Influence of sleep-wake and circadian rhythm disturbances in psychiatric disorders.

Recent evidence shows that the temporal alignment between the sleep-wake cycle and the circadian pacemaker affects self-assessment of mood in healthy subjects. Despite the differences in affective state between healthy subjects and patients with psychiatric disorders, these results have implications for analyzing diurnal variation of mood in unipolar and bipolar affective disorders and sleep disturbances in other major psychiatric conditions such as chronic schizophrenia. In a good proportion of patients with depression, mood often improves over the course of the day; an extension of waking often has an antidepressant effect. Sleep deprivation has been described as a treatment for depression for more than 30 years, and approximately 50% to 60% of patients with depression respond to this approach, especially those patients who report that their mood improves over the course of the day. The mechanisms by which sleep deprivation exerts its antidepressant effects are still controversial, but a reduction in rapid eye movement sleep (REM sleep), sleep pressure and slow-wave sleep (SWS), or a circadian phase disturbance, have been proposed. Although several studies support each of these hypotheses, none is sufficient to explain all observations reported to date. Unfortunately, the disturbed sleep-wake cycle or behavioural activities of depressed patients often explain several of the abnormalities reported in the diurnal rhythms of these patients. Thus, protocols that specifically manipulate the sleep-wake cycle to unmask the expression of the endogenous circadian pacemaker are greatly needed. In chronic schizophrenia, significant disturbances in sleep continuity, REM sleep, and SWS have been consistently reported. These disturbances are different from those observed in depression, especially with regard to REM sleep. Circadian phase abnormalities in schizophrenic patients have also been reported. Future research is expected to clarify the nature of these abnormalities.

[1]  J. Horne,et al.  Early morning driver sleepiness: effectiveness of 200 mg caffeine. , 2000, Psychophysiology.

[2]  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.

[3]  Lewis R. Baxter,et al.  Disruption of social circadian rhythms in major depression: A preliminary report , 1992, Psychiatry Research.

[4]  K. Honma A human phase response curve for bright light pulses , 1988 .

[5]  A. Rechtschaffen,et al.  A manual of standardized terminology, technique and scoring system for sleep stages of human subjects , 1968 .

[6]  D. Healy,et al.  The circadian system and the therapeutics of the affective disorders. , 1995, Pharmacology & therapeutics.

[7]  R. Tandon,et al.  Effect of neuroleptic treatment on polysomnographic measures in schizophrenia , 1991, Biological Psychiatry.

[8]  Body temperature and mood variations during forced desynchronization in winter depression: a preliminary report , 2000, Biological Psychiatry.

[9]  C. Eastman,et al.  The circadian rhythm of temperature during light treatment for winter depression , 1993, Biological Psychiatry.

[10]  R. V. D. Hoofdakker Chronobiological theories of nonseasonal affective disorders and their implications for treatment. , 1994 .

[11]  S Folkard,et al.  Complex interaction of the sleep-wake cycle and circadian phase modulates mood in healthy subjects. , 1997, Archives of general psychiatry.

[12]  P. Lavie Melatonin: Role in Gating Nocturnal Rise in Sleep Propensity , 1997, Journal of biological rhythms.

[13]  D. Kupfer,et al.  Electroencephalographic sleep in young, never-medicated schizophrenics. A comparison with delusional and nondelusional depressives and with healthy controls. , 1987, Archives of general psychiatry.

[14]  F. Goodwin,et al.  Phase advance of the circadian sleep-wake cycle as an antidepressant. , 1979, Science.

[15]  S. Taylor,et al.  Electroencephalographic sleep abnormalities in schizophrenia. Relationship to positive/negative symptoms and prior neuroleptic treatment. , 1992, Archives of general psychiatry.

[16]  S. Kasper,et al.  The role of sleep and wakefulness in the genesis of depression and mania. , 1992, L'Encephale.

[17]  C. Hock,et al.  A rapid-cycling bipolar patient treated with long nights, bedrest, and light , 1999, Biological Psychiatry.

[18]  P. Linkowski,et al.  24-hour profiles of adrenocorticotropin, cortisol, and growth hormone in major depressive illness: effect of antidepressant treatment. , 1987, The Journal of clinical endocrinology and metabolism.

[19]  C. Kornetsky,et al.  The relationship between attention and slow-wave sleep in chronic schizophrenia [proceedings]. , 1977, Psychopharmacology bulletin.

[20]  J. Wright,et al.  Mania Following Sleep Deprivation , 1993, British Journal of Psychiatry.

[21]  C A Czeisler,et al.  The prevalence and health impact of shiftwork. , 1986, American journal of public health.

[22]  F. Turek Manipulation of a central circadian clock regulating behavioral and endocrine rhythms with a short-acting benzodiazepine used in the treatment of insomnia , 1988, Psychoneuroendocrinology.

[23]  M A Young,et al.  Bright light treatment of winter depression: a placebo-controlled trial. , 1998, Archives of general psychiatry.

[24]  P. Linkowski,et al.  The 24-hour profiles of cortisol, prolactin, and growth hormone secretion in mania. , 1994, Archives of general psychiatry.

[25]  Daniel J Buysse,et al.  PSYCHIATRIC DISORDERS ASSOCIATED WITH DISTURBED SLEEP AND CIRCADIAN RHYTHMS , 1999 .

[26]  T. Neylan,et al.  Decreased slow-wave sleep and enlarged lateral ventricles in schizophrenia. , 1988, Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology.

[27]  Daniel J Buysse,et al.  Minute-by-minute analysis of REM sleep timing in major depression , 1990, Biological Psychiatry.

[28]  J. Lönnqvist,et al.  Suppression of melatonin secretion by bright light in seasonal affective disorder , 1997, Biological Psychiatry.

[29]  D. Healy,et al.  Shiftwork, helplessness and depression. , 1993, Journal of affective disorders.

[30]  J. Williams,et al.  Interpersonal sensitivity predicts depressive symptom response to the circadian rhythm disruption of nightwork , 1996, Psychological Medicine.

[31]  D J Kupfer,et al.  Polysomnographic characteristics of young manic patients. Comparison with unipolar depressed patients and normal control subjects. , 1992, Archives of general psychiatry.

[32]  E. Domino,et al.  Electroencephalographic and eye movement patterns during sleep in chronic schizophrenic patients. , 1967, Electroencephalography and clinical neurophysiology.

[33]  C. Tamminga,et al.  Sleep polygraphy in schizophrenia: Methodological issues , 1990, Biological Psychiatry.

[34]  A. Bouhuys,et al.  A longitudinal study of diurnal mood variation in depression; characteristics and significance. , 1994, Journal of affective disorders.

[35]  V. Zarcone,et al.  Rapid eye movement sleep eye movements in schizophrenia and depression. , 1993, Archives of general psychiatry.

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

[37]  A. Borbély,et al.  Sleep, sleep deprivation and depression. A hypothesis derived from a model of sleep regulation. , 1982, Human neurobiology.

[38]  R B Briner,et al.  Associations of sleep with everyday mood, minor symptoms and social interaction experience. , 1994, Sleep.

[39]  I. Nir,et al.  Serum melatonin levels in schizophrenic and schizoaffective hospitalized patients , 1991, Acta psychiatrica Scandinavica.

[40]  A. Wirz-Justice,et al.  EEG and subjective sleepiness during extended wakefulness in seasonal affective disorder: circadian and homeostatic influences , 2000, Biological Psychiatry.

[41]  R. H. van den Hoofdakker Chronobiological theories of nonseasonal affective disorders and their implications for treatment. , 1994, Journal of biological rhythms.

[42]  W. Dement DREAM RECALL AND EYE MOVEMENTS DURING SLEEP IN SCHIZOPHRENICS AND NORMALS , 1955, The Journal of nervous and mental disease.

[43]  A. Steiger,et al.  Corticotropin-releasing hormone inhibits melatonin secretion in healthy volunteers--a potential link to low-melatonin syndrome in depression? , 1997, Neuroendocrinology.

[44]  D J Kupfer,et al.  REM latency: a psychobiologic marker for primary depressive disease. , 1976, Biological psychiatry.

[45]  D. Caldwell Differential levels of stage IV sleep in a group of clinically similar chronic schizophrenic patients. , 1969, Biological psychiatry.

[46]  D. Kupfer,et al.  Sleep and treatment prediction in endogenous depression. , 1981, The American journal of psychiatry.

[47]  I Feinberg,et al.  Further evidence of abnormal non-rapid-eye-movement sleep in schizophrenia. , 1985, Archives of general psychiatry.

[48]  G. Emilien,et al.  Circadian system and sleep anomaly in depression , 1999, Irish Journal of Psychological Medicine.

[49]  N. Yamada,et al.  Clinical and chronobiological effects of light therapy on nonseasonal affective disorders , 1995, Biological Psychiatry.

[50]  P N Prinz,et al.  Dim light melatonin onset and circadian temperature during a constant routine in hypersomnic winter depression , 1993, Acta psychiatrica Scandinavica.

[51]  Derk-Jan Dijk,et al.  Entrained phase of the circadian pacemaker serves to stabilize alertness and performance throughout the habitual waking day. , 1994 .

[52]  D. Braus,et al.  The value of REM sleep parameters in differentiating Alzheimer's disease from old-age depression and normal aging. , 1998, Journal of psychiatric research.

[53]  Caldwell Df Differential levels of stage IV sleep in a group of clinically similar chronic schizophrenic patients. , 1969 .

[54]  A. Wirz-Justice,et al.  Haloperidol Disrupts, Clozapine Reinstates the Circadian Rest–Activity Cycle in a Patient With Early-Onset Alzheimer Disease , 2000, Alzheimer disease and associated disorders.

[55]  B. Pitt Psychopharmacology , 1968, Mental Health.

[56]  C. Thompson,et al.  Effects of morning phototherapy on circadian markers in seasonal affective disorder , 1997, British Journal of Psychiatry.

[57]  P. Linkowski,et al.  Simultaneous study of 24-hour patterns of melatonin and cortisol secretion in depressed patients. , 1982, Neuropsychobiology.

[58]  D. Dijk,et al.  Circadian and sleep/wake dependent aspects of subjective alertness and cognitive performance , 1992, Journal of sleep research.

[59]  M. Thase,et al.  REM sleep enhancement by bupropion in depressed men. , 1995, The American journal of psychiatry.

[60]  R. Kronauer,et al.  Bright light induction of strong (type 0) resetting of the human circadian pacemaker. , 1989, Science.

[61]  L. Altshuler,et al.  Rapid resolution of first episodes of mania: sleep related? , 1994, Journal of Clinical Psychiatry.

[62]  R. H. van den Hoofdakker,et al.  Can non-REM sleep be depressogenic? , 1992, Journal of affective disorders.

[63]  D F Kripke,et al.  Light treatment for nonseasonal depression: speed, efficacy, and combined treatment. , 1998, Journal of affective disorders.

[64]  E. Palazidou,et al.  Melatonin Rhythms in Seasonal Affective Disorder , 1993, British Journal of Psychiatry.

[65]  A. Smith,et al.  Seasonal affective disorder and season-dependent abnormalities of melatonin suppression by light , 1990, The Lancet.

[66]  J. Mooney,et al.  Biologic rhythm disorders, depression, and phototherapy. A new hypothesis. , 1987, The Psychiatric clinics of North America.

[67]  D.G.M. Dijk,et al.  Contribution of the circadian pacemaker and the sleep homeostat to sleep propensity, sleep structure, electroencephalographic slow waves, and sleep spindle activity in humans , 1995, The Journal of neuroscience : the official journal of the Society for Neuroscience.

[68]  N. Kajimura,et al.  Association between Delta Waves during Sleep and Negative Symptoms in Schizophrenia , 1999, Neuropsychobiology.

[69]  D. Kupfer,et al.  Relationship between social rhythms and mood in patients with rapid cycling bipolar disorder , 1999, Psychiatry Research.

[70]  A. Wirz-Justice,et al.  Circadian Rhythm Mechanisms in Affective Illness and in Antidepressant Drug Action , 1982, Pharmacopsychiatria.

[71]  A. Wirz-Justice Beginning to see the light. , 1998, Archives of general psychiatry.

[72]  T. Silverstone,et al.  Season and manic relapse , 1992, Acta psychiatrica Scandinavica.

[73]  F. Letemendia,et al.  Five Variations of Sleep Deprivation in a Depressed Woman , 1979, British Journal of Psychiatry.

[74]  G. Burrows,et al.  Melatonin supersensitivity to dim light in seasonal affective disorder , 1990, The Lancet.

[75]  R. Lam,et al.  Seasonal affective disorder. , 1990, Canadian family physician Medecin de famille canadien.

[76]  A. Wirz-Justice Circadian rhythms in mammalian neurotransmitter receptors , 1987, Progress in Neurobiology.

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

[78]  A. Wirz-Justice,et al.  An open trial of light therapy in hospitalised major depression. , 1999, Journal of affective disorders.

[79]  J. Gillin,et al.  Antidepressant effects of sleep deprivation in bright and dim light , 1985, Acta psychiatrica Scandinavica.

[80]  A. Rush,et al.  A multicenter, double-blind comparison of the effects of nefazodone and fluoxetine on sleep architecture and quality of sleep in depressed outpatients. , 1997, Journal of clinical psychopharmacology.

[81]  C. Thompson,et al.  Effect of Fluoxetine on Melatonin in Patients with Seasonal Affective Disorder and Matched Controls , 1995, British Journal of Psychiatry.

[82]  T. Crow,et al.  REDUCED NOCTURNAL MELATONIN SECRETION IN CHRONIC SCHIZOPHRENIA: RELATIONSHIP TO BODY WEIGHT , 1982, Clinical endocrinology.

[83]  R. Lam,et al.  L-Tryptophan Augmentation of Light Therapy in Patients with Seasonal Affective Disorder , 1997, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[84]  G. Vogel,et al.  Improvement of depression by REM sleep deprivation. New findings and a theory. , 1980, Archives of general psychiatry.

[85]  Anna Wirz-Justice,et al.  A human phase-response curve to light , 1991, Neuroscience Letters.

[86]  Trevor R. Norman,et al.  Overnight human plasma melatonin, Cortisol, prolactin, TSH, under conditions of normal sleep, sleep deprivation, and sleep recovery , 1996, Journal of pineal research.

[87]  H. Kraemer,et al.  REM phase deprivation and schizophrenia II. , 1975, Archives of General Psychiatry.

[88]  Daniel J Buysse,et al.  Sleep in late-life recurrent depression. Changes during early continuation therapy with nortriptyline. , 1991, Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology.

[89]  J. Wu,et al.  The biological basis of an antidepressant response to sleep deprivation and relapse: review and hypothesis. , 1990, The American journal of psychiatry.

[90]  J. Lönnqvist,et al.  Effects of bright light on sleepiness, melatonin, and 25-hydroxyvitamin D3in winter seasonal affective disorder , 1996, Biological Psychiatry.

[91]  T H Monk,et al.  Rhythmic vs homeostatic influences on mood, activation, and performance in young and old men. , 1992, Journal of gerontology.

[92]  George L. Brengelmann,et al.  Circadian temperature and cortisol rhythms during a constant routine are phase-delayed in hypersomnic winter depression , 1997, Biological Psychiatry.

[93]  M. Bauer Summertime bright-light treatment of bipolar major depressive episodes , 1993, Biological Psychiatry.

[94]  D. Kupfer,et al.  Sleep disturbance in acute schizophrenic patients. , 1970, The American journal of psychiatry.

[95]  J. Eagles The relationship between mood and daily hours of sunlight in rapid cycling bipolar illness , 1994, Biological Psychiatry.

[96]  D. Dijk,et al.  Effect of a single 3-hour exposure to bright light on core body temperature and sleep in humans , 1991, Neuroscience Letters.

[97]  E. Wolpert A Manual of Standardized Terminology, Techniques and Scoring System for Sleep Stages of Human Subjects. , 1969 .

[98]  P. Bräunig,et al.  Circadian rhythm of tryptophan, serotonin, melatonin, and pituitary hormones in schizophrenia , 1994, Biological Psychiatry.

[99]  M. Thase,et al.  Depression, sleep, and antidepressants. , 1998, The Journal of clinical psychiatry.

[100]  J. Amsterdam,et al.  Differences in nocturnal melatonin secretion between melancholic depressed patients and control subjects. , 1985, The American journal of psychiatry.

[101]  M. Candito,et al.  Circadian rhythms in depression and recovery: Evidence for blunted amplitude as the main chronobiological abnormality , 1989, Psychiatry Research.

[102]  Daniel J Buysse,et al.  Sleep stage physiology, mood, and vigilance responses to total sleep deprivation in healthy 80-year-olds and 20-year-olds. , 1990, Psychophysiology.

[103]  G. Vogel,et al.  Drug effects on REM sleep and on endogenous depression , 1990, Neuroscience & Biobehavioral Reviews.

[104]  C. Wood,et al.  Diurnal Changes in Perceptions of Energy and Mood , 1992, Journal of the Royal Society of Medicine.

[105]  T. Partonen Involvement of melatonin and serotonin in winter depression. , 1994, Medical hypotheses.

[106]  J. Waterhouse,et al.  The free-running circadian rhythms of two schizophrenics. , 1977, Chronobiologia.

[107]  R. Kronauer,et al.  Sensitivity of the Human Circadian Pacemaker to Moderately Bright Light , 1994, Journal of biological rhythms.

[108]  G. Winokur,et al.  Circadian analysis of plasma cortisol levels before and after dexamethasone administration in depressed patients. , 1984, Archives of General Psychiatry.

[109]  A. Wirz-Justice,et al.  A schizophrenic patient with an arrhythmic circadian rest-activity cycle , 1997, Psychiatry Research.

[110]  R. Ogilvie,et al.  Sleep onset: Normal and abnormal processes. , 1994 .

[111]  H. Klemfuss Rhythms and the pharmacology of lithium. , 1992, Pharmacology & therapeutics.

[112]  A. Borbély A two process model of sleep regulation. , 1982, Human neurobiology.

[113]  Anna Wirz-Justice,et al.  Sleep deprivation in depression: what do we know, where do we go? , 1999, Biological Psychiatry.

[114]  A. Wirz-Justice,et al.  Morning or night-time melatonin is ineffective in seasonal affective disorder. , 1990, Journal of psychiatric research.

[115]  D. Kupfer,et al.  Electroencephalographic sleep in schizophrenia: a critical review. , 1990, Comprehensive psychiatry.

[116]  S. Daan,et al.  Bright morning light advances the human circadian system without affecting NREM sleep homeostasis. , 1989, The American journal of physiology.

[117]  P. O’Brien,et al.  Exposure to bright light and darkness to treat physiologic maladaptation to night work , 1991 .

[118]  F. Wollnik Effects of chronic administration and withdrawal of antidepressant agents on circadian activity rhythms in rats , 1992, Pharmacology Biochemistry and Behavior.

[119]  J. Backhaus,et al.  How to preserve the antidepressive effect of sleep deprivation: A comparison of sleep phase advance and sleep phase delay , 1999, European Archives of Psychiatry and Clinical Neuroscience.

[120]  A. Jus,et al.  Sleep EEG studies in untreated, long-term schizophrenic patients. , 1973, Archives of general psychiatry.

[121]  W. Paulus,et al.  Parallel increase of heterochromatic increment threshold and postadaptation thresholds in Parkinson's disease and in neuroleptic treatment , 1997, Vision Research.

[122]  M. Berger,et al.  Sleep deprivation with consecutive sleep-phase advance therapy in patients with major depression: A pilot study , 1993, Biological Psychiatry.

[123]  S. Daan,et al.  Timing of human sleep: recovery process gated by a circadian pacemaker. , 1984, The American journal of physiology.

[124]  N. Kleitman,et al.  Effect of non-twenty-four-hour routines of living on oral temperature and heart rate. , 1953, Journal of applied physiology.

[125]  R. Berger,et al.  Performance and mood following variations in the length and timing of sleep. , 1973, Psychophysiology.

[126]  Sonia Ancoli-Israel,et al.  Actigraphic estimates of circadian rhythms and sleep/wake in older schizophrenia patients , 2001, Schizophrenia Research.

[127]  Fred W. Turek,et al.  Regulation of sleep and circadian rhythms , 1999 .

[128]  P. Linkowski,et al.  Circadian and sleep-related endocrine rhythms in schizophrenia. , 1991, Archives of general psychiatry.

[129]  D. Kupfer,et al.  Delta sleep deficits in schizophrenia: evidence from automated analyses of sleep data. , 1998, Archives of general psychiatry.

[130]  E. Leibenluft,et al.  Treatment of a Rapidly Cycling Bipolar Patient by Using Extended Bed Rest and Darkness to Stabilize the Timing and Duration of Sleep , 1998, Biological Psychiatry.

[131]  F. Goodwin,et al.  Seasonal affective disorder. A description of the syndrome and preliminary findings with light therapy. , 1984, Archives of general psychiatry.

[132]  H. Haug,et al.  Diurnal variations of mood in depressed patients in relation to severity of depression. , 1990, Journal of affective disorders.

[133]  G. Vogel A review of REM sleep deprivation. , 1975, Archives of general psychiatry.

[134]  P. Linkowski,et al.  Sleep EEG variables in young schizophrenic and depressive patients , 1988, Biological Psychiatry.

[135]  E. Leibenluft,et al.  Diurnal variation in the direction of mood switches in patients with rapid-cycling bipolar disorder. , 1997, The Journal of clinical psychiatry.

[136]  E. Leibenluft,et al.  Is sleep deprivation useful in the treatment of depression? , 1992, The American journal of psychiatry.

[137]  A. Wirz-Justice,et al.  Disturbed circadian rest-activity cycles in schizophrenia patients: an effect of drugs? , 2001, Schizophrenia bulletin.

[138]  A. Bouhuys Towards a model of mood responses to sleep deprivation in depressed patients , 1991, Biological Psychiatry.

[139]  T. Wehr,et al.  Improvement of depression and triggering of mania by sleep deprivation. , 1992, JAMA.

[140]  A. Wirz-Justice,et al.  Light therapy in seasonal affective disorder is independent of time of day or circadian phase. , 1993, Archives of general psychiatry.

[141]  T. Wehr,et al.  Disruption of the Activity–Rest Cycle by MAOI Treatment: Dependence on Light and a Secondary Visual Pathway to the Circadian Pacemaker , 1998, Brain Research Bulletin.

[142]  J. Nurnberger,et al.  Supersensitivity to light: possible trait marker for manic-depressive illness. , 1985, The American journal of psychiatry.

[143]  D. Kupfer,et al.  Reduced cortisol latency in depressive illness. , 1983, Archives of general psychiatry.

[144]  C. Pollak,et al.  Effects of phototherapy on non-seasonal unipolar and bipolar depressive spectrum disorders. , 1991, Journal of affective disorders.

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

[146]  W. Dement,et al.  Partial REM phase deprivation and schizophrenia. , 1968, Archives of general psychiatry.

[147]  G. Leonhardt,et al.  Sleep deprivation response in seasonal affective disorder during a 40-h constant routine. , 1998, Journal of affective disorders.

[148]  B. Tursky,et al.  All-night sleep studies of acute schizophrenics. , 1969, Archives of general psychiatry.

[149]  F. Holsboer,et al.  In quest of identifying vulnerability markers for psychiatric disorders by all-night polysomnography. , 1995, Archives of general psychiatry.

[150]  C. Ogura,et al.  Long-term observation of a manic-depressive patient with rapid cycles , 1991, Biological Psychiatry.