Circadian Rhythm Disorders Treatment

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Treatments for circadian rhythm disorders aim to reset your sleep-wake rhythm to align with your environment. Your treatment plan will depend on the type and severity of your circadian rhythm disorder. The most common treatments are healthy lifestyle changes, bright light therapy, and melatonin. Often, your doctor will recommend a combination of these treatments.

To help reset your sleep-wake cycle, your doctor may recommend that you establish a daily routine with set activities that happen during the day and another set of activities that happen at night. This may help manage the symptoms of circadian rhythm disorders.

• Keep a regular meal schedule, especially if you are a shift worker or sleep at irregular times of the day or night.
• Start a regular bedtime routine. Sleep in a cool, quiet place and follow a relaxing bedtime routine that limits stress. These practices, along with regular sleep and waking times, can help you fall asleep faster and stay asleep longer.
• Avoid daytime naps, especially in the afternoon. However, shift workers may benefit from a short nap before the start of their shift.
• Get regular physical activity. Your doctor may recommend getting regular physical activity during the daytime and avoiding exercising close to bedtime, which may make it hard to fall asleep.
• Limit caffeine, alcohol, nicotine, and some medicines, especially close to bedtime.
• Manage your exposure to light. Light is the strongest signal in the environment to help reset your sleep-wake cycle. You may need more sunlight during the day and less artificial light at night from TV screens and electronic devices. Artificial light can lower your melatonin levels, making it harder to fall asleep. Light-blocking glasses, screen filters, or smartphone apps can help dim the light from your electronic devices. Dim lighting for a period before bed may also help reduce the symptoms of a circadian rhythm disorder. For shift workers, wearing light-blocking glasses when you are outside during the day may help.

Your doctor may suggest that you try light therapy to treat some types of circadian rhythm disorders. With this approach, you plan time each day to sit in front of a light box, which produces bright light similar to sunlight. Light visors and light glasses may also be effective. Light therapy may help adjust how much melatonin your body makes to reset your sleep-wake cycle.

• To move your sleep and wake times earlier, use the light box when you wake up in the morning. This may also help reduce daytime sleepiness. This method may be used to help treat delayed sleep-wake phase disorder, irregular sleep-wake rhythm disorder, and jet lag disorder when you travel east.
• To move your sleep and wake times later, use the light box late in the afternoon or early in the evening. This method may be used to help treat advanced sleep-wake phase disorder, shift work disorder, and jet lag disorder when you travel west.

Side effects of light therapy may include agitation, eye strain, headaches, migraines, and nausea. Ask your doctor before using light therapy if you have an eye condition or use medicines that make you sensitive to light.

Your doctor may recommend melatonin medicines or supplements to help align your sleep-wake cycle with your environment.

• Melatonin medicine, called melatonin receptor agonists, can help treat non–24-hour sleep-wake rhythm disorder. Side effects can include dizziness and fatigue.
• Melatonin supplements are lab-made versions of the sleep hormone that your doctor may recommend for delayed sleep-wake phase disorder, irregular sleep-wake rhythm disorder, and non–24-hour sleep-wake rhythm disorder. These supplements are not regulated by the U.S. Food and Drug Administration. Because of this, the dose and purity of these supplements can vary between brands. Talk with your doctor about how to find safe, effective melatonin supplements, as well as any possible side effects or medicine interactions, especially if you are pregnant or trying to become pregnant. Side effects of melatonin may include excess sleepiness, headaches, high blood pressure, low blood pressure, stomach upsets, and worsening symptoms of depression.

Your doctor may talk to you about other ways to treat the symptoms of circadian rhythm disorders.

• Caffeine may help prevent daytime sleepiness. Your doctor may recommend that you avoid caffeine within eight hours of your desired bedtime.
• Sleep-promoting medicines, such as benzodiazepines and zolpidem, can help you fall asleep faster and stay asleep longer. These medicines may cause side effects and complications, such as muscle weakness and confusion, that may be more severe in older adults and people who have dementia.
• Wake-promoting medicines, such as modafinil and armodafinil, can help you stay alert and improve performance during shift work. The effects of these medicines may last only for a short time, and you may still experience some sleepiness.