Adjunctive and Alternative Treatment of Circadian Rhythm Sleep Disorders

Circadian rhythm sleep disorders (CRSDs) are caused by a misalignment between the endogenous circadian timing system and the desired/required sleep-wake schedule. Treatment usually focuses on shifting the circadian system to align with the desired sleep-wake schedule or on ways to alleviate sleep impairment during sleep periods and decreased alertness during wake periods. Bright light and melatonin are the dominant therapies used in treating CRSDs. Alternative methods to shifting the circadian system involve the manipulation of the sleep-wake schedule and the use of nonphotic cues such as exercise, food timing, and arousal. However, little is known regarding the proper timing of these stimuli for shifting the circadian system, and there has been minimal investigation of their use with specific CRSDs. As a result, most specific treatment recommendations for CRSDs involve combinations of bright light, melatonin, and/or sleep-wake manipulations.