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Sleep-Wake Neurobiology and Pharmacology pp 261–276Cite as

Clinical Sleep–Wake Disorders II: Focus on Insomnia and Circadian Rhythm Sleep Disorders

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Part of the book series: Handbook of Experimental Pharmacology ((HEP,volume 253))

Abstract

Insomnia and circadian rhythm sleep disorders affect large proportions of the population and have pronounced effects on quality of life and daytime performance. While the neurobiology of insomnia is not yet fully understood, circadian rhythm sleep disorders are assumed to be caused by a mismatch between the individual circadian phase position and the desired sleep–wake schedule. Benzodiazepines and non-benzodiazepine positive allosteric GABAA receptor modulators improve sleep onset and maintenance in the short-term treatment of insomnia. However, tolerance and dependence are important side effects. Sedating antidepressants are frequently prescribed for insomnia, however, only few randomised controlled trials have been published so far. Melatonin and melatonin receptor agonists are considered to be an option for the treatment of insomnia especially because of their minimal abuse potential and safety. First data on orexin (aka hypocretin) receptor antagonists are promising, however, the risk-benefit ratio needs to be further evaluated. With respect to circadian rhythm sleep disorders, there is solid evidence from meta-analyses supporting the use of melatonin in jet lag disorder to accelerate entrainment to the new time zone, and in delayed sleep phase disorder to advance sleep–wake rhythms. In addition to that, there is evidence supporting the use of melatonin in patients with shift work disorder in order to promote daytime sleep after night shifts.

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Authors and Affiliations

  1. Department of Psychiatry and Psychotherapy, Faculty of Medicine, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany

    Kai Spiegelhalder & Dieter Riemann

  2. University Hospital of Psychiatry and Psychotherapy, Neuroscience Center, University of Bern, Bern, Switzerland

    Christoph Nissen

Authors
  1. Kai Spiegelhalder
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  2. Christoph Nissen
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  3. Dieter Riemann
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Correspondence to Kai Spiegelhalder .

Editor information

Editors and Affiliations

  1. Human Sleep Psychopharmacology Laboratory, Institute of Pharmacology and Toxicology, University of Zürich, Zürich, Switzerland

    Hans-Peter Landolt

  2. Surrey Sleep Research Centre, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK

    Derk-Jan Dijk

Conflicts of Interest

Conflicts of Interest

Kai Spiegelhalder declares no competing interests. Christoph Nissen has received speaker honoraria from Servier and serves on the advisory board of Vanda Pharmaceuticals. Dieter Riemann received an honorarium from Abbvie in 2014 for consultation on the development of new drugs for neurodegenerative disorders.

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Spiegelhalder, K., Nissen, C., Riemann, D. (2017). Clinical Sleep–Wake Disorders II: Focus on Insomnia and Circadian Rhythm Sleep Disorders. In: Landolt, HP., Dijk, DJ. (eds) Sleep-Wake Neurobiology and Pharmacology . Handbook of Experimental Pharmacology, vol 253. Springer, Cham. https://doi.org/10.1007/164_2017_40

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