Phase advance with separate and combined melatonin and light treatment

Paul, Michel; Gray, Gary; Lieberman, Harris R.; Love, Ryan J.; Miller, James C.; Trouborst, Matthew; Arendt, Joséphine

doi:10.1007/s00213-010-2059-5

Cited by 60 publications

(33 citation statements)

References 34 publications

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“…We have recently completed a 4-year project to evaluate, and provide a framework for, the manipulation of the circadian system forwards or backwards to minimize fatigue among Canadian Forces personnel during critical military operations [8][9][10]. This capability can be applied to help those military members who are posted in the high Arctic during the seasonal extremes of photoperiod (24 h darkness or 24 h sunlight) by providing the necessary circadian system time cues that are otherwise absent.…”

Section: Introductionmentioning

confidence: 97%

Sleep and the endogenous melatonin rhythm of high arctic residents during the summer and winter

Paul

Love

Hawton

et al. 2015

Physiology & Behavior

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Section: Introductionmentioning

confidence: 97%

Sleep and the endogenous melatonin rhythm of high arctic residents during the summer and winter

Paul

Love

Hawton

et al. 2015

Physiology & Behavior

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“…99 Particularly relevant to the discussion of combination therapies, at least three laboratory-based studies among healthy adults describe a synergistic effect (with respect to circadian phase advances) when strategically timed light and melatonin therapy are used together. [100][101][102] In addition, although physiologic phase assessments were not employed, a separate case series described success with this treatment combination among DSWPD patients in the field (age range 15-60 years). Three milligrams melatonin was taken 2 hours prior to desired bedtime in conjunction with either outdoor or 5000 lux white broad spectrum light exposure, for a minimum of 30 minutes, between 06:00-08:00.…”

Section: Light/combination Treatments For Adults With Dswpdmentioning

confidence: 99%

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

Auger

Burgess

Emens

et al. 2015

Journal of Clinical Sleep Medicine

342

201

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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 confi dence) 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 fi rst-tier degree of confi dence, respectively. No recommendations were provided for remaining treatments/ populations, due to either insuffi cient or absent data. Areas where further research is needed are discussed.

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“…Usually, these deviations have already been diagnosed, but it is also important to know the approximate period lengths, in other words, how many hours the spontaneous rhythm is shorter or longer than 24-26 h. Although this deviation may not be easily identified under normal-life conditions, at least a rough idea about the extent of the abnormalities would help to select appropriate changes for treatment with synchronizing time cues. Notably, such a treatment may not be restricted to melatonin or other melatonergic drugs, but can comprise an additional light treatment, however, under consideration of efficacy and limits by discomfort or visual impairments caused by intense light or, specifically, blue light selected for acting via melanopsin-containing retinal ganglion cells (RGCs) [23,39].…”

Section: Circadian Disorders: Necessity Of Identifying the Deviationsmentioning

confidence: 99%

Melatonergic Sleep Promotion: Fundamental Chronobiological Issues Concerning Sleep Onset and Maintenance, Dose and Duration of Action

Hardeland

2017

Sleep Vigilance

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Purpose This review summarizes the conditions under which sleep promotion by melatonin or other melatonergic drugs can be successfully achieved or not. Importantly, the chronobiological rules are outlined which have to be followed in cases in which an etiology of circadian deviations is responsible for sleep difficulties. Dose and Duration of Action Sleep initiation is already possible with low doses (below 1 mg) of immediate-release melatonin. Prolonged actions have only caused moderate improvements of sleep maintenance. At elevated doses, melatonin may occasionally cause sleep fragmentation in some patients. Low doses (below 1 mg) of short-acting melatonin are also suitable for entraining and readjusting circadian rhythms, because circadian oscillators are particularly sensitive to nonparametric synchronizing signals. Phase Response Curve Successful entrainment of circadian rhythms is only possible if the phase response curve (PRC) is considered, which consists of phases of a silent zone with poor resetting, a delay and an advance part. Notably, the dim light melatonin onset (DLMO) is still in the silent zone. Conclusions For purposes of melatonergic treatment, the knowledge of synchronization-sensitive phases within the circadian cycle is helpful in correcting circadian rhythm sleep disorders, otherwise poorly entrainable rhythms, e.g., in blind people, and mood disorders with circadian etiology. The disregard of the PRC leads to false conclusions on inefficacy of melatonin or other melatonergic drugs. Correcting actions by melatonin should not be inhibited by other drugs. For instance, attempts of shortening a circadian oscillation by well-timed melatonin should not be counteracted by period-lengthening drugs, such as lithium.

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Phase advance with separate and combined melatonin and light treatment

Abstract: The phase advance from the combination of afternoon melatonin with next morning light is additive.

Cited by 60 publications

References 34 publications

Sleep and the endogenous melatonin rhythm of high arctic residents during the summer and winter

Sleep and the endogenous melatonin rhythm of high arctic residents during the summer and winter

Melatonergic Sleep Promotion: Fundamental Chronobiological Issues Concerning Sleep Onset and Maintenance, Dose and Duration of Action

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