Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Practice Guideline
. 2015 Oct 15;11(10):1199-236.
doi: 10.5664/jcsm.5100.

Clinical Practice Guideline for the Treatment of Intrinsic Circadian Rhythm Sleep-Wake Disorders: Advanced Sleep-Wake Phase Disorder (ASWPD), Delayed Sleep-Wake Phase Disorder (DSWPD), Non-24-Hour Sleep-Wake Rhythm Disorder (N24SWD), and Irregular Sleep-Wake Rhythm Disorder (ISWRD). An Update for 2015: An American Academy of Sleep Medicine Clinical Practice Guideline

R Robert Auger  1 , Helen J Burgess  2 , Jonathan S Emens  3 , Ludmila V Deriy  4 , Sherene M Thomas  4 , Katherine M Sharkey  5
Affiliations
Practice Guideline

Clinical Practice Guideline for the Treatment of Intrinsic Circadian Rhythm Sleep-Wake Disorders: Advanced Sleep-Wake Phase Disorder (ASWPD), Delayed Sleep-Wake Phase Disorder (DSWPD), Non-24-Hour Sleep-Wake Rhythm Disorder (N24SWD), and Irregular Sleep-Wake Rhythm Disorder (ISWRD). An Update for 2015: An American Academy of Sleep Medicine Clinical Practice Guideline

R Robert Auger et al. J Clin Sleep Med. .

Abstract

A systematic literature review and meta-analyses (where appropriate) were performed and the GRADE approach was used to update the previous American Academy of Sleep Medicine Practice Parameters on the treatment of intrinsic circadian rhythm sleep-wake disorders. Available data allowed for positive endorsement (at a second-tier degree of confidence) of strategically timed melatonin (for the treatment of DSWPD, blind adults with N24SWD, and children/ adolescents with ISWRD and comorbid neurological disorders), and light therapy with or without accompanying behavioral interventions (adults with ASWPD, children/adolescents with DSWPD, and elderly with dementia). Recommendations against the use of melatonin and discrete sleep-promoting medications are provided for demented elderly patients, at a second- and first-tier degree of confidence, respectively. No recommendations were provided for remaining treatments/ populations, due to either insufficient or absent data. Areas where further research is needed are discussed.

Keywords: ASWPD; DSWPD; ISWRD; N24SWD; circadian rhythms.

PubMed Disclaimer

Figures

Figure 1
Figure 1. Guide for interpretation of clinical significance of the results.
Examples of (A) clinically significant improvement; (B) “serious” imprecision, grade one level down; (C) “very serious” imprecision, grade two levels down.
Figure 2
Figure 2. Meta-analysis of data for PSG determined TST in response to melatonin treatment of adult patients with DSWPD and comorbid depression.
Figure 3
Figure 3. Meta-analysis of data for PSG determined ISL in response to melatonin treatment of adult patients with DSWPD and comorbid depression.
Figure 4
Figure 4. Meta-analysis of data for DLMO in response to melatonin treatment of children/adolescents with DSWPD and comorbid psychiatric conditions.
Figure 5
Figure 5. Meta-analysis of data for actigraphically-determined SOT in response to melatonin treatment of children/ adolescents with DSWPD and comorbid psychiatric conditions.
Figure 6
Figure 6. Meta-analysis of evidence for entrainment as a result of melatonin treatment of blind adult patients with N24SWD.
See this image and copyright information in PMC

References

    1. Morgenthaler TI, Lee-Chiong T, Alessi C, et al. Practice parameters for the clinical evaluation and treatment of circadian rhythm sleep disorders. An American Academy of Sleep Medicine report. Sleep. 2007;30:1445–59. - PMC - PubMed
    1. Sack RL, Auckley D, Auger RR, et al. Circadian rhythm sleep disorders: part I, basic principles, shift work and jet lag disorders. An American Academy of Sleep Medicine review. Sleep. 2007;30:1460–83. - PMC - PubMed
    1. Sack RL, Auckley D, Auger RR, et al. Circadian rhythm sleep disorders: part II, advanced sleep phase disorder, delayed sleep phase disorder, free-running disorder, and irregular sleep-wake rhythm. An American Academy of Sleep Medicine review. Sleep. 2007;30:1484–501. - PMC - PubMed
    1. American Academy of Sleep Medicine. International classification of sleep disorders. 2nd ed. Westchester, IL: American Academy of Sleep Medicine; 2005.
    1. American Academy of Sleep Medicine. International classification of sleep disorders. 3rd ed. Darien, IL: American Academy of Sleep Medicine; 2014.

Publication types