A practical approach to circadian rhythm sleep disorders

Circadian rhythm steep disorders are common in clinical practice. The disorders covered in this review are delayed steep phase disorder, advanced steep phase disorder, free-running, irregular steep-wake rhythm, jet tag disorder and shift work disorder. Bright light treatment and exogenous melatonin administration are considered to be the treatments of choice for these circadian rhythm steep disorders. Circadian phase needs to be estimated in order to time the treatments appropriately. Inappropriately timed bright light and melatonin wilt likely worsen the condition. Measurements of core body temperature or endogenous melatonin rhythms wilt objectively assess circadian phase; however, such measurements are seldom or never used in a busy clinical practice. This review wilt focus on how to estimate circadian phase based on a careful patient history. Based on such estimations of circadian phase, we will recommend appropriate timing of bright light and/or melatonin in the different circadian rhythm steep disorders. We hope this practical approach and simple recommendations wilt stimulate clinicians to treat patients with circadian rhythm steep disorders. (C) 2008 Elsevier Ltd. All rights reserved.