. Regular exposure to artificial light, coupled with social and economic pressures have shortened the time spent asleep. Otherwise, Circadian Rhythm Sleep Disorders are characterized by desynchronization between the intrinsic circadian clock and the extrinsic cycles of light/dark and social activities. This desynchronization produces excessive sleepiness and insomnia. The International Classification of Sleep Disorders describes nine sleep disorders under the category of Circadian Rhythm Sleep Disorders. Currently, this diagnosis is made based on the patient's history, a sleep log alone, or the sleep logs and actigraphy conducted for at least 7 days. This review contains an overview of current treatment options, including chronotherapy, timed bright light exposure, and administration of exogenous melatonin.
Asunto(s)
Ritmo Circadiano , Síndrome Jet Lag/epidemiología , Trastornos del Sueño del Ritmo Circadiano/epidemiología , Tolerancia al Trabajo Programado , Adulto , Brasil/epidemiología , Femenino , Humanos , Síndrome Jet Lag/clasificación , Síndrome Jet Lag/diagnóstico , Masculino , Prevalencia , Factores de Riesgo , Trastornos del Sueño del Ritmo Circadiano/clasificación , Trastornos del Sueño del Ritmo Circadiano/diagnóstico , VigiliaRESUMEN
Jet lag is due to the misalignment of the internal circadian clock(s) with external time cues. For short stopovers (1-2 days) adapting the circadian system is not advised, and at present immediate circadian adaptation is virtually impossible. The use of short-term measures such as judicious naps, caffeine and short acting hypnotics to maintain alertness and sleep is preferred. For intermediate length stays (3-5 days) a phase position with the circadian nadir situated within the sleep period is desirable but difficult to achieve. For longer stays (more than 4-5 days) strategies to hasten adaptation include timed exposure to and avoidance of light. The use of artificial light enriched with short wavelengths may be beneficial. The American Academy of Sleep Medicine recommends the timed use of the chronobiotic melatonin to hasten adaptation. Large individual differences in rate and direction of adaptation make timing treatment according to individual circadian phase difficult. Individual differences in tolerance to the sleep deprivation of jet lag may relate to a length polymorphism in the human clock gene PER3. The maximum efficacy for jet lag avoidance is by pre-flight adaptation, however, this requires time and commitment.
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Síndrome Jet Lag/terapia , Adaptación Fisiológica/efectos de los fármacos , Ritmo Circadiano/efectos de los fármacos , Terapia Combinada , Predisposición Genética a la Enfermedad/genética , Humanos , Individualidad , Síndrome Jet Lag/diagnóstico , Síndrome Jet Lag/etiología , Síndrome Jet Lag/genética , Melatonina/uso terapéutico , Proteínas Nucleares/genética , Proteínas Circadianas Period , Fototerapia/métodos , Polimorfismo Genético/genética , Receptor de Melatonina MT1/agonistas , Receptor de Melatonina MT2/agonistas , Privación de Sueño/etiología , Privación de Sueño/prevención & control , Factores de Transcripción/genéticaRESUMEN
Circadian rhythm sleep disorders are common in clinical practice. The disorders covered in this review are delayed sleep phase disorder, advanced sleep phase disorder, free-running, irregular sleep-wake rhythm, jet lag disorder and shift work disorder. Bright light treatment and exogenous melatonin administration are considered to be the treatments of choice for these circadian rhythm sleep disorders. Circadian phase needs to be estimated in order to time the treatments appropriately. Inappropriately timed bright light and melatonin will likely worsen the condition. Measurements of core body temperature or endogenous melatonin rhythms will objectively assess circadian phase; however, such measurements are seldom or never used in a busy clinical practice. This review will focus on how to estimate circadian phase based on a careful patient history. Based on such estimations of circadian phase, we will recommend appropriate timing of bright light and/or melatonin in the different circadian rhythm sleep disorders. We hope this practical approach and simple recommendations will stimulate clinicians to treat patients with circadian rhythm sleep disorders.
Asunto(s)
Trastornos del Sueño del Ritmo Circadiano/terapia , Adolescente , Adulto , Ritmo Circadiano/fisiología , Femenino , Humanos , Síndrome Jet Lag/diagnóstico , Síndrome Jet Lag/fisiopatología , Síndrome Jet Lag/terapia , Masculino , Melatonina/efectos adversos , Melatonina/sangre , Melatonina/uso terapéutico , Persona de Mediana Edad , Fototerapia/efectos adversos , Trastornos del Sueño del Ritmo Circadiano/diagnóstico , Trastornos del Sueño del Ritmo Circadiano/fisiopatología , Fases del Sueño/fisiologíaRESUMEN
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.