A practical approach to circadian rhythm sleep disorders

Sleep Med Rev. 2009 Feb;13(1):47-60. doi: 10.1016/j.smrv.2008.04.009. Epub 2008 Oct 8.


Circadian rhythm sleep disorders are common in clinical practice. The disorders covered in this review are delayed sleep phase disorder, advanced sleep phase disorder, free-running, irregular sleep-wake rhythm, jet lag disorder and shift work disorder. Bright light treatment and exogenous melatonin administration are considered to be the treatments of choice for these circadian rhythm sleep disorders. Circadian phase needs to be estimated in order to time the treatments appropriately. Inappropriately timed bright light and melatonin will likely worsen the condition. Measurements of core body temperature or endogenous melatonin rhythms will objectively assess circadian phase; however, such measurements are seldom or never used in a busy clinical practice. This review will focus on how to estimate circadian phase based on a careful patient history. Based on such estimations of circadian phase, we will recommend appropriate timing of bright light and/or melatonin in the different circadian rhythm sleep disorders. We hope this practical approach and simple recommendations will stimulate clinicians to treat patients with circadian rhythm sleep disorders.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Adolescent
  • Adult
  • Circadian Rhythm / physiology
  • Female
  • Humans
  • Jet Lag Syndrome / diagnosis
  • Jet Lag Syndrome / physiopathology
  • Jet Lag Syndrome / therapy
  • Male
  • Melatonin / adverse effects
  • Melatonin / blood
  • Melatonin / therapeutic use
  • Middle Aged
  • Phototherapy / adverse effects
  • Sleep Disorders, Circadian Rhythm / diagnosis
  • Sleep Disorders, Circadian Rhythm / physiopathology
  • Sleep Disorders, Circadian Rhythm / therapy*
  • Sleep Stages / physiology


  • Melatonin