Sleeplessness and Circadian Rhythm Disorder Differential Diagnoses

  • Author: Mary E Cataletto, MD; Chief Editor: Selim R Benbadis, MD   more...
 
Updated: Mar 22, 2012
 
 

Diagnostic Considerations

Jet lag should be differentiated from delayed sleep-phase syndrome (DSPS). DSPS should be differentiated from lifestyle preference, inadequate sleep hygiene, primary insomnia, and psychiatric conditions. (Psychopathology has been found in 50% of patients with DSPS.)

Transient circadian rhythm disturbances define themselves by their timing. Many psychiatric conditions distinguish themselves by short sleep times and disrupted sleep. Regardless of their bedtime, patients with psychiatric disorders have sleep-onset insomnia. Coping styles distinguish the night owl.

Advanced sleep-phase disorders should be differentiated from atypical depression, seasonal affective disorder, and excessive daytime sleepiness (EDS) associated with other sleep disorders.

Patients with irregular sleep-wake schedules are distinguished by the irregularity not only of their sleep cycle, but also of their cycles of eating and other daily activities. The rhythm of body temperature also is affected. Irregular sleep-wake schedules should be differentiated from psychiatric disorders and from insomnia associated with shift work.

Daytime sleepiness in DSPS should be distinguished from sleep-disordered breathing, narcolepsy, and atypical depression. All of these conditions often present with early bedtime.

Nocturnal eating disorder may also have a substantial impact on circadian cycles, with frequent awakenings for feeding. Sleep distribution may resemble that of infants, with sleep and feeding distributed over a 24-hour period.

Insomnia is a core feature of posttraumatic stress disorder and has been reported in 70% of patients.

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

Mary E Cataletto, MD  Director of Children's Sleep Services, Winthrop Sleep Disorders Center; Professor of Clinical Pediatrics, State University of New York at Stony Brook

Mary E Cataletto, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Chest Physicians

Disclosure: Shering Plough Pharmaceuticals Honoraria Consulting

Coauthor(s)

Gila Hertz, PhD, ABSM  Director, Center for Insomnia and Sleep Disorders, Clinical Associate Professor of Psychiatry and Behavioral Sciences, State University of New York at Stony Brook

Gila Hertz, PhD, ABSM is a member of the following medical societies: American Academy of Sleep Medicine and American Psychological Association

Disclosure: Nothing to disclose.

Chief Editor

Selim R Benbadis, MD  Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, Tampa General Hospital, University of South Florida College of Medicine

Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association

Disclosure: UCB Pharma Honoraria Speaking, consulting; Lundbeck Honoraria Speaking, consulting; Cyberonics Honoraria Speaking, consulting; Glaxo Smith Kline Honoraria Speaking, consulting; Pfizer Honoraria Speaking, consulting; Sleepmed/DigiTrace Honoraria Speaking, consulting

Additional Contributors

Norberto Alvarez, MD Assistant Professor, Department of Neurology, Harvard Medical School; Consulting Staff, Department of Neurology, Boston Children's Hospital; Medical Director, Wrentham Developmental Center

Norberto Alvarez, MD is a member of the following medical societies: American Academy of Neurology, American Epilepsy Society, and Child Neurology Society

Disclosure: Nothing to disclose.

Carmel Armon, MD, MSc, MHS Professor of Neurology, Tufts University School of Medicine; Chief, Division of Neurology, Baystate Medical Center

Carmel Armon, MD, MSc, MHS is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Association of Neuromuscular and Electrodiagnostic Medicine, American Clinical Neurophysiology Society, American College of Physicians, American Epilepsy Society, American Medical Association, American Neurological Association, American Stroke Association, Massachusetts Medical Society, Movement Disorders Society, and Sigma Xi

Disclosure: Avanir Pharmaceuticals Consulting fee Consulting

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

References

  1. Katzenberg D, Young T, Finn L, et al. A CLOCK polymorphism associated with human diurnal preference. Sleep. Sep 15 1998;21(6):569-76. [Medline].

  2. Rosen GM, Shor AC, Geller TJ. Sleep in children with cancer. Curr Opin Pediatr. Dec 2008;20(6):676-81. [Medline].

  3. Ming X, Walters AS. Autism spectrum disorders, attention deficit/hyperactivity disorder, and sleep disorders. Curr Opin Pulm Med. Aug 26 2009;[Medline].

  4. Dagan Y, Eisenstein M. Circadian rhythm sleep disorders: toward a more precise definition and diagnosis. Chronobiol Int. Mar 1999;16(2):213-22. [Medline].

  5. Schrader H, Bovim G, Sand T. The prevalence of delayed and advanced sleep phase syndromes. J Sleep Res. Mar 1993;2(1):51-55. [Medline].

  6. Johnson EO, Roehrs T, Roth T, Breslau N. Epidemiology of alcohol and medication as aids to sleep in early adulthood. Sleep. Mar 15 1998;21(2):178-86. [Medline].

  7. Morgenthaler TI, Lee-Chiong T, Alessi C, Friedman L, Aurora RN, Boehlecke B. Practice parameters for the clinical evaluation and treatment of circadian rhythm sleep disorders. An American Academy of Sleep Medicine report. Sleep. Nov 1 2007;30(11):1445-59. [Medline].

  8. Cochrane Review [book on CD-ROM]. Oxford: Cochrane; 2001. Herxheimer A, Petrie KJ.

  9. Allen R. Development of the human circadian cycle. In: Loughlin G, et al, eds. Sleep and Breathing in Children. 2000:313-32.

  10. Ancoli-Israel S, Klauber MR, Jones DW, et al. Variations in circadian rhythms of activity, sleep, and light exposure related to dementia in nursing-home patients. Sleep. Jan 1997;20(1):18-23. [Medline].

  11. Boggild H, Suadicani P, Hein HO, et al. Shift work, social class, and ischaemic heart disease in middle aged and elderly men; a 22 year follow up in the Copenhagen Male Study. Occup Environ Med. Sep 1999;56(9):640-5. [Medline].

  12. Chesson AL Jr, Littner M, Davila D, et al. Practice parameters for the use of light therapy in the treatment of sleep disorders. Standards of Practice Committee, American Academy of Sleep Medicine. Sleep. Aug 1 1999;22(5):641-60. [Medline].

  13. Chesson AL, Anderson WM, Littner M, et al. Practice parameters for the nonpharmacologic treatment of chronic insomnia. An American Academy of Sleep Medicine report. Standards of Practice Committee of the American Academy of Sleep Medicine. Sleep. Dec 15 1999;22(8):1128-33. [Medline].

  14. Epstein R, Chillag N, Lavie P. Starting times of school: effects on daytime functioning of fifth-grade children in Israel. Sleep. May 1 1998;21(3):250-6. [Medline].

  15. Glaze DG. Childhood insomnia: why Chris can't sleep. Pediatr Clin North Am. Feb 2004;51(1):33-50, vi. [Medline].

  16. Hauri PJ. Insomnia. Clin Chest Med. Mar 1998;19(1):157-68. [Medline].

  17. Morin C, ed. Insomnia: Psychological Assessment and Management. New York, NY: Guilford Press; 1993.

  18. Manni R, Ratti MT, Tartara A. Nocturnal eating: prevalence and features in 120 insomniac referrals. Sleep. Sep 1997;20(9):734-8. [Medline].

  19. Martin SK, Eastman CI. Medium-intensity light produces circadian rhythm adaptation to simulated night-shift work. Sleep. Mar 15 1998;21(2):154-65. [Medline].

  20. Meltzer LJ, Mindell JA. Nonpharmacologic treatments for pediatric sleeplessness. Pediatr Clin North Am. Feb 2004;51(1):135-51. [Medline].

  21. Mulrooney DA, Ness KK, Neglia JP, Whitton JA, Green DM, Zeltzer LK. Fatigue and sleep disturbance in adult survivors of childhood cancer: a report from the childhood cancer survivor study (CCSS). Sleep. Feb 1 2008;31(2):271-81. [Medline].

  22. Natale D, Sabrine W. Melatonin. Clin Tox Rev. 1997;20 (1).

  23. Roehrs T, Roth T. Chronic insomnias associated with circadian rhythm disorders. In: Kryger M, Roth T, Dement W, eds. Principles and Practice of Sleep Medicine. 2nd ed. Philadelphia, PA: WB Saunders; 1994.

  24. Vgontzas AN, Bixler EO, Lin HM, et al. Chronic insomnia is associated with nyctohemeral activation of the hypothalamic-pituitary-adrenal axis: clinical implications. J Clin Endocrinol Metab. Aug 2001;86(8):3787-94. [Medline].

  25. Walsh JK, Engelhardt CL. The direct economic costs of insomnia in the United States for 1995. Sleep. May 1 1999;22 Suppl 2:S386-93. [Medline].

  26. Yazaki M, Shirakawa S, Okawa M, et al. Demography of sleep disturbances associated with circadian rhythm disorders in Japan. Psychiatry Clin Neurosci. Apr 1999;53(2):267-8. [Medline].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.