Abstract
Circadian disruptions are common in modern society, and there is an urgent need for effective treatment strategies. According to standard diagnostic criteria, most adolescents showing both insomnia and daytime sleepiness are diagnosed as having behavioral-induced sleep efficiency syndrome resulting from insomnia due to inadequate sleep hygiene. However, a simple intervention of adequate sleep hygiene often fails to treat them. As a solution to this clinical problem, the present review first overviews the basic neurochemical and neuropharmachological aspects of sleep and circadian rhythm regulation, then explains several circadian disruptions from similar viewpoints, and finally introduces the clinical notion of asynchronization. Asynchronization is designated to explain the pathophysiology/pathogenesis of exhibition of both insomnia and hypersomnia in adolescents, which comprises disturbances in various aspects of biological rhythms. The major triggers for asynchronization are considered to be a combination of light exposure during the night, which disturbs the biological clock and decreases melatonin secretion, as well as a lack of light exposure in the morning, which prohibits normal synchronization of the biological clock to the 24-hour cycle of the earth and decreases the activity of serotonin. In the chronic phase of asynchronization, involvement of both wake- and sleep-promoting systems is suggested. Both conventional and alternative therapeutic approaches for potential treatment of asynchronization are suggested.
Highlights
People whose circadian rhythms are out of phase with their daily schedule are said to have ‘social jet lag’ [1, 2]
In Japan, approximately one quarter of junior high school students suffer from insomnia, while more than half of the students complain of daytime sleepiness [3]
Neuropeptide S (NPS), and histamine are known as representative neurotransmitters that participate in promoting arousal
Summary
People whose circadian rhythms are out of phase with their daily schedule are said to have ‘social jet lag’ [1, 2]. Circadian rhythm problems are common in modern society, and there is an urgent need for effective treatment strategies. Among adolescents in Spain, the prevalence of insomnia was found to be 9.9% and that of daytime sleepiness, 53.0% [6]. These subjects had delayed bedtimes with complaint of insomnia. The subjects are living with disturbed habits such as delayed wake-up times, delayed bedtimes, and an irregular lifestyle. These subjects may be suffering from behavioral-induced sleep efficiency syndrome, presumably resulting from insomnia due to inadequate sleep hygiene. Frequent complaints of these subjects introduced in my former review (Table 1) [3] were compatible with associated features of behavioral-induced sleep-deficient syndrome [8], most likely due to inadequate sleep hygiene with low-level physical activity
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