Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia.
College of Education, Psychology, and Social Work, Flinders University, Adelaide, South Australia, Australia.
J Sleep Res. 2023 Dec;32(6):e13976. doi: 10.1111/jsr.13976. Epub 2023 Aug 3.
Because the endogenous circadian pacemaker is a very strong determinant of alertness/sleep propensity across the 24 h period, its mistiming may contribute to symptoms of insomnia (e.g., difficulties initiating sleep and maintaining sleep) and to the development of insomnia disorder. Despite the separation of insomnia and circadian rhythm disorders in diagnostic nosology implying independent pathophysiology, there is considerable evidence of co-morbidity and interaction between them. Sleep onset insomnia is associated with later timed circadian rhythms and can be treated with morning bright light to shift rhythms to an earlier timing. It is also possible that the causal link may go in both directions and that having a delayed circadian rhythm can result in enough experiences of delayed sleep onset to lead to some conditioned insomnia or insomnia disorder further exacerbating a delayed circadian rhythm. Early morning awakening insomnia is associated with an advanced circadian phase (early timing) and can be treated with evening bright light resulting in a delay of rhythms and an improved ability to sleep later in the morning and to obtain more sleep. There is some evidence suggesting that sleep maintenance insomnia is associated with a blunted amplitude of circadian rhythm that may be treated with increased regularity of sleep and light exposure timing. However, this is an insomnia phenotype that requires considerably more circadian research as well as further insomnia clinical research with the other insomnia phenotypes incorporating circadian timing measures and treatments.
由于内源性昼夜节律起搏器是决定 24 小时内警觉性/睡眠倾向的非常重要因素，其时间安排不当可能导致失眠症状（例如，入睡困难和维持睡眠困难），并导致失眠障碍的发展。尽管在诊断分类学中将失眠和昼夜节律障碍分开意味着独立的病理生理学，但它们之间存在相当多的共病和相互作用的证据。起始性失眠与时间较晚的昼夜节律有关，可以通过早晨明亮的光线治疗来将节律转移到更早的时间。也有可能因果关系可能是双向的，并且昼夜节律延迟会导致足够的延迟入睡体验，从而导致一些条件性失眠或失眠障碍进一步加重延迟的昼夜节律。清晨觉醒性失眠与昼夜节律提前（早时间）有关，可以通过晚上明亮的光线治疗来延迟节律，从而改善早上晚些时候入睡和获得更多睡眠的能力。有一些证据表明，维持睡眠性失眠与昼夜节律振幅减弱有关，增加睡眠和光照时间的规律性可能对此有效。然而，这是一种失眠表型，需要进行更多的昼夜节律研究，以及对其他失眠表型进行更多的失眠临床研究，包括昼夜节律计时测量和治疗。
