Circadian rhythm disorder is a sleep-wake cycle problem that occurs when the body's biological clock loses its natural regularity. This disorder is caused by the failure of the biological clock to synchronize with external factors such as light, darkness, meal times and physical activity. The human body is a system that works according to a 24-hour rhythm, and this rhythm governs many vital functions such as sleep patterns, hormone release, body temperature and energy levels. The circadian rhythm is controlled by the suprachiasmatic nucleus (SCN) region of the brain in the hypothalamus and directly affects quality of life.
A circadian rhythm disorder is when the body's biological clock fails to regulate the sleep-wake cycle correctly. Circadian rhythm disturbance can lead to a variety of problems, including deviations in sleep patterns, concentration problems, mood changes and a decrease in overall quality of life. Common causes of this disorder include working late into the night, irregular sleep habits and frequent time zone changes, especially in modern life. Circadian rhythm disorders usually affect the following basic functions
- Sleep Patterns: Shifts in sleeping and waking hours occur.
- Energy Level: Energy fluctuations may occur during the day.
- Hormone Levels: The release of sleep-regulating hormones such as melatonin may be disrupted.
- Mood: Irregular biological rhythm can cause mental problems such as anxiety and depression. This disorder can seriously affect an individual's daily life and, if left untreated, can have negative consequences on physical and mental health in the long term. For a better understanding and treatment of circadian rhythm disorder, it is important to pay attention to its causes and symptoms.
What are the Types of Circadian Rhythm Disorders?
Circadian rhythm disorders consist of different types that occur when the biological clock fails to adapt to environmental time cues. These disorders affect the sleep-wake cycle and the overall rhythm of life. Circadian rhythm disorders are as follows:
Jet Lag Syndrome: Rapid shifting to different time zones (e.g. long airplane trips) causes the biological clock to be thrown off. Jet lag leads to disruptions in the sleep-wake cycle, fatigue and concentration problems.
Disorganized Sleep-Wake Disorder: Sleep patterns are completely fragmented. Individuals cannot establish a regular sleep-wake cycle and may take short naps throughout the day. It is often associated with neurological disorders such as Alzheimer's disease.
Delayed Sleep Phase Syndrome (DSPS): In this disorder, individuals sleep and wake up several hours later than usual. For example, the person goes to sleep late at night and wakes up late in the morning. It is usually seen in young people and adolescents.
Advanced Sleep Phase Syndrome (ASPS): This condition is characterized by individuals sleeping and waking up earlier than usual. For example, the person goes to sleep early in the evening and wakes up very early in the morning. It is more common in older people.
Free-Running Sleep-Wake Disorder (Non-24 Hour Sleep-Wake Disorder): In this disorder, a person's biological clock cannot adapt to the 24-hour cycle. Sleeping and waking hours change every day. It is usually seen in visually impaired individuals because the lack of light perception affects the biological clock.
Shift Work Sleep Disorder: It is seen in individuals who work night shifts or irregular hours. The quality of sleep is reduced and excessive daytime sleepiness is experienced due to the inability of the biological clock to adapt to the environmental light and dark cycle. Each type of circadian rhythm disorder presents with different symptoms and affects the daily life of individuals in different ways. Accurate diagnosis is important for determining appropriate treatment methods.
What Causes Circadian Rhythm Disorder?
Circadian rhythm disorder occurs as a result of disruptions in the mechanisms that regulate the body's biological clock or when external factors disrupt this rhythm. The main mechanism that controls the circadian rhythm is the suprachiasmatic nucleus (SCN) region of the brain located in the hypothalamus. This region synchronizes our biological clock based on cues from the external environment, such as light. However, this synchronization can be disrupted for various reasons. The main causes of circadian rhythm disturbance:
External Environmental Conditions:
- Light Exposure: Exposure to screen light late at night or too much artificial lighting can affect the biological clock.
- Time Zone Changes: Jet lag can cause the body's biological clock to fail to adapt to a new time zone.
- Shift Work: Working night shifts can severely disrupt the sleep-wake cycle.
Lifestyle Factors:
- Irregular Sleep Habits: Using electronic devices for a long time before going to sleep or constantly going to bed and waking up at different times can disorganize the biological clock.
- Lack of Exercise: Lack of regular physical activity negatively affects the body's natural rhythm.
- Irregular Mealtimes: Eating late or irregular eating habits can disrupt the biological clock.
Genetic Predisposition: Some individuals' biological clocks work genetically differently. For example, some people are predisposed to delayed sleep phase syndrome known as "night owl". This may be due to genetic factors.
Health Conditions:
- Hormone Irregularities: A deficiency or unbalanced release of the hormone melatonin can disrupt the circadian rhythm.
- Neurological Disorders: Diseases such as Alzheimer's or Parkinson's can disrupt the mechanisms that control the biological clock.
- Psychiatric Problems: Mental disorders such as depression, anxiety and bipolar disorder can negatively affect sleep patterns.
Visual Impairment: Visually impaired individuals may have difficulty synchronizing their biological clocks to the 24-hour cycle because they cannot perceive environmental cues such as light. This can lead to free-running sleep-wake disorder.
Aging: As we age, the mechanisms that regulate the biological clock weaken. Therefore, circadian rhythm disorders are more common in older people. The causes of circadian rhythm disorders may differ from person to person. However, determining the underlying cause is of great importance in order to create the right treatment plan.
What are the Symptoms of Circadian Rhythm Disorder?
Circadian rhythm disorder occurs when the body's biological clock fails to work in harmony with environmental time cues and manifests itself with various symptoms. These symptoms can affect an individual's sleep patterns, energy, mood and overall quality of life. Common symptoms of circadian rhythm disorder include
Deviations in Sleep Patterns: Abnormal changes are observed in the person's sleeping and waking hours. Sleeping too late at night, waking up early in the morning or irregular sleep cycles are common.
Daytime Sleepiness: Even if the individual has had enough sleep at night, he/she may feel sleepy throughout the day. This negatively affects functionality at work, school or social life.
Inability to Sleep at Night: In some individuals, a circadian rhythm disorder can cause insomnia. The person has difficulty sleeping at night or wakes up frequently after falling asleep.
Lack of Energy: Low energy levels during the day and a general feeling of fatigue are common symptoms. This can make it difficult for the individual to carry out daily activities.
Mood Changes: Circadian rhythm disturbance can be associated with mental states such as depression, anxiety or irritability. Irregularities in sleep patterns negatively affect emotional balance.
- Concentration and Attention Problems: Individuals may have difficulties focusing and processing information due to the brain not getting enough rest.
- Social and Functional Problems: Sleep irregularities due to circadian rhythm disorder negatively affect individuals' participation in social activities, performance at work and daily tasks.
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Physical Disorders: Physical symptoms such as headaches, digestive problems and immune system weakness can also be associated with this disorder. The symptoms of a circadian rhythm disorder can vary from individual to individual and are often shaped by the type of disorder. If these symptoms persist for a long period of time, it is important to seek the support of a specialist.
How is Circadian Rhythm Disorder Diagnosed?
Circadian rhythm disorder is diagnosed through a detailed examination of a person's sleep patterns and tests that assess the alignment of the biological clock with environmental factors. This process is carried out by a specialized physician and aims to accurately identify problems that affect the quality of life of the individual. Methods used in the diagnostic process:
Medical History and Anamnesis: The first step in the diagnostic process is to collect information about the individual's sleep habits, general health status and complaints. Details such as the person's sleeping and waking hours, daytime sleepiness attacks and feeling of rest are questioned. It is also assessed whether there are similar sleep disorders in the family.
Keeping a Sleep Diary: The individual is asked to keep a sleep diary for several weeks. In this diary, details such as sleeping and waking times, napping episodes during the day and the quality of night sleep are recorded. This information provides important clues to understand deviations in sleep patterns.
Polysomnography (sleep test): Polysomnography, which involves monitoring a person overnight in a sleep center, can be used to diagnose circadian rhythm disorder. Brain waves, respiratory movements, heart rate and muscle activity are measured to detect disruptions in the sleep-wake cycle.
Multiple Sleep Latency Test (MSLT): This test, which assesses daytime sleepiness, measures the time it takes for a person to fall asleep and transition to REM sleep at certain intervals throughout the day. This test is helpful in excluding other sleep disorders such as hypersomnia and narcolepsy.
Actigraphy: A device called an actigraph is worn on an individual's wrist and monitors the sleep-wake cycle for several weeks. This method is used to objectively assess a person's sleep patterns in real-life situations.
Blood Tests and Hormone Analysis: Blood tests can be performed to investigate the underlying biological causes. In particular, the levels of hormones such as melatonin and cortisol are measured to evaluate the functioning of the biological clock.
Psychiatric Evaluation: Circadian rhythm disturbance may be associated with psychiatric conditions such as depression or anxiety. Therefore, an evaluation by a psychiatrist may be necessary.
Epworth Sleepiness Scale: A simple test used to assess a patient's daytime sleepiness. The person is asked to rate the likelihood of falling asleep in certain situations. The combination of these methods in the diagnosis of circadian rhythm disorder ensures an accurate diagnosis. After diagnosis, an appropriate treatment plan can be developed to improve the quality of life of the individual.
What are the Treatment Methods for Circadian Rhythm Disorder?
Circadian rhythm disorder treatment aims to resynchronize the individual's biological clock and improve sleep patterns. Treatment methods usually vary depending on the type, severity and underlying causes of the disorder. Commonly used treatment methods:
Light Therapy: Involves exposure to a special light source in the morning or evening to reorganize the biological clock. In delayed sleep phase syndrome, light therapy is used in the morning, while in advanced sleep phase syndrome it is used in the evening.
Melatonin Supplementation: Melatonin, the body's natural sleep hormone, can help regulate the biological clock. Especially in cases such as delayed sleep phase syndrome, melatonin supplements taken before bedtime can be effective.
Sleep Hygiene and Lifestyle Changes: Developing regular sleep habits, reducing the use of electronic devices, increasing physical activity and regulating feeding times contribute to balancing the biological clock.
Behavioral Therapies: Cognitive behavioral therapy (CBT) is an effective method to change negative habits and thoughts about sleep. Chronotherapy is used to gradually readjust sleep and waking hours.
Medication Therapy: In some cases, wakefulness-enhancing or sleep-regulating medications may be used. These medications should only be prescribed by a qualified doctor.
Special Approaches for Jet Lag and Shift Work: Melatonin, light therapy and a regular sleep schedule are recommended to adapt to time zone changes or irregular shift hours.
Social Rhythm Therapy: Organizing daily activities and social interactions can improve the adaptation of the biological clock. A routine is important in this process. Circadian rhythm disorder treatment is tailored to the specific needs of the individual and should be supported by regular medical check-ups.
