From the Guidelines
To treat circadian dysregulation, establish consistent sleep and wake times every day, including weekends, and expose yourself to bright light, preferably natural sunlight, for 30-60 minutes in the morning, ideally within an hour of waking, as this approach has been shown to be effective in regulating the body's internal clock, according to the American Academy of Sleep Medicine clinical practice guideline 1.
Key Recommendations
- Expose yourself to bright light, preferably natural sunlight, for 30-60 minutes in the morning, ideally within an hour of waking, to help regulate your circadian rhythm, as suggested by the American Academy of Sleep Medicine 1.
- Avoid bright lights, especially blue light from electronic devices, for 1-2 hours before bedtime, as this can suppress melatonin secretion and disrupt the body's natural sleep-wake cycle, as noted in the clinical practice guideline 1.
- Create a sleep-conducive environment that is dark, quiet, and cool (around 65-68°F or 18-20°C), to promote better sleep quality, as recommended by the American Academy of Sleep Medicine 1.
- Consider using blue light blocking glasses in the evening, to minimize the disruptive effects of blue light on the body's natural sleep-wake cycle, as suggested by the clinical practice guideline 1.
Additional Considerations
- Regular exercise, preferably in the morning or afternoon but not within 2-3 hours of bedtime, can help regulate your circadian rhythm, as noted in the clinical practice guideline 1.
- For more severe cases, melatonin supplements (0.5-5mg) taken 1-2 hours before desired bedtime can be effective for short-term use, as recommended by the American Academy of Sleep Medicine 1.
- Light therapy using a 10,000 lux light box for 20-30 minutes in the morning may help reset your body clock, especially for seasonal affective disorder or shift work disorder, as suggested by the clinical practice guideline 1.
- In some cases, prescription medications like ramelteon (8mg before bedtime) or tasimelteon (20mg before bedtime) might be recommended by a healthcare provider, as noted in the clinical practice guideline 1.
From the FDA Drug Label
The mechanism by which tasimelteon exerts its therapeutic effect in patients with Non-24 is unclear. However, tasimelteon is an agonist at melatonin MT1 and MT2 receptors which are thought to be involved in the control of circadian rhythms. Advise patients to take tasimelteon before bedtime at the same time every night. Because of individual differences in circadian rhythms, daily use for several weeks or months may be necessary before benefit from tasimelteon capsules is observed.
Treatment of Circadian Dysregulation:
- Tasimelteon is an agonist at melatonin MT1 and MT2 receptors, which are involved in the control of circadian rhythms.
- Patients should take tasimelteon before bedtime at the same time every night.
- Daily use for several weeks or months may be necessary before benefit from tasimelteon capsules is observed 2, 2, 2.
From the Research
Treatment Options for Circadian Dysregulation
- Light therapy: strategically timed light therapy can help resynchronize the endogenous biological clock with the external clock and environment 3, 4
- Melatonin: melatonin and melatonin receptor agonists (such as ramelteon, prolonged-release melatonin, agomelatine, and tasimelteon) can be used to treat circadian rhythm sleep-wake disorders 3, 5, 6
- Behavioral therapies: behavioral therapies, such as sleep diaries and actigraphy monitoring, can be used to diagnose and manage circadian rhythm sleep-wake disorders 3, 4
- Pharmacological therapies: pharmacological therapies, such as melatonin agonists, can be used to treat circadian rhythm sleep-wake disorders 3, 5
Management Strategies for Specific Disorders
- Jet lag and shift work disorders: management strategies include strategically timed light therapy and melatonin 3, 4
- Delayed and advanced sleep-wake phase rhythm disorders: management strategies include strategically timed light therapy and melatonin 3, 4
- Non-24-h sleep-wake rhythm disorder: management strategies include strategically timed light therapy and melatonin 3, 4
- Irregular sleep-wake rhythm disorder: management strategies include strategically timed light therapy and melatonin 3, 4