Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts: Gene/Protein Disease Symptom Drug Enzyme Compound   Target Concepts: Gene/Protein Disease Symptom Drug Enzyme Compound

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Query: UMLS:C0917801 (insomnia)
10,606 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Delayed sleep phase syndrome (DSPS) is a common but little reported cause of severe insomnia. Affected individuals complain of difficulty falling asleep and difficulty awaking at socially acceptable hours. It results from a dysregulation of the circadian sleep-wake cycle. DSPS presents in clinically heterogenous ways as modulated by motivation, psychopathology, drug status, and treatment compliance factors. Patients respond variably to the range of possible treatments. Bright light treatment potentially corrects the circadian abnormality of DSPS. Other treatments reported to relieve some DSPS patients include schedule shifts, drugs, and vitamin and hormone treatments. The safety and efficacy of light treatment have not been conventionally defined, but available information suggests that it is ophthalmologically safe. At present, DSPS must be managed empirically by various methods.
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PMID:Treatment of delayed sleep phase syndrome. 852 48

An intrinsic body clock residing in the suprachiasmatic nucleus (SCN) within the brain regulates a complex series of rhythms in humans, including sleep/wakefulness. The individual period of the endogenous clock is usually >24 hours and is normally entrained to match the environmental rhythm. Misalignment of the circadian clock with the environmental cycle may result in sleep disorders. Among these are chronic insomnias associated with an endogenous clock which runs slower or faster than the norm [delayed (DSPS) or advanced (ASPS) sleep phase syndrome, or irregular sleep-wake cycle], periodic insomnias due to disturbances in light perception (non-24-hour sleep-wake syndrome and sleep disturbances in blind individuals) and temporary insomnias due to social circumstances (jet lag and shift-work sleep disorder). Synthesis of melatonin (N-acetyl-5-methoxytryptamine) within the pineal gland is induced at night, directly regulated by the SCN. Melatonin can relay time-of-day information (signal of darkness) to various organs, including the SCN itself. The phase-shifting effects of melatonin are essentially opposite to those of light. In addition, melatonin facilitates sleep in humans. In the absence of a light-dark cycle, the timing of the circadian clock, including the timing of melatonin production in the pineal gland, may to some extent be adjusted with properly timed physical exercise. Bright light exposure has been demonstrated as an effective treatment for circadian rhythm sleep disorders. Under conditions of entrainment to the 24-hour cycle, bright light in the early morning and avoidance of light in the evening should produce a phase advance (for treatment of DSPS), whereas bright light in the evening may be effective in delaying the clock (ASPS). Melatonin, given several hours before its endogenous peak at night, effectively advances sleep time in DSPS and adjusts the sleep-wake cycle to 24 hours in blind individuals. In some blind individuals, melatonin appears to fully entrain the clock. Melatonin and light, when properly timed, may also alleviate jet lag. Because of its sleep-promoting effect, melatonin may improve sleep in night-shift workers trying to sleep during the daytime. Melatonin replacement therapy may also provide a rational approach to the treatment of age-related insomnia in the elderly. However, there is currently no melatonin formulation approved for clinical use, neither are there consensus protocols for light or melatonin therapies. The use of bright light or melatonin for circadian rhythm sleep disorders is thus considered exploratory at this stage.
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PMID:Circadian rhythm sleep disorders: pathophysiology and potential approaches to management. 1146 35

Bright light therapy is a recent physical treatment in chronodisabled situations. The most recognized indication is the seasonal affective disorder. However, any disease or dysfunction where a misalignment of sleep-wake and circadian rhythms may be suspected is a potential tool for this treatment. Analyses of the literature throughout the interpretation methods of the evidence based medicine indicate that bright light therapy, if not a standard, could be recommended in a number of circadian rhythm sleep disorders, mainly the delayed and advanced sleep phase syndromes. Time aspects are essential for the success of phototherapy. From this point of view, easy and practical technological means or methods, allowing to shape a Phase Response Curve in each individual to be treated, should be clear progress. A future extension of indications will also depend on the checking of essential hypotheses linking circadian and sleep-wake rhythms in diseases such as psychophysiological insomnia, multiple sclerosis, brain dysgeneses or dementias. At last, a non negligible advantage of bright light therapy appears to be its relative safety.
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PMID:[Photoperiod phototherapy and wakefulness-sleep rhythm disorders]. 1192 27

Circadian rhythms have a strong effect on the ability to sleep across the 24-h period. Maximum sleepiness occurs at the phase of lower endogenous core body temperature. This period is bracketed by two periods of alertness: a "wake-maintenance zone" occurring 6-10h before the time of core temperature minimum, and a "wake-up zone" occurring 4-7h after the minimum. Therefore, if the circadian rhythm drifts earlier with respect to the attempted sleep period, the wake-up zone can impinge on the end of the normal sleep period resulting in premature awakening and the development of early morning awakening insomnia. Similarly, a delay of the circadian rhythm can impose the wake-maintenance zone on the attempted bedtime and lead to sleep onset insomnia. Therefore, these two types of insomnia should be treatable with chronobiologic effects such as bright light and, possibly, melatonin administration. Bright light stimulation at normal wake-up time and melatonin administration 4-8h before normal bedtime can phase advance circadian rhythms to an earlier time. While morning bright light has been efficacious for sleep onset insomnia, evening melatonin administration has yet to be tested. Early morning awakening insomnia has been treated with phase delays imposed by evening bright light but not yet with morning melatonin administration. There is now sufficient evidence to warrant the consideration of chronobiologic manipulations such as bright light therapy for the treatment of chronic sleep onset and early morning awakening insomnia that show evidence of circadian delay or advance, respectively.
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PMID:Treating chronobiological components of chronic insomnia. 1738 35

Comorbid insomnia and other sleep disturbances are common in patients with neurodegenerative disorders, such as Parkinson's or Alzheimer's disease. Insomnia in patients with neurological conditions may occur as a direct consequence of the disease itself or may be secondary to factors associated with the condition, such as pain, depression or the effects of medications. Disturbed sleep can have a significant impact on the patient's cognitive and physical function and may be associated with distress and depression. Insomnia also impacts patients' and caregivers' quality of life and is often cited as one of the primary reasons for patient institutionalization. Management of insomnia in patients with neurological disorders should be individualized to each patient's needs. The type of insomnia and any underlying causes of disturbed sleep must first be determined. Non-pharmacological interventions, such as behavioral modification, should be considered for all patients. Bright light therapy may be an effective treatment option for patients with disturbed sleep-wake patterns. Medications causing sleep problems should be withdrawn or doses and/or timing adjusted, whenever possible. Several pharmacological options are available to relieve the symptoms of insomnia as short-term treatment.
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PMID:Insomnia in patients with neurodegenerative conditions. 1834 74

Bright light is a treatment of choice for seasonal affective disorder. Other indications for bright light therapy have also been tested. These include non-seasonal depression, bipolar depression, chronic depressive disorder, ante- and postpartum depression, late luteal phase dysphoric disorder, circadian phase sleep disorders, jet lag, shift work problems, and behavioral disturbance and insomnia in organic dementia. Future studies should focus on exploring the use of light therapy in combination with sleep deprivation, other classes of antidepressants, and with psychotherapy and their possible combined effect on subtypes of depression or other mentioned diagnoses, light treatment duration, and the applicability and efficacy of adjunct light treatment for in-patients.
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PMID:Bright light therapy. 1902 78

Circadian system is master clock of daily sleep-wake cycle. It is able to create periodic activity with a period of almost 24 hours autonomously, and is able to entrain itself to day-night cycle of environment using with daily change of sunlight as time clue. Circadian rhythm sleep disorders (CRSDs) are defined as sleep disorders caused by misalignment between internal circadian clock and social schedule. Insomnia, hypersomnia, headache or intestinal symptoms are common complaints of CRSD patients, and these symptoms may deteriorate patients' social function. Jet lag disorder and shift work disorder are originated by acute shift of social schedule that exceed ability of circadian entrainment. However, pathophysiology of other CRSDs are not fully cleared. Treatments of CRSDs aim to facilitate circadian entrainment to desirable schedule with time clues at proper timing of circadian system. Bright light therapy (BLT) and melatonin administration are effective. Hypnotic administration is not effective in most cases.
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PMID:[Circadian rhythm sleep disorders]. 1976 31

Bright light is a treatment of choice for seasonal affective disorder. Other indications for bright light therapy have also been tested. These include circadian rhythm sleep disorders, early-morning awakening or sleep-maintenance insomnia in elders and behavioral disturbance or insomnia in organic dementia. In these sleep disorders, the pattern of sleep-wake is misaligned with the patient's circadian system or the external environment, resulting in insomnia. Appropriately-timed exposure to bright light can shift the sleep-wake cycle to earlier or later times, in order to correct for misalignment between the circadian system and the desired sleep-wake schedule. Evidence of the efficacy of bright light was so limited. Further research is needed to determine guidelines for the appropriate timing and safe use of bright light therapy.
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PMID:[Bright light therapy]. 1976 50

Sleep/wake disorders are common, underdiagnosed, and associated with serious consequences. Patients tend not to mention sleep problems and clinicians often do not ask about them. Using a few simple screening questions and tools can uncover sleep/wake disorders that will respond to treatment. Consider asking about sleep during annual physicals and regular visits for chronic conditions. This is especially relevant when following patients with conditions linked to sleep/wake disorders. Educating patients about normal sleep and good sleep hygiene may improve sleep and prompt mention of unhealthy sleep/wake patterns.The use of CPAP leads to beneficial outcomes in OSA. Psychological and behavioral measures offer the best choice for patients with chronic insomnia. Bright light can help retrain the circadian rhythm in patients with circadian rhythm sleep disorders. Dopamine agonists are approved for treatment of RLS. Through a greater awareness of sleep/wake disorders and taking a proactive approach to patient questioning, diagnosis, education, and management, clinicians can better detect and treat sleep/wake disorders and improve patient outcomes and quality of life.
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PMID:Screening & treating patients with sleep/wake disorders. 2039 3

Bright light exposure is as one of the non-pharmacological measures to sleep management in shift-worker. This study was conducted to determine the effectiveness of bright light exposure in shift-worker nurses. We performed a systematic review and meta-analysis according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement and using existing literature in the following databases: Cochrane Library, Embase, PubMed, Scopus, Web of Science, to examine any eligible and relevant interventional (randomized controlled trial, experimental and quasi-experimental studies) which were published by December 31, 2018. The obtained documents were analyzed using Stata 14.1 and Cochrane Collaboration's RevMan 5.3. Five studies met eligibility criteria. Results from fixed-effect meta-analysis of the included studies revealed that the exposure could decrease the sleepiness levels, complaints related to shift-work, insomnia and increased the psychomotor error (95% confidence interval (CI): -0.87,-0.43, p=0.000, I²=98.6%), alertness and daytime sleep duration following night shifts (95% CI: 0.08,0.99, p=0.000, I²=92.7%). However, in the random effects model, none of them were statistically significant. Although the results of fixed-effect are in favor of beneficial effects of bright light exposure in shift-worker nurses, the random effects could not approve these findings. Maybe because of either large heterogeneity or insufficiency of the number of studies. Besides, because of the low number of studies, it was impossible to deal with high amount of heterogeneity using subgroup analysis or meta-regression. So the controversy on this topic continues to persist, which highlights the need for more well-designed randomized control trials with larger sample sizes in the future.
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PMID:The effectiveness of bright light exposure in shift-worker nurses: A systematic review and meta-analysis. 3274 86


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