Information
Circadian rhythm disorders are disorders of the timing of the light-dark cycle response in humans around the 24-hour clock.
They comprise the following:
- Delayed sleep phase syndrome (most commonly encountered)
- Advanced sleep phase syndrome
- Irregular sleep-wake schedule – most commonly see in association with antipsychotic medications
- Free-running rhythm (commonly encountered in blind people with NO light perception)
- Shift work disorder
- Jet-lag
Please see link to further information on Circadian Rhythm Disorders.
Who can refer:
Any health care professional
Who to refer:
Most circadian rhythm disorders encountered in clinical practice are related to behaviour and poor sleep hygiene. The use of blue and white light emitting devices compounds the problem, not just in adolescents.
A sleep diary for a month is essential to include with the referral.
Any disorder contributing to excessive daytime somnolence should be managed appropriately.
Blood tests as per excessive daytime somnolence guidelines should be included in the referral.
If the disorder appears severe or recalcitrant we are happy to give advice. We will occasionally accept referrals.
Who not to refer:
Any person who has not engaged in lifestyle changes, good sleep hygiene or in the treatment of their mental health issues.
Much DSPS is behaviourally induced for a variety of reasons. Underlying depression, anxiety and ADHD are often missed.
How to refer:
Sci-Gateway = RIE > Respiratory Sleep > LI Sleep Referral
Or by post:
Department of Sleep Medicine
Royal Infirmary of Edinburgh
51 Little France Crescent
Old Dalkeith Road
Edinburgh
EH16 4SA
- Basic sleep hygiene is the cornerstone to fixing most of these disorders. Avoidance of light-emitting devices one hour prior to bedtime is ideal and they should not be in the room or used in bed or during the night routinely.
- A set rising time in the morning is non-negotiable and key to entrainment.
- In DSPS, bright light in the early morning for 30-60 minutes is sufficient to resent the ‘owlish’ behaviour. This can be given via a SAD lamp. These can easily purchased for very little cost on-line e.g. amazon.co.uk
- Measures for time in bed restriction should be practised and implemented, i.e. a person uses the bed for sleep and/or sex only. If they are not sleeping in the bed, they must get out of it. Principles integral to cognitive-behaviour therapy for insomnia.
- Routine is key! Other ways of resetting the circadian clock, include regular meal-times, lowering the temperature prior to bed-time and winding down. Having a reason to get up in the morning is essential, including responsibility for a pet, job, volunteering scheme etc.
A total reset can be effected quickly in a setting of strict routine generally accompanied by some physical endeavour, e.g. camping for two weeks without any electronic devices.
