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JCOM Abstract

J Clin Outcomes Manage 
2013 Nov;20(11):513-528
Circadian rhythm sleep disorders
Kim MJ, Lee JH, Duffy JF

Abstract Objective: To review circadian rhythm sleep disorders (CRSDs), including underlying causes, diagnostic considerations, and typical treatments. Methods: Literature review and discussion of specific cases. Results: Survey studies suggest that up to 3% of the adult population have a CRSD. However, these sleep disorders are often confused with insomnia, and an estimated 10% of adult and 16% of adolescent sleep disorders patients may have a CRSD. While some CRSDs (such as jet lag) can be self-limiting, others, if untreated, can lead to adverse medical, psychological, and social consequences. The International Classification of Sleep Disorders classifies CRSDs as dyssomnias, with 6 subtypes: advanced sleep phase type, delayed sleep phase type, irregular sleep-wake type, free running type, jet lag type, and shift work type. The primary clinical characteristic of all CRSD is an inability to fall asleep and wake at the desired time. It is believed that CRSDs arise from a problem with the internal biological clock (circadian timing system) and/or misalignment between the circadian timing system and the external 24-hour environment. This misalignment can be the result of biological and/or behavioral factors. Conclusions: It is important for physicians to recognize potential CRSDs so that appropriate diagnosis, treatment, and referral can be made.

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