Ina Keyser

10144383
FLG 327

University of Pretoria
17 October 2012

Figure 1: Woman Sleeping

Also known as: free-running type circadian arrhythmia DEF: Chronic sleeping disorder

Circadian Rhythms Latin origin: circa means around and diem means day

Biological process that displays an endogenous, entrained oscillation of 24 hours Self-sustained and adjust to the local environment by external cues (zeitgebers) Important zeitgeber = daylight

Suprachiasmic nucleus (SCN) is a group of cells located in the hypothalamus Receives information through illimination of the eyes Retina contain photosensitive ganglion cells which contains melanopsin Signals follow a pathway, known as the retinohypothalamic tract to SCN

Figure 2: Sagittal Section of Brain

SCN takes the information, interprets it and passes it on to the pineal gland (epithalamus) Pineal gland secretes melatonin Melatonin peaks at night and ebbs during the day

Figure 2: Sagittal Section of Brain

Internal biological clock or circadian rhythm adheres to a 24 hour cycle Daily variances are caused by environmental factors: physical or emotional stress These variances even out and stabilises again to a 24 hour cycle No harmful effects to the body

No internal clocks that resets balances within a 24 hour schedule Body insists that the day is longer than 24 hours

Circadian rhythm function over longer periods of time

e.g. 72 hour cycles: stay awake for 48 straight hours and then sleep for 24 straight hours as a regular sleeping pattern

Most cases fall within a 25 to 27 hour range.

N24 makes it impossible for the individual to sleep at normal (socially accepted) times Untreated N24 causes a person's sleep-wake cycle to change every day

Degree related to how much over 24 hours the cycle lasts The cycle progresses around the clock, eventually returning to "normal" for one or two days before "going off" again
Figure 3: Woman Awake

Most cases reported in medical literature occurred in blind individuals 50% of completely blind individuals present with N24 Circadian arrhythmia can occur at any age, from birth onwards Generally follows shortly after loss or removal of the individuals eyes or damage to the retina The first detailed study of N24 was made on a blind subject 28-year-old male presented with a 24.9-hour sleep cycle (as well as plasma cortisol and other parameters). Even while adhering to a 24-hour schedule for bedtime, rise time, work and meals; the mans body rhythms continued to shift.

Rare among visually impaired individuals (maintain some light perception)

Research suggest, low light exposure can synchronize the body clock

N24 have been reported in sighted individuals

BUT very rare and the etiology is less well understood in these cases Since 2005, less than 140 cases reported

cranial injury pituitary adenoma removed (involving the optic chiasma)

N24 is thought to involve abnormal functioning of the SCN abnormal secretions of melatonin Thus neurological in origin

Figure 4: Pituitary Adenoma

Difficulty in adjusting to changes in "regular" sleep-wake cycles, due to:

stress evening activities travel to different time zones vacations illness and use of medications (especially stimulants or sedatives) changes in daylight hours in different seasons time changes e.g. daylight savings time growth spurts (which cause fatigue)

Figure 5: Girl in Class

Commonly impairs their ability to function socially and occupationally Characteristically, they are "partially or totally unable to function in scheduled activities on a daily basis, and most are unable to work at conventional jobs"[1] Attempts to keep to the social and conventional hours, patients may develop insomnia (not a normal symptom of N24) and excessive sleepiness during the day

Side-effects associated with acute and chronic sleep deprivation:

Cognitive dysfunction Confusion Diarrhoea Extreme nausea Extreme fatigue Hair loss Headaches
Figure 6: Man Sleeping at Work

Diagnosis: History of your past sleeping routines Medical history Recent changes in your lifestyle Drug or medication use Neurological test e.g. ECG Body temperature and melatonin levels Prognosis: Attempt to reset and balance your circadian rhythm

Fixed schedule at set times no matter when you wake up Melatonin hormone therapy is the most widely used treatment Chronotherapy and acupuncture

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"Gene Discovered in Mice that Regulates Biological Clock". Chicago Tribune. 29 April 1994.