Advances in the pharmacological management of non-24-h sleep-wake disorder

• Published in: Expert opinion on pharmacotherapy p. 1
• Main Authors: Nishimon, Shohei, Nishino, Naoya, Nishino, Seiji
• Format: Journal Article
• Language: English
• Published: England 24.05.2021
• Subjects: non-24-h sleep-wake disorder; free-running rhythm; tasimelteon; daytime sleepiness; Circadian rhythm; melatonin; melatonin receptor agonist; insomnia
• ISSN: 1744-7666
• DOI: 10.1080/14656566.2021.1876665

: Melatonin, a hormone that regulates circadian rhythms and the sleep-wake cycle, is produced mainly during the dark period in the pineal gland and is suppressed by light exposure. Patients with non-24-h sleep-wake disorder (non-24) fail to entrain the master clock with the 24-h light-dark cycle due to the lack of light perception to the suprachiasmatic nucleus typically in totally blind individuals or other organic disorders in sighted individuals, causing a progressive delay in the sleep-wake cycle and periodic insomnia and daytime sleepiness. : Herein, the authors review the pharmacological therapies including exogenous melatonin and melatonin receptor agonists for the management of non-24. They introduce a historical report about the effects of melatonin on the phase shift and entrainment for blind individuals with the free-running circadian rhythm. : Orally administered melatonin entrains the endogenous circadian rhythm and improves nighttime sleep and daytime alertness for non-24. Currently, tasimelteon is the only approved medication for non-24 by the US Food and Drug Administration and the European Medicines Agency. Treatments that focus only on sleep problems are insufficient for the treatment of non-24, and aids to entrain the free-running rhythm with the light-dark cycle are needed.