Treatment guidelines for Circadian Rhythm Sleep – Wake Disorders of the Polish Sleep Research Society and the Section of Biological Psychiatry of the Polish Psychiatric Association. Part II. Diagnosis and treatment

Jan 1, 2018Psychiatria polska

Diagnosis and Treatment Guidelines for Circadian Rhythm Sleep-Wake Disorders by Polish Sleep and Psychiatry Experts, Part II

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Abstract

Patients with endogenous circadian rhythm sleep-wake disorders (CRSWD) are often misdiagnosed and treated for insomnia or hypersomnia.

Accurate diagnosis of CRSWD requires assessment of sleep quality and timing during free days.
Sleep diaries/logs and actigraphy can help establish a valid diagnosis of CRSWD.
Chronotherapy, which includes melatonin, light therapy, and behavioral interventions, is the recommended treatment for CRSWD.
Misdiagnosis leads to the inappropriate use of hypnotics and psychostimulants, which may alleviate symptoms but do not effectively treat CRSWD.
Shift work and time zone changes are recognized as significant health issues related to sleep disorders.

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AIM: Circadian rhythm sleep-wake disorders (CRSWD) are a group of disorders, in which the timing of sleep and wakefulness significantly differs from a patient's expectations or socially acceptable times. The aimof the article is to present the current principles for the diagnosis and treatment of CRSWD in adults and children.

METHOD: Guidelines proposed as CRSWD treatment standard are based on the recommendations from the scientific societies involved in the sleep research and medicine. Researchers participating in the guidelines preparation were invited by the Polish Sleep Research Society and the Section of Biological Psychiatry of the Polish Psychiatric Association based on their significant contribution to the circadian rhythm research and/or clinical experience in the treatment of these disorders. Finally, the guidelines were adjusted to the questions and comments given by the members of both Societies.

RESULTS: Patients with endogenous CRSWD are often misdiagnosed and treated for insomnia or hypersomnia. Therefore, each patient reporting sleep-wake disorders should be interviewed about the quality of sleep and its timing during free days (e.g. weekends, holidays). Avalid CRSWD diagnosis can be also established by using sleep diaries/logs and actigraphy. The treatment of choice for CRSWD is chronotherapy, which involves melatonin application, light therapy, and behavioral interventions. Sleep disorders associated with shift work and time zone changes are a growing health problem. Interventions for these disorders should primarily focus on prevention.

CONCLUSIONS: The main problem in the treatment of CRSWD is an invalid diagnosis. Hypnotics and/or psychostimulants are often used instead of chronotherapeutic interventions, what can alleviate symptoms but is not an effective treatment.

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Treatment guidelines for Circadian Rhythm Sleep – Wake Disorders of the Polish Sleep Research Society and the Section of Biological Psychiatry of the Polish Psychiatric Association. Part II. Diagnosis and treatment

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