Circadian rhythm sleep disorders: part II, advanced sleep phase disorder, delayed sleep phase disorder, free-running disorder, and irregular sleep-wake rhythm. An American Academy of Sleep Medicine review.

  title={Circadian rhythm sleep disorders: part II, advanced sleep phase disorder, delayed sleep phase disorder, free-running disorder, and irregular sleep-wake rhythm. An American Academy of Sleep Medicine review.},
  author={Robert Sack and Dennis H. Auckley and R. Robert Auger and Mary A. Carskadon and Kenneth P. Wright and M. Vitiello and Irina V. Zhdanova},
  volume={30 11},
OBJECTIVE This the second 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. We herein report on the accumulated evidence regarding the evaluation and treatment of Advamced Sleep Phase Disorder (ASPD), Delayed Sleep Phase Disorder (DSPD), Free-Running Disorder (FRD) and Irregular Sleep-Wake Rhythm ISWR). METHODS A set of specific questions relevant to clinical… 
Practice parameters for the clinical evaluation and treatment of circadian rhythm sleep disorders. An American Academy of Sleep Medicine report.
A range of therapeutic interventions were considered including planned sleep schedules, timed light exposure, timed melatonin doses, hypnotics, stimulants, and alerting agents.
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 20
A systematic literature review and meta-analyses (where appropriate) were performed and the GRADE approach was used to update the previous American Academy of Sleep Medicine Practice Parameters on
Circadian Rhythm Sleep Disorders.
Circadian rhythm sleep disorders are a distinct class of sleep disorders characterized by a mismatch between the desired timing of sleep and the ability to fall asleep and remain asleep, with negative medical, psychological, and social consequences.
Circadian rhythm sleep disorders: An update
DSPD and ASPD are the common primary circadian rhythm disorders and the recent developments in the pathogenesis, diagnosis, and management of CRSDs are discussed.
Advanced Sleep-Wake Rhythm Disorder
While several treatment options have been considered, sleep scheduling and use of strategic timed light therapy in the evenings have the most, albeit limited, evidence to suggest clinical utility for these complaints.
A practical approach to circadian rhythm sleep disorders.
Melatonin in the treatment of Circadian Rhythm Sleep-Wake Disorders – the principles of choosing the right time and dose of administration
Treatment of CRSWD is based primarily on chronotherapeutic interventions that influence, among other things, the rhythm of meals, physical and social activity, and melatonin is an effective form for relieving symptoms of exogenous CRS WD: shift work disorder and jet lag disorder.
Out of synch with society: an update on delayed sleep phase disorder
Advances in the understanding of the dynamics of circadian physiology, sleep–wake regulation and the deleterious effects of misalignment and sleep deprivation, are spurring on efforts to find optimal treatment paradigms for patients presenting to sleep clinics with delayed sleep phase disorder.
Delayed sleep-wake phase disorder.
  • A. Nesbitt
  • Psychology
    Journal of thoracic disease
  • 2018
This review highlights elements of the current understanding of the epidemiology, associations and pathophysiology of the delayed sleep-wake phase disorder, before discussing how some of the knowledge of sleep and circadian physiology can be applied to guide treatment of it.
Clinical Sleep-Wake Disorders II: Focus on Insomnia and Circadian Rhythm Sleep Disorders.
Melatonin and melatonin receptor agonists are considered to be an option for the treatment of insomnia especially because of their minimal abuse potential and safety, and first data on orexin (aka hypocretin) receptor antagonists are promising, however, the risk-benefit ratio needs to be further evaluated.


Delayed and advanced sleep phase symptoms.
Complaints suggesting circadian rhythm advance or delay mismatches were common, but evidently such complaints do not usually correspond with objective abnormalities of observed sleep timing.
Circadian sleep regulation in the absence of light perception: chronic non-24-hour circadian rhythm sleep disorder in a blind man with a regular 24-hour sleep-wake schedule.
The findings in this blind man suggest that both his sleep structure and the severity of his daily sleep disruption are directly related to circadian phase and his circadian pacemaker cannot be entrained by periodic daily exposure to nonphotic time cues, including a very regular 24-hour sleep-wake schedule.
Circadian rhythm sleep disorders in adolescents: Clinical trials of combined treatments based on chronobiology
A step‐by‐step procedure of combined treatments for the circadian rhythm sleep disorders is proposed, based on clinical studies of patients with delayed sleep phase syndrome and non‐24‐h sleep–wake rhythm.
Phase-dependent treatment of delayed sleep phase syndrome with melatonin.
Melatonin advances the circadian clock and sleep in patients with DSPS in a phase-dependent manner, and this is the first study that reports a relationship between timing of melatonin administration and phase changes in patientsWith DSPS.
Evaluating the role of melatonin in the long-term treatment of delayed sleep phase syndrome (DSPS).
Examination of the efficiency of melatonin treatment in a relatively large population of DSPS subjects by means of subjective reports found that the pretreatment falling asleep and waking times of patients in whom the changes were retained for a relatively long period of time were significantly earlier than those of patients whose relapse was immediate.
Delayed sleep phase syndrome. A chronobiological disorder with sleep-onset insomnia.
A new syndrome called "delayed sleep phase insomnia" is described, which is proposed to be a disorder of the circadian sleep-wake rhythm in which the "advance" portion of the phase response curve is small.
Melatonin treatment for circadian rhythm sleep disorders
Comparison of clinical background between responders and non‐responders revealed that the responders were characterized by short total sleep time and later onset age of clinical symptoms.
Clinical features of circadian rhythm sleep disorders in outpatients
The clinical data of 86 cases of primary circadian rhythm sleep disorder (primary CRSD) were retrospectively examined and compared to 40 cases of secondary circadian rhythm sleep disorder (secondary
Poor compensatory function for sleep loss as a pathogenic factor in patients with delayed sleep phase syndrome.
It is suggested that poor compensatory function for sleep loss predisposes DSPS patients to failure to reset their sleep phase and provides implications for understanding not only the pathophysiology of DSPS but also the biological basis for why some people can change their sleep schedule easily according to personal or social demands while others cannot.
Non-24-hour sleep-wake syndrome in a sighted man: circadian rhythm studies and efficacy of melatonin treatment.
The case of a 41-year-old sighted man with non-24-hour sleep-wake syndrome is presented and it is revealed that the patient appeared to be subsensitive to bright light.