Treatment Options for Circadian Rhythm Disorders

Circadian rhythm disorders may involve the following treatments:

  • Advancing or delaying sleep schedule
  • Use of melatonin, either over-the-counter or prescription formulations.
  • Bright light treatment. The timing of this is important, so talk to your sleep doctor!
  • Medications.

Talk to a trained sleep doctor to determine what the best treatment option is for you.

Establish a Bed Time and Wake Time

Couple using theirs mobile phones in bed

ARE YOU A LARK OR AN OWL?

There is a biological tendency to be a “day” or a “night” person. Lately, electronic devices have made it difficult to ascertain true circadian physiology. For example, some prefer to be “late” sleepers but only go to sleep later than normal because of electronic usage at bedtime, which activates the mind and suppresses natural melatonin – delaying the onset of sleep.

 

  • To find out when your body naturally wants to go to sleep, take away your electronics after dinner for a week. Start tracking what time you start to feel sleepy and what time you tend to wake up.
  • Once you establish a routine bedtime and wake time, STICK WITH IT. The more variable your sleep schedule is, the more difficult it will be to “fix” it.
  • If you have to have a variable schedule (e.g. rotating shifts), then consider an established routine specifically for workdays and for days off. This may involve a slightly restricted sleep schedule and scheduled naps to aid between the transitions. Talk to your sleep doctor about how best to establish this routine.
  • Once the alarm sounds, get out of bed. If you snooze more than once, consider just setting the alarm to a later time and definitively get up at that time.

Avoid Bright Light Before Sleep

Light dampens the effect of naturally secreted melatonin in the evening. This includes cell phones, computers, and any reading device (regardless of whether there are claims of filtering out a specific wavelength or using a different “backlight”).

  • Dim the lights about 1-2 hours before sleep.
  • For readers, use an actual book with a book light or a lamp that shines specifically on the reading material. The “special screens” with “backlights” still suppress melatonin.
  • AVOID any electronics (we know this one is difficult, but sleep is worth it).

Increase Bright Light in the Morning

brilliant sunriseThe best way to do this is to go outside! Sun has a strong influence over the circadian rhythm and therefore can effectively entrain your sleep and wake schedules. If this cannot be accomplished, there are several bright light devices that can help. Here are the best options for exposure to bright light in the morning:

 

  • Sunlight! This has to be first thing in the morning. Do not look directly at the sun; just being outside is enough exposure. Be cautious if you have eye issues.
  • Light boxes. Only certain brands are effective in affecting the circadian rhythm. Light boxes should be placed within 18 inches of your face, and tilted at a slight angle upwards. Looking directly into the light is not recommended.
  • Light glasses. Some companies make glasses with lights around the rims. This allows light exposure to occur at a certain angle to influence the circadian rhythm and anchor the morning time as your wake time. Light glasses also allow for mobility (so you can brush your teeth or eat breakfast while they are on). The downsides include possible headaches and potential vision irritation from too much light, so make sure you see your eye doctor regularly to ensure that this is not contraindicated for you.

Daytime Activities

Maintaining a regular routine during the day is another way to help entrain your body’s circadian rhythm. This includes regular mealtimes, regular exercise times, and regular relaxation times.

Over-the-Counter Preparations

Over-the-counter preparations that are specifically made for sleep usually have an antihistamine (look at the label, most have diphenhydramine or alcohol). These preparations are not meant for long-term use! Antihistamines can make you sleepy but they also have anticholinergic effects, which can have poor health consequences (e.g. increasing your heart rate) if used chronically. Similarly, herbal medications can interact with prescription medications so check with your doctor and pharmacist about potential harmful interactions. Additionally, watch out for side effects of taking more or higher than recommended doses, as many erroneously tend to take more than one dose if ineffective.

If you have a circadian rhythm sleep disorder, think about the following questions:

  • Are you a morning person or a night person?
  • If you could pick and choose, what work hours would be ideal?
  • Do you sleep better when you are in a different time zone? For example, do you sleep better on the west coast or east coast?
  • How alert do you feel while you are working?
  • Look at substances you are using every day including nicotine, alcohol, and caffeine. What times of day are these substances being taken?

See a sleep doctor to discuss diagnosis and treatment options – do NOT ignore it, as this is not something that will just “go away.”

 

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