From the Guidelines
Treatment options for circadian rhythm disorders should prioritize light therapy and melatonin supplementation, as these interventions have shown promise in resetting the body's internal clock and improving sleep quality. When considering treatment options, it's essential to evaluate the following:
- Light therapy, which involves exposure to bright light (typically 10,000 lux) for 30-60 minutes at specific times to reset the body's internal clock 1
- Melatonin supplementation, with typical doses ranging from 0.5-5mg taken 2-3 hours before desired bedtime for delayed sleep phase disorder, or in the early evening for free-running disorder 1
- Behavioral interventions, including maintaining consistent sleep-wake schedules, avoiding bright light at inappropriate times, practicing good sleep hygiene, and gradually shifting sleep times (chronotherapy) 1 Some key points to consider:
- For delayed sleep phase disorder, morning light exposure is recommended, while evening light helps with advanced sleep phase disorder 1
- Prescription medications like ramelteon (8mg before bed) or tasimelteon (20mg before bed) may be used for certain conditions, but their effectiveness and potential side effects should be carefully evaluated 1
- Strategic napping, controlled light exposure, and temporary melatonin use can help shift workers adapt to new sleep schedules 1 It's crucial to note that the quality of evidence for these treatments varies, and more research is needed to fully understand their effects. However, based on the available evidence, light therapy and melatonin supplementation are the most promising treatment options for circadian rhythm disorders.
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. One treatment option for circadian rhythm disorders is tasimelteon, a melatonin receptor agonist that targets MT1 and MT2 receptors.
- The exact mechanism of tasimelteon is unclear, but it is thought to be involved in the control of circadian rhythms.
- Tasimelteon should be taken without food and before bedtime at the same time every night 2.
- Patients should be advised to limit their activities to preparing for bed after taking tasimelteon because it can potentially impair mental alertness 2.
From the Research
Treatment Options for Circadian Rhythm Disorders
The treatment options for circadian rhythm disorders include:
- Melatonin agonists, such as tasimelteon, which can help shift and/or stabilize the circadian phase 3
- Bright light therapy, which can reset the timing of sleep and wake to the desired times, and improve sleep quality and daytime alertness 4, 5
- Behavioral and environmental approaches, such as avoiding light in the evening and getting morning sunlight, to help synchronize the circadian rhythm with the 24-hour environment 4, 6
- Physical exercise, which can help adjust the timing of the circadian clock in the absence of a light-dark cycle 4
Melatonin Agonists
Melatonin agonists, such as tasimelteon, have been shown to be effective in treating circadian rhythm sleep disorders, including non-24-hour sleep-wake disorder 3, 7
- Tasimelteon has been approved for the treatment of non-24-hour sleep-wake disorder, and has been shown to improve sleep latency, sleep efficiency, and wake after sleep onset 7
- Other melatonin agonists, such as agomelatine, prolonged-release melatonin, and ramelteon, have also been investigated for the treatment of circadian rhythm sleep disorders, but further studies are needed to determine their efficacy 3
Bright Light Therapy
Bright light therapy has been shown to be effective in treating circadian rhythm sleep disorders, including advanced and delayed sleep-phase disorder, free-running disorder, shiftwork disorder, and jet lag disorder 5
- The efficacy of bright light therapy depends on the time of day and the timing of the circadian cycle, and should be administered at the appropriate time to reset the circadian clock 5
- Bright light therapy can be used in combination with melatonin agonists and behavioral approaches to help synchronize the circadian rhythm with the 24-hour environment 4, 5