Sleep
-
Comparative Study Clinical Trial Controlled Clinical Trial
Improving adaptation to simulated night shift: timed exposure to bright light versus daytime melatonin administration.
Chronic circadian disturbance is thought to cause many of the health and social problems reported by shift workers. In recent years, appropriately timed exposure to bright light and exogenous melatonin have been used to accelerate adaptation to phase shifts of the circadian system. In this study we compared adaptation to night shift in three groups of subjects. ⋯ On the basis of these results, bright light is clearly superior in its ability ot phase shift the circadian system and thereby improve sleep and performance. However, melatonin may permit shift workers to override the circadian system for short periods and avoid the potential toxicity due to overzealous manipulations of the circadian pacemaker. In rapidly rotating shift schedules, melatonin may be preferable because it would not require workers to reverse the large phase shift induced by light.
-
These clinical guidelines, which have been reviewed and approved by the Board of Directors of the American Sleep Disorders Association, provide recommendations for the practice of sleep medicine in North America for the use of polysomnography in the evaluation of insomnia. The diagnosis of sleeplessness, or insomnia, is primarily based upon a careful, detailed medical and psychiatric history. Clinicians have sought an objective means to measure this symptom and have, therefore, turned to polysomnography. ⋯ Polysomnography is not required for the routine evaluation of transient or chronic insomnia. Polysomnography is, however, indicated in the evaluation of suspected sleep-related breathing disorders and periodic limb movement disorder, which may occasionally contribute to a complaint of insomnia, particularly in middle-aged or elderly patients. In addition, when the cause of insomnia is uncertain or when behavioral or pharmacologic therapy is unsuccessful, polysomnography may be helpful.