Circadian sleep-wake rhythm disorder
| Classification according to ICD-10 | |
|---|---|
| F51.2 | Inorganic disruption of the sleep-wake cycle |
| G47.2 |
Disturbances of the sleep-wake rhythm Syndrome of the delayed sleep phases Irregular sleep-wake rhythm |
| ICD-10 online (WHO version 2019) | |
The circadian sleep-wake rhythm disorders is a group of sleep disorders . The underlying problem is that people cannot sleep when sleep is wanted, needed, or expected, and are not awake when wakefulness is wanted, needed, or expected.
Sleeping and being awake according to the individual sleep-wake rhythm do not take place at the times accepted by the environment and do not match the light-dark change and the rhythm of the environment. In addition to the potential for conflict, there are health problems for those affected if the times for falling asleep and waking up that match the individual sleep-wake rhythm are not adhered to due to the demands of school, work, family and friends. The consequence is insomnic and hypersomnic complaints, which can have considerable effects on the patient.
Circadian rhythm
The circadian rhythm is designed to enable optimum sleep and recovery in humans in the dark phase and optimum performance in the light phase. That is why the circadian rhythm is synchronized with the light-dark change from the geophysical day-night rhythm. The inner rhythm does not need any external signals, but does not always have a period of exactly 24 hours and is adapted to the 24-hour cycle with the help of external stimuli , so-called timers . The intrinsic period length averages 24.18 hours in healthy young and older adults. Sudden deviations such as other local times after a long-haul flight and thus a light-dark change after a period of time not expected by the organism, as well as insufficient strength of the timers required for correction near the pole ( midnight sun and winter solstice) can be problematic. This also explains the high proportion of blind people in some of the circadian sleep-wake arrhythmias. A key variable of the circadian rhythm is the core body temperature , which has its lowest point ( nadir ) at the time of the lowest performance around 3 o'clock in the morning.
classification
According to the classification system for sleep disorders " International Classification of Sleep Disorders " (ICSD-2), a distinction is made between transient and chronic forms, which are partly intrinsic and partly exogenous. Sleep itself is initially not disturbed, but it occurs at the "wrong" time.
In the two following forms, inner and outer rhythms are temporarily decoupled, the disturbances only occur during this decoupling:
- Jetlag (detailed term: "circadian sleep-wake rhythm disorder, type jetlag")
- Shiftworker syndrome ("circadian sleep-wake rhythm disorder, type shiftworker syndrome")
In both types of sleep phase syndrome , the individual sleep-wake rhythm is constantly shifted by a few hours compared to the rhythm of the environment:
- Syndrome of the delayed sleep phase ("circadian sleep-wake rhythm disorder, type of delayed sleep phase")
- Syndrome of the advanced sleep phase ("circadian sleep-wake rhythm disorder, type of advanced sleep phase")
In the case of the chronic forms, the effects in school, work and family are considerable, as suitable activities are hard to find and contacts are difficult for those affected to maintain:
- Hypernycthemeral syndrome ("circadian sleep-wake rhythm disorder, type of free-running rhythm", also referred to as "non-24-hour sleep-wake rhythm"). The individual sleep-wake rhythm shifts from day to day by a fairly constant amount. There are temporary times when the person's sleep-wake rhythm is in sync with that of their surroundings.
- Irregular sleep-wake rhythm ("circadian sleep-wake rhythm disorder, type of irregular sleep-wake rhythm"). The sleep episodes are irregular and unpredictably distributed for those affected, whereby the sum of the sleep hours is age-appropriate.
In addition, circadian sleep-wake rhythm disturbances occur due to physical illnesses and due to drugs, medication or substances.
distribution
The forms of jet lag and shiftworker syndrome are quite common, the other forms are rather rare in comparison.
Research needs
The German Society for Sleep Research and Sleep Medicine saw a need for research in 2009 for all types of circadian sleep-wake rhythm disturbances, although studies that focus on the symptoms have so far been lacking. The chronic forms are problematic due to the small number of cases.
Web links
- German Society for Sleep Research and Sleep Medicine: S3 guideline: Non-restful sleep / sleep disorders - insomnia in adults " (as of December 31, 2017)
Individual evidence
- ↑ Michael J. Thorpy: Classification of Sleep Disorders . In: Neurotherapeutics . tape 9 , no. 4 , 2012, p. 687-701 , PMID 22976557 (English).
- ↑ a b Brandon S. Lu, Phyllis C. Zee: Circadian Rhythm Sleep Disorders . In: Chest . Vol. 130, No. 6 , 2006, p. 1915-1923 , PMID 17167016 (English).
- ^ Charles A. Czeisler, Jeanne F. Duffy et al: Stability, Precision, and Near-24-Hour Period of the Human Circadian Pacemaker . In: Science . tape 284 , no. 5423 , 1999, p. 2177-2181 , doi : 10.1126 / science.284.5423.2177 (English).
- ↑ a b c S3 guideline for non-restful sleep / sleep disorders of the German Society for Sleep Research and Sleep Medicine (DGSM). In: AWMF online (as of 2009)
