Circadian Rhythm Sleep Disorders: Part I, Basic Principles, Shift Work and Jet Lag Disorders

OBJECTIVE This the first of two articles reviewing the scientific literature on the evaluation and treatment of circadian rhythm sleep disorders (CRSDs), employing the methodology of evidence-based medicine. In this first part of this paper, the general principles of circadian biology that underlie clinical evaluation and treatment are reviewed. We then report on the accumulated evidence regarding the evaluation and treatment of shift work disorder (SWD) and jet lag disorder (JLD). METHODS A set of specific questions relevant to clinical practice were formulated, a systematic literature search was performed, and relevant articles were abstracted and graded. RESULTS A substantial body of literature has accumulated that provides a rational basis the evaluation and treatment of SWD and JLD. Physiological assessment has involved determination of circadian phase using core body temperature and the timing of melatonin secretion. Behavioral assessment has involved sleep logs, actigraphy and the Morningness-Eveningness Questionnaire (MEQ). Treatment interventions fall into three broad categories: 1) prescribed sleep scheduling, 2) circadian phase shifting ("resetting the clock"), and 3) symptomatic treatment using hypnotic and stimulant medications. CONCLUSION Circadian rhythm science has also pointed the way to rational interventions for the SWD and JLD, and these treatments have been introduced into the practice of sleep medicine with varying degrees of success. More translational research is needed using subjects who meet current diagnostic criteria.

[1]  Jennifer J. Loros,et al.  Chronobiology: Biological Timekeeping , 2009 .

[2]  A. Chesson,et al.  Practice parameters for the use of actigraphy in the assessment of sleep and sleep disorders: an update for 2007. , 2007, Sleep.

[3]  G. Brainard,et al.  Dim Light Adaptation Attenuates Acute Melatonin Suppression in Humans , 2006, Journal of biological rhythms.

[4]  Walter W. Hauck,et al.  Light Therapy for Seasonal Affective Disorder with Blue Narrow-Band Light-Emitting Diodes (LEDs) , 2006, Biological Psychiatry.

[5]  C. Eastman,et al.  A late wake time phase delays the human dim light melatonin rhythm , 2006, Neuroscience Letters.

[6]  Björn Meyer,et al.  Daily activities and sleep quality in college students , 2006, Chronobiology international.

[7]  C. Eastman,et al.  Advancing human circadian rhythms with afternoon melatonin and morning intermittent bright light. , 2006, The Journal of clinical endocrinology and metabolism.

[8]  J. Walsh,et al.  Laboratory and field studies of naps and caffeine as practical countermeasures for sleep-wake problems associated with night work. , 2006, Sleep.

[9]  C. Eastman,et al.  The dim light melatonin onset following fixed and free sleep schedules , 2005, Journal of sleep research.

[10]  Todd S. Horowitz,et al.  Scheduling of sleep/darkness affects the circadian phase of night shift workers , 2005, Neuroscience Letters.

[11]  D. Dinges,et al.  Modafinil for excessive sleepiness associated with shift-work sleep disorder. , 2005, The New England journal of medicine.

[12]  G. Brainard,et al.  Photons, Clocks, and Consciousness , 2005, Journal of biological rhythms.

[13]  Kenneth P. Wright,et al.  Entrainment of the Human Circadian System by Light , 2005, Journal of biological rhythms.

[14]  C. Hart,et al.  Combined effects of methamphetamine and zolpidem on performance and mood during simulated night shift work , 2005, Pharmacology Biochemistry and Behavior.

[15]  K. Reid,et al.  Stability of Melatonin and Temperature as Circadian Phase Markers and Their Relation to Sleep Times in Humans , 2005, Journal of biological rhythms.

[16]  H. Nishikawa,et al.  Ramelteon (TAK-375) Accelerates Reentrainment of Circadian Rhythm after a Phase Advance of the Light-Dark Cycle in Rats , 2005, Journal of biological rhythms.

[17]  S. Daan,et al.  Comparison of the Munich Chronotype Questionnaire with the Horne‐Östberg's Morningness‐Eveningness score , 2005, Chronobiology international.

[18]  C. Eastman,et al.  Advancing circadian rhythms before eastward flight: a strategy to prevent or reduce jet lag. , 2005, Sleep.

[19]  M. Muehlbach,et al.  Effect of caffeine on physiological sleep tendency and ability to sustain wakefulness at night , 2005, Psychopharmacology.

[20]  P. Lavie.  Effects of midazolam on sleep disturbances associated with westward and eastward flights: Evidence for directional effects , 2005, Psychopharmacology.

[21]  C. Drake,et al.  Shift work sleep disorder: prevalence and consequences beyond that of symptomatic day workers. , 2004, Sleep.

[22]  S. Squarcia,et al.  Professional shift-work drivers who adopt prophylactic naps can reduce the risk of car accidents during night work. , 2004, Sleep.

[23]  C. Eastman,et al.  Complete or partial circadian re-entrainment improves performance, alertness, and mood during night-shift work. , 2004, Sleep.

[24]  Gary H Kamimori,et al.  Caffeine improves physical performance during 24 h of active wakefulness. , 2004, Aviation, space, and environmental medicine.

[25]  C. Czeisler,et al.  Adaptation of human pineal melatonin suppression by recent photic history. , 2004, The Journal of clinical endocrinology and metabolism.

[26]  R. Kronauer,et al.  Efficacy of a single sequence of intermittent bright light pulses for delaying circadian phase in humans. , 2004, American journal of physiology. Endocrinology and metabolism.

[27]  J. Paquet,et al.  Phase Relationships between Sleep-Wake Cycle and Underlying Circadian Rhythms in Morningness-Eveningness , 2004, Journal of biological rhythms.

[28]  Laura K Barger,et al.  Daily exercise facilitates phase delays of circadian melatonin rhythm in very dim light. , 2004, American journal of physiology. Regulatory, integrative and comparative physiology.

[29]  D. Dijk,et al.  Low-dose repeated caffeine administration for circadian-phase-dependent performance degradation during extended wakefulness. , 2004, Sleep.

[30]  Gary Gray,et al.  Melatonin and zopiclone as facilitators of early circadian sleep in operational air transport crews. , 2004, Aviation, space, and environmental medicine.

[31]  J. Walsh,et al.  Modafinil improves alertness, vigilance, and executive function during simulated night shifts. , 2004, Sleep.

[32]  A. Wirz-Justice,et al.  Evening melatonin and bright light administration induce additive phase shifts in dim light melatonin onset , 2004, Journal of pineal research.

[33]  T. Åkerstedt,et al.  Suppression of sleepiness and melatonin by bright light exposure during breaks in night work , 2004, Journal of Sleep Research.

[34]  C. Piérard,et al.  Caffeine or melatonin effects on sleep and sleepiness after rapid eastward transmeridian travel. , 2004, Journal of applied physiology.

[35]  C. Eastman,et al.  Combinations of Bright Light, Scheduled Dark, Sunglasses, and Melatonin to Facilitate Circadian Entrainment to Night Shift Work , 2003, Journal of biological rhythms.

[36]  Charles A Czeisler,et al.  High sensitivity of the human circadian melatonin rhythm to resetting by short wavelength light. , 2003, The Journal of clinical endocrinology and metabolism.

[37]  B. Griefahn,et al.  The reliability of melatonin synthesis as an indicator of the individual circadian phase position. , 2003, Military medicine.

[38]  C. Eastman,et al.  Preflight Adjustment to Eastward Travel:3 Days of Advancing Sleep with and without Morning Bright Light , 2003, Journal of biological rhythms.

[39]  D. Dawson,et al.  The Relationship Between the Dim Light Melatonin Onset and Sleep on a Regular Schedule in Young Healthy Adults , 2003, Behavioral sleep medicine.

[40]  C. Pollak,et al.  The role of actigraphy in the study of sleep and circadian rhythms. , 2003, Sleep.

[41]  Orfeu M Buxton,et al.  Exercise elicits phase shifts and acute alterations of melatonin that vary with circadian phase. , 2003, American journal of physiology. Regulatory, integrative and comparative physiology.

[42]  Raymond Cluydts,et al.  Effects of Slow-Release Caffeine and a Nap on Driving Simulator Performance after Partial Sleep Deprivation , 2003, Perceptual and motor skills.

[43]  A. Wirz-Justice,et al.  Life between Clocks: Daily Temporal Patterns of Human Chronotypes , 2003, Journal of biological rhythms.

[44]  Thomas Reilly,et al.  The Use of Actimetry to Assess Changes to the Rest–Activity Cycle , 2003, Chronobiology international.

[45]  Diane B Boivin,et al.  Circadian Adaptation to Night-Shift Work by Judicious Light and Darkness Exposure , 2002, Journal of biological rhythms.

[46]  C. Eastman,et al.  The effects of prior light history on the suppression of melatonin by light in humans , 2002, Journal of pineal research.

[47]  B. Griefahn,et al.  Melatonin synthesis: a possible indicator of intolerance to shiftwork. , 2002, American journal of industrial medicine.

[48]  J. Roberts.  Screening for Ocular Phototoxicity , 2002, International journal of toxicology.

[49]  Ziad Boulos,et al.  Light visor treatment for jet lag after westward travel across six time zones. , 2002, Aviation, space, and environmental medicine.

[50]  G. P. Herbison,et al.  The impact of a nap opportunity during the night shift on the performance and alertness of 12‐h shift workers , 2002, Journal of sleep research.

[51]  C. Czeisler,et al.  Absence of Circadian Phase Resetting in Response to Bright Light Behind the Knees , 2002, Science.

[52]  N. C. Reynolds,et al.  Using the Argonne diet in jet lag prevention: deployment of troops across nine time zones. , 2002, Military medicine.

[53]  Y. Dagan,et al.  The effects of coffee consumption on sleep and melatonin secretion. , 2002, Sleep Medicine.

[54]  D. Cardinali,et al.  Circadian rhythms in airline pilots submitted to long-haul transmeridian flights. , 2002, Aviation, space, and environmental medicine.

[55]  D. Jeong,et al.  Bright light exposure at night and light attenuation in the morning improve adaptation of night shift workers. , 2002, Sleep.

[56]  Richard E Kronauer,et al.  Comparisons of the Variability of Three Markers of the Human Circadian Pacemaker , 2002, Journal of biological rhythms.

[57]  K. Yau,et al.  Melanopsin-Containing Retinal Ganglion Cells: Architecture, Projections, and Intrinsic Photosensitivity , 2002, Science.

[58]  D. Berson,et al.  Phototransduction by Retinal Ganglion Cells That Set the Circadian Clock , 2002, Science.

[59]  Charles A. Czeisler,et al.  Age-related change in the relationship between circadian period, circadian phase, and diurnal preference in humans , 2002, Neuroscience Letters.

[60]  Derk-Jan Dijk,et al.  Functional Genomics of Sleep and Circadian Rhythm Invited Review : Integration of human sleep-wake regulation and circadian rhythmicity , 2001 .

[61]  T Reilly,et al.  Identifying some determinants of “jet lag” and its symptoms: a study of athletes and other travellers , 2002, British journal of sports medicine.

[62]  K. Sharkey,et al.  Melatonin phase shifts human circadian rhythms in a placebo-controlled simulated night-work study. , 2002, American journal of physiology. Regulatory, integrative and comparative physiology.

[63]  C. Eastman,et al.  SLEEP LOGS OF YOUNG ADULTS WITH SELF-SELECTED SLEEP TIMES PREDICT THE DIM LIGHT MELATONIN ONSET , 2002, Chronobiology international.

[64]  J. Emens,et al.  Low, but not high, doses of melatonin entrained a free-running blind person with a long circadian period , 2002, Chronobiology international.

[65]  D. Cardinali,et al.  A multifactorial approach employing melatonin to accelerate resynchronization of sleep–wake cycle after a 12 time‐zone westerly transmeridian flight in elite soccer athletes , 2002, Journal of pineal research.

[66]  I. Yoon,et al.  ROLE OF MORNING MELATONIN ADMINISTRATION AND ATTENUATION OF SUNLIGHT EXPOSURE IN IMPROVING ADAPTATION OF NIGHT-SHIFT WORKERS , 2002, Chronobiology international.

[67]  T. Ebisawa,et al.  Larger phase angle between sleep propensity and melatonin rhythms in sighted humans with non-24-hour sleep-wake syndrome. , 2002, Sleep.

[68]  M. Härmä,et al.  Evaluation of a fast forward rotating shift schedule in the steel industry with a special focus on ageing and sleep. , 2001, Journal of human ergology.

[69]  L. Smith,et al.  Reducing night shift exposure: a pilot study of rota, night shift and age effects on sleepiness and fatigue. , 2001, Journal of human ergology.

[70]  C A Czeisler,et al.  Intrinsic near-24-h pacemaker period determines limits of circadian entrainment to a weak synchronizer in humans , 2001, Proceedings of the National Academy of Sciences of the United States of America.

[71]  J. Paquet,et al.  Profile of 24-h Light Exposure and Circadian Phase of Melatonin Secretion in Night Workers , 2001, Journal of biological rhythms.

[72]  K. Sharkey,et al.  Effects of melatonin administration on daytime sleep after simulated night shift work , 2001, Journal of sleep research.

[73]  Jeffrey R. Davis,et al.  Zolpidem reduces the sleep disturbance of jet lag. , 2001, Sleep medicine.

[74]  R Cluydts,et al.  Slow‐release caffeine as a countermeasure to driver sleepiness induced by partial sleep deprivation , 2001, Journal of sleep research.

[75]  D. Cardinali,et al.  Circadian urinary 6‐sulphatoxymelatonin, cortisol excretion and locomotor activity in airline pilots during transmeridian flights , 2001, Journal of pineal research.

[76]  C A Czeisler,et al.  Association of intrinsic circadian period with morningness-eveningness, usual wake time, and circadian phase. , 2001, Behavioral neuroscience.

[77]  A. Muzet,et al.  Innovative working schedule: introducing one short nap during the night shift , 2001, Ergonomics.

[78]  J. Wolfe,et al.  Efficacy of bright light and sleep/darkness scheduling in alleviating circadian maladaptation to night work. , 2001, American journal of physiology. Endocrinology and metabolism.

[79]  R. Steffen,et al.  Effectiveness and tolerability of melatonin and zolpidem for the alleviation of jet lag. , 2001, Aviation, space, and environmental medicine.

[80]  Jonathan French,et al.  Resynchronization of hormonal rhythms after an eastbound flight in humans: effects of slow-release caffeine and melatonin , 2001, European Journal of Applied Physiology.

[81]  T Reilly,et al.  Effect of low-dose temazepam on physiological variables and performance tests following a westerly flight across five time zones. , 2001, International journal of sports medicine.

[82]  B. Bioulac,et al.  Is Self-Reported Morbidity Related to the Circadian Clock? , 2001, Journal of biological rhythms.

[83]  A. Nevill,et al.  TEMPERATURE PROFILES, AND THE EFFECT OF SLEEP ON THEM, IN RELATION TO MORNINGNESS-EVENINGNESS IN HEALTHY FEMALE SUBJECTS , 2001, Chronobiology international.

[84]  M M Heitkemper,et al.  CIRCADIAN RHYTHMICITY OF CORTISOL AND BODY TEMPERATURE: MORNINGNESS-EVENINGNESS EFFECTS , 2001, Chronobiology international.

[85]  D. Dawson,et al.  Comparing performance on a simulated 12 hour shift rotation in young and older subjects , 2001, Occupational and environmental medicine.

[86]  宮崎 俊彦.  Phase-Advance Shifts of Human Circadian Pacemaker are Accelerated by Daytime Physical Exercise , 2001 .

[87]  E. van Cauter,et al.  A benzodiazepine hypnotic facilitates adaptation of circadian rhythms and sleep-wake homeostasis to an eight hour delay shift simulating westward jet lag. , 2000, Sleep.

[88]  T. Reilly,et al.  Use of melatonin in recovery from jet-lag following an eastward flight across 10 time-zones , 2000, Ergonomics.

[89]  R. Kronauer,et al.  Sensitivity of the human circadian pacemaker to nocturnal light: melatonin phase resetting and suppression , 2000, The Journal of physiology.

[90]  Daniel J Buysse,et al.  Inducing jet‐lag in older people: Directional asymmetry , 2000, Journal of sleep research.

[91]  W. Revelle,et al.  Individual differences in the phase and amplitude of the human circadian temperature rhythm: with an emphasis on morningness–eveningness , 2000, Journal of sleep research.

[92]  A. Daurat,et al.  Effects of zopiclone on the rest/activity rhythm after a westward flight across five time zones , 2000, Psychopharmacology.

[93]  E. van Cauter,et al.  Daytime naps in darkness phase shift the human circadian rhythms of melatonin and thyrotropin secretion. , 2000, American journal of physiology. Regulatory, integrative and comparative physiology.

[94]  J. Carrier,et al.  SLEEP AND CIRCADIAN PHASE CHARACTERISTICS OF ADOLESCENT AND YOUNG ADULT MALES IN A NATURALISTIC SUMMERTIME CONDITION , 2000, Chronobiology international.

[95]  C. Eastman,et al.  FAILURE OF EXTRAOCULAR LIGHT TO FACILITATE CIRCADIAN RHYTHM REENTRAINMENT IN HUMANS , 2000, Chronobiology international.

[96]  M. F. Ceolim,et al.  Sleep/wake cycle and physical activity in healthy elderly people. , 2000, Sleep research online : SRO.

[97]  J. Marquié,et al.  Sleep, age, and shiftwork experience , 1999, Journal of sleep research.

[98]  C. Eastman,et al.  Intermittent bright light and exercise to entrain human circadian rhythms to night work. , 1999, The American journal of physiology.

[99]  M. Dumont,et al.  Association between melatonin secretion and daytime sleep complaints in night nurses. , 1999, Sleep.

[100]  M Terman,et al.  Jet lag: clinical features, validation of a new syndrome-specific scale, and lack of response to melatonin in a randomized, double-blind trial. , 1999, The American journal of psychiatry.

[101]  J. Marquié,et al.  Effects of age, working hours, and job content on sleep: a pilot study. , 1999, Experimental aging research.

[102]  G Kecklund,et al.  Bright light treatment used for adaptation to night work and re‐adaptation back to day life. A field study at an oil platform in the North Sea , 1999, Journal of sleep research.

[103]  M. Okawa,et al.  Demography of sleep disturbances associated with circadian rhythm disorders in Japan , 1999, Psychiatry and clinical neurosciences.

[104]  P. Lercher,et al.  Influence of beta-blockers on melatonin release , 1999, European Journal of Clinical Pharmacology.

[105]  C A Czeisler,et al.  Relationship of endogenous circadian melatonin and temperature rhythms to self-reported preference for morning or evening activity in young and older people. , 1999, Journal of investigative medicine : the official publication of the American Federation for Clinical Research.

[106]  Charles A. Czeisler,et al.  INFLUENCE OF LIGHT ON CIRCADIAN RHYTHMICITY IN HUMANS , 1999 .

[107]  T. Reilly,et al.  The effect of activity on the waking temperature rhythm in humans. , 1999, Chronobiology international.

[108]  Y. Dagan,et al.  Circadian rhythm sleep disorders: toward a more precise definition and diagnosis. , 1999, Chronobiology international.

[109]  T. Åkerstedt,et al.  Promoting alertness with a short nap during a night shift , 1998, Journal of Sleep Research.

[110]  A. Lewy,et al.  Morning vs evening light treatment of patients with winter depression. , 1998, Archives of general psychiatry.

[111]  M. Uchiyama,et al.  Circadian rhythm sleep disorders in adolescents: Clinical trials of combined treatments based on chronobiology , 1998, Psychiatry and clinical neurosciences.

[112]  M. J. Forbes,et al.  Shift type and season affect adaptation of the 6-sulphatoxymelatonin rhythm in offshore oil rig workers , 1998, Neuroscience Letters.

[113]  J. Krohmer,et al.  Can melatonin improve adaptation to night shift? , 1998, The American journal of emergency medicine.

[114]  T. Åkerstedt,et al.  Retaining home-base sleep hours to prevent jet lag in connection with a westward flight across nine time zones. , 1998, Chronobiology international.

[115]  M. Witting,et al.  Does exogenous melatonin improve day sleep or night alertness in emergency physicians working night shifts? , 1998, Annals of emergency medicine.

[116]  W. Yamadera,et al.  Clinical features of circadian rhythm sleep disorders in outpatients , 1998, Psychiatry and clinical neurosciences.

[117]  Trevor R. Norman,et al.  Modulation of plasma melatonin concentrations by changes in posture , 1998, Journal of pineal research.

[118]  Y. Kamei,et al.  Clinical characteristics of circadian rhythm sleep disorders , 1998, Psychiatry and clinical neurosciences.

[119]  C. Eastman,et al.  Medium-intensity light produces circadian rhythm adaptation to simulated night-shift work. , 1998, Sleep.

[120]  S. Campbell,et al.  Extraocular circadian phototransduction in humans. , 1998, Science.

[121]  R. Steffen,et al.  Comparative study to determine the optimal melatonin dosage form for the alleviation of jet lag. , 1998, Chronobiology international.

[122]  C. M. Singer,et al.  The human phase response curve (PRC) to melatonin is about 12 hours out of phase with the PRC to light. , 1998, Chronobiology international.

[123]  A. Daurat,et al.  Effect of bright light at night on core temperature, subjective alertness and performance as a function of exposure time. , 1998, Scandinavian journal of work, environment & health.

[124]  A. Lewy,et al.  Melatonin as a Chronobiotic: Treatment of Circadian Desynchrony in Night Workers and the Blind , 1997, Journal of biological rhythms.

[125]  Daniel J Buysse,et al.  Sleep and morningness‐eveningness in the ‘middle’ years of life (20–59y) , 1997, Journal of sleep research.

[126]  C. Guilleminault,et al.  Rapid shift in peak melatonin secretion associated with improved performance in short shift work schedule. , 1997, Sleep.

[127]  A. Lewy,et al.  Sleep-promoting effects of melatonin: at what dose, in whom, under what conditions, and by what mechanisms? , 1997, Sleep.

[128]  Y. Mizuki,et al.  Vitamin B12 treatment for delayed sleep phase syndrome: A multi‐center double‐blind study , 1997, Psychiatry and clinical neurosciences.

[129]  M. Ferrara,et al.  Performance, ability to stay awake, and tendency to fall asleep during the night after a diurnal sleep with temazepam or placebo. , 1997, Sleep.

[130]  Claude Gronfier,et al.  Twenty-four-hour melatonin and core body temperature rhythms: their adaptation in night workers. , 1997, The American journal of physiology.

[131]  Charmane I. Eastman,et al.  Conflicting Bright Light Exposure during Night Shifts Impedes Circadian Adaptation , 1997, Journal of biological rhythms.

[132]  M. Hakel,et al.  Caffeine and light effects on nighttime melatonin and temperature levels in sleep-deprived humans , 1997, Brain Research.

[133]  C. Remé,et al.  Bright light therapy in focus: lamp emission spectra and ocular safety. , 1996, Technology and health care : official journal of the European Society for Engineering and Medicine.

[134]  Hans P. A. Van Dongen,et al.  Morning-type and evening-type individuals differ in the phase position of their endogenous circadian oscillator , 1996, Neuroscience Letters.

[135]  C. Guilleminault,et al.  Rapid shift in sleep time and acrophase of melatonin secretion in short shift work schedule. , 1996, Sleep.

[136]  R. Leproult,et al.  Progressive elevation of plasma thyrotropin during adaptation to simulated jet lag: effects of treatment with bright light or zolpidem. , 1996, The Journal of clinical endocrinology and metabolism.

[137]  G. Libro,et al.  Quality of life in shift work syndrome. , 1996, Functional neurology.

[138]  J. Crowley,et al.  Melatonin efficacy in aviation missions requiring rapid deployment and night operations. , 1996, Aviation, space, and environmental medicine.

[139]  Richard E. Kronauer,et al.  Dose-response relationships for resetting of human circadian clock by light , 1996, Nature.

[140]  P. Badia,et al.  Nonsteroidal anti-inflammatory drugs alter body temperature and suppress melatonin in humans , 1996, Physiology & Behavior.

[141]  C. Eastman,et al.  Circadian rhythm adaptation to simulated night shift work: effect of nocturnal bright-light duration. , 1995, Sleep.

[142]  Ziad Boulos,et al.  Light treatment for sleep disorders: Consensus report .7. Jet lag , 1995 .

[143]  M. Nicolich,et al.  An evaluation of scheduled bright light and darkness on rotating shiftworkers: trial and limitations. , 1995, American journal of industrial medicine.

[144]  J. Horne,et al.  Night-shift work in antarctica: Sleep characteristics and bright light treatment , 1995, Physiology & Behavior.

[145]  M Terman,et al.  Light Treatment for Sleep Disorders: Consensus Report , 1995, Journal of biological rhythms.

[146]  Benita C. Hayes,et al.  Light treatment for NASA shiftworkers. , 1995, Chronobiology international.

[147]  J K Walsh,et al.  The effects of caffeine on simulated night-shift work and subsequent daytime sleep. , 1995, Sleep.

[148]  C. Eastman,et al.  Dark goggles and bright light improve circadian rhythm adaptation to night-shift work. , 1994, Sleep.

[149]  T. Åkerstedt,et al.  Age and adjustment to night work. , 1994, Occupational and environmental medicine.

[150]  M. Bonnet,et al.  Impact of naps and caffeine on extended nocturnal performance , 1994, Physiology & Behavior.

[151]  M. Bonnet,et al.  The use of prophylactic naps and caffeine to maintain performance during a continuous operation. , 1994, Ergonomics.

[152]  M Kundi,et al.  Different patterns of light exposure in relation to melatonin and Cortisol rhythms and sleep of night workers , 1994, Journal of pineal research.

[153]  J. Arendt,et al.  Posture influences melatonin concentrations in plasma and saliva in humans , 1994, Neuroscience Letters.

[154]  M. Byrne,et al.  Nocturnal exercise phase delays circadian rhythms of melatonin and thyrotropin and thyrotropin secretion in normal men , 1994 .

[155]  G. Costa,et al.  Effect of bright light on tolerance to night work. , 1993, Scandinavian journal of work, environment & health.

[156]  K. Ando,et al.  Long‐Term Course of Adult Patients with Delayed Sleep Phase Syndrome , 1993, The Japanese journal of psychiatry and neurology.

[157]  M. Roden,et al.  The circadian melatonin and cortisol secretion pattern in permanent night shift workers. , 1993, The American journal of physiology.

[158]  J. Waterhouse,et al.  Separating the endogenous and exogenous components of the circadian rhythm of body temperature during night work using some 'purification' models. , 1993, Ergonomics.

[159]  M Kundi,et al.  Personal light dosimetry in permanent night and day workers. , 1993, Chronobiology international.

[160]  Alexander G. Dawson,et al.  A double-blind trial of melatonin as a treatment for jet lag in international cabin crew , 1993, Biological Psychiatry.

[161]  DM Edgar,et al.  Effect of SCN lesions on sleep in squirrel monkeys: evidence for opponent processes in sleep-wake regulation , 1993, The Journal of neuroscience : the official journal of the Society for Neuroscience.

[162]  C. Eastman,et al.  Circadian rhythms during gradually delaying and advancing sleep and light schedules , 1993, Physiology & Behavior.

[163]  S. Folkard,et al.  Can melatonin improve shift workers' tolerance of the night shift? Some preliminary findings. , 1993, Chronobiology international.

[164]  J. Pokorski,et al.  Gender, ageing, and shiftwork intolerance. , 1993, Ergonomics.

[165]  G. Sassolas,et al.  Melatonin and jet lag: Confirmatory result using a simplified protocol , 1992, Biological Psychiatry.

[166]  D. Dawson,et al.  Aging young sleep: a test of the phase advance hypothesis of sleep disturbance in the elderly , 1992, Journal of sleep research.

[167]  J. Walsh,et al.  Sleepiness/alertness on a simulated night shift schedule and morningness-eveningness tendency. , 1992, Sleep.

[168]  T H Monk,et al.  Daily social rhythms in the elderly and their relation to objectively recorded sleep. , 1992, Sleep.

[169]  T H Monk,et al.  Age-related differences in recovery from simulated jet lag. , 1992, Sleep.

[170]  A. Lewy,et al.  Melatonin shifts human circadian rhythms according to a phase-response curve. , 1992, Chronobiology international.

[171]  A. Benedito‐Silva,et al.  Correlations between morningness-eveningness character, sleep habits and temperature rhythm in adolescents. , 1992, Brazilian journal of medical and biological research = Revista brasileira de pesquisas medicas e biologicas.

[172]  D Dawson,et al.  Timed exposure to bright light improves sleep and alertness during simulated night shifts. , 1991, Sleep.

[173]  C A Czeisler,et al.  Light exposure induces equivalent phase shifts of the endogenous circadian rhythms of circulating plasma melatonin and core body temperature in men. , 1991, The Journal of clinical endocrinology and metabolism.

[174]  D. Kennaway,et al.  Effects of temazepam on sleep, performance, and rhythmic 6-sulphatoxymelatonin and cortisol excretion after transmeridian travel. , 1991, Aviation, space, and environmental medicine.

[175]  J K Walsh,et al.  Sleepiness/alertness on a simulated night shift following sleep at home with triazolam. , 1991, Sleep.

[176]  M. Midwinter,et al.  Adaptation of the melatonin rhythm in human subjects following nightshift work in Antarctica , 1991, Neuroscience Letters.

[177]  R. Daroff,et al.  The International Classification of Sleep Disorders , 1991, Neurology.

[178]  I. Hindmarch,et al.  The effect of zopiclone 7.5 mg on the sleep, mood and performance of shift workers. , 1990, International clinical psychopharmacology.

[179]  T H Monk,et al.  The Social Rhythm Metric An Instrument to Quantify the Daily Rhythms of Life , 1990, The Journal of nervous and mental disease.

[180]  P. Knauth,et al.  The relation of age to the adjustment of the circadian rhythms of oral temperature and sleepiness to shift work. , 1990, Chronobiology international.

[181]  R. Wever,et al.  Light Effects on Human Circadian Rhythms: A Review of Recent Andechs Experiments , 1989, Journal of biological rhythms.

[182]  R. Newcombe,et al.  Effect of melatonin on jet lag after long haul flights. , 1989, BMJ.

[183]  N. Mrosovsky,et al.  Effects of Induced Wheel Running on the Circadian Activity Rhythms of Syrian Hamsters: Entrainment and Phase Response Curve , 1989, Journal of biological rhythms.

[184]  R. Phillips,et al.  Zopiclone in insomniac shiftworkers , 1989, International archives of occupational and environmental health.

[185]  A. Lewy,et al.  The dim light melatonin onset as a marker for circadian phase position. , 1989, Chronobiology international.

[186]  J. Walsh,et al.  Physiological sleep tendency on a simulated night shift: adaptation and effects of triazolam. , 1988, Sleep.

[187]  H. Morris,et al.  Traveler's amnesia. Transient global amnesia secondary to triazolam. , 1987, JAMA.

[188]  A. Lewy,et al.  Antidepressant and circadian phase-shifting effects of light. , 1987, Science.

[189]  S. Strogatz,et al.  Bright light resets the human circadian pacemaker independent of the timing of the sleep-wake cycle. , 1986, Science.

[190]  J. Arendt,et al.  Alleviation of jet lag by melatonin: preliminary results of controlled double blind trial. , 1986, British medical journal.

[191]  S. Daan,et al.  Scheduled exposure to daylight: a potential strategy to reduce "jet lag" following transmeridian flight. , 1984, Psychopharmacology bulletin.

[192]  J. Waterhouse,et al.  Does ‘anchor sleep’ entrain circadian rhythms? Evidence from constant routine studies. , 1983, The Journal of physiology.

[193]  J. Redman,et al.  Free-running activity rhythms in the rat: entrainment by melatonin. , 1983, Science.

[194]  C A Czeisler,et al.  Rotating shift work schedules that disrupt sleep are improved by applying circadian principles. , 1982, Science.

[195]  C A Czeisler,et al.  Chronotherapy: resetting the circadian clocks of patients with delayed sleep phase insomnia. , 1981, Sleep.

[196]  D A Newsome,et al.  Light suppresses melatonin secretion in humans. , 1980, Science.

[197]  J. Horne,et al.  A self-assessment questionnaire to determine morningness-eveningness in human circadian rhythms. , 1976, International journal of chronobiology.