Diagnosis and Treatment of Non-24-h Sleep-Wake Disorder in the Blind.
Study Goal
The researchers aimed to evaluate the effectiveness of melatonin and tasimelteon in entraining the circadian clock in individuals with Non-24-h sleep-wake disorder (non-24).
Results Summary
Melatonin and tasimelteon were found to entrain the circadian clock, improving night-time sleep and daytime alertness. The timing of administration was critical, with optimal effects observed when administered 6 h before bedtime for most individuals or at wake time for those with shorter circadian periods.
Population
Totally blind individuals (lacking conscious light perception) with Non-24-h sleep-wake disorder.
Effective Dosage
0.5 mg melatonin (small, non-soporific doses).
Duration
Not specified.
Interactions
None mentioned.
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
Orally administered melatonin | no change | circadian clock | individuals with non-24-h sleep-wake disorder (non-24) | - | have been shown to entrain (synchronize) the circadian clock | #1 |
Orally administered melatonin | increase | night-time sleep | individuals with non-24-h sleep-wake disorder (non-24) | - | resulting in improvements | #2 |
Orally administered melatonin | increase | daytime alertness | individuals with non-24-h sleep-wake disorder (non-24) | - | resulting in improvements | #3 |
the melatonin agonist tasimelteon | no change | circadian clock | individuals with non-24-h sleep-wake disorder (non-24) | - | have been shown to entrain (synchronize) the circadian clock | #4 |
the melatonin agonist tasimelteon | increase | night-time sleep | individuals with non-24-h sleep-wake disorder (non-24) | - | resulting in improvements | #5 |
the melatonin agonist tasimelteon | increase | daytime alertness | individuals with non-24-h sleep-wake disorder (non-24) | - | resulting in improvements | #6 |
Administration of melatonin or tasimelteon at bedtime | no change | circadian clock | individuals with non-24 | - | will entrain individuals with non-24 but at an abnormally late time | #7 |
Administration of melatonin or tasimelteon at bedtime | decrease | sleep | individuals with non-24 | - | resulting in continued problems | #8 |
Administration of melatonin or tasimelteon at bedtime | decrease | alertness | individuals with non-24 | - | resulting in continued problems | #9 |
tasimelteon | neutral | administration timing | patients with non-24 | 1 h | has only been administered 1 h before the target bedtime | #10 |
melatonin | neutral | administration timing | most individuals, those with circadian periods longer than 24 h | about 6 h | should be administered about 6 h before the desired bedtime | #11 |
melatonin | neutral | administration timing | a minority, those with circadian periods shorter than 24 h (more commonly female individuals and African-Americans) | - | should be administered at the desired wake time | #12 |
Small doses (e.g., 0.5 mg of melatonin) | neutral | dose selection | individuals with non-24 | 0.5 mg | would thus be preferable | #13 |
Non-24-h sleep-wake disorder (non-24) is a circadian rhythm disorder occurring in 55-70% of totally blind individuals (those lacking conscious light perception) in which the 24-h biological clock (central, hypothalamic, circadian pacemaker) is no longer synchronized, or entrained, to the 24-h day. Instead, the overt rhythms controlled by the biological clock gradually shift progressively earlier or later (free run) in accordance with the clock's near-24-h period, resulting in a recurrent pattern of daytime hypersomnolence and night-time insomnia. Orally administered melatonin and the melatonin agonist tasimelteon have been shown to entrain (synchronize) the circadian clock, resulting in improvements in night-time sleep and daytime alertness. We review the basic principles of circadian rhythms necessary to understand and treat non-24. The time of melatonin or tasimelteon administration must be considered carefully. For most individuals, those with circadian periods longer than 24 h, low-dose melatonin should be administered about 6 h before the desired bedtime, while in a minority, those with circadian periods shorter than 24 h (more commonly female individuals and African-Americans), melatonin should be administered at the desired wake time. Small doses (e.g., 0.5 mg of melatonin) that are not soporific would thus be preferable. Administration of melatonin or tasimelteon at bedtime will entrain individuals with non-24 but at an abnormally late time, resulting in continued problems with sleep and alertness. To date, tasimelteon has only been administered 1 h before the target bedtime in patients with non-24. Issues of cost, dose accuracy, and purity may figure into the decision of whether tasimelteon or melatonin is chosen to treat non-24. However, there are no head-to-head studies comparing efficacy, and studies to date show comparable rates of treatment success (entrainment).