It has long been known that a person’s internal biological clock regulates sleep and the functioning of all body systems. They synchronize with the light-dark cycle and are regulated by a special protein that accumulates at night and is used up during the day. When the phase of biological rhythms shifts, a person becomes hostage to disruption of circadian rhythms. Experiences a constant need to get a dose of sleep during the day and sleeps poorly at night. This condition leads to difficulties in living at a normal pace of life, decreased concentration, and requires urgent treatment from a somnologist.
What is circadian rhythm
Almost every cell of the human body is involved in biological processes that repeat cyclically throughout the day. Under the influence of special proteins, there is a timely activation of the synthesis of hormones for falling asleep, and an increase in blood pressure for awakening. It has been proven that appetite and brain activity depend on circadian rhythms.
The intensity of biological processes is affected by the duration of daylight and darkness. Information about the change of day and night is processed by a special part of the brain, receiving a signal through the retina. Today it is known that not only external factors are responsible for biorhythms. There is a section of DNA in the body that controls the human biological clock.
The circadian system is individual - everyone has their own time of falling asleep and waking up. When the “genetic clock” fails, the body adapts to new conditions. As a result, disorders arise that cause sleep disturbances, deterioration of well-being and a high risk of developing diseases.
Forecast
It is impossible to say with certainty how the condition of a person suffering due to circadian index disorders will change. The complexity of treatment and the time required for recovery depend on the diagnosis. The stage of the disease also influences the duration of therapy. If it is detected at an early stage of development and does not have time to cause significant complications, a complete cure is possible.
Sometimes QI disorders occur due to chronic pathologies. Their symptoms can be relieved, significantly improving the patient’s quality of life. However, systematic taking of prescribed medications may be required. In some cases, sudden cardiac arrest is possible. A sign of irreversible disorders is the circadian index below 110%. In this case, the drugs prolong life, but do not guarantee a complete cure or stabilization of the patient’s condition. Only the attending physician can give the exact timing, based on the test data. There are factors that worsen the outcome with decreased or increased CI:
- presence of hereditary diseases;
- concomitant pathologies, in particular endocrine and neurological;
- age over 50 years;
- the need for surgery if the person is weakened and may not tolerate surgery;
- lack of results from taking prescribed medications.
How does jet lag manifest itself?
The main symptom of circadian disorders is a person's inability to fall asleep or wake up at a certain time. Lack of sleep leads to:
- to inattention;
- increased daytime sleepiness;
- lack of clarity of thinking;
- difficulty performing usual activities during the day;
- irritability, aggression;
- chronic fatigue, depression.
Sleep disturbances are accompanied by attacks of nausea and general malaise. Failure of biological rhythms threatens deterioration of heart function and the appearance of metabolic disorders.
Very often, in order to stay awake or, conversely, fall asleep, patients uncontrollably use sleeping pills and alcohol. But this behavior only makes the situation worse. If such signs appear, there is no need to try to cope with the problem on your own; it is correct to contact a specialist at a sleep medicine clinic.
Treatment
Treatment of the underlying pathological process is carried out. The circadian index should not be specifically normalized. Yes, and there is no such possibility. Contractility needs to be increased.
Treatment is mainly conservative, with the use of medications to relieve symptoms and combat the etiological factor. Both problems are solved at once.
What drugs are prescribed:
- Antiarrhythmic. Amiodarone or Quinidine. To restore normal heart rate and intervals between contractions. Used in short courses, it is not used on an ongoing basis due to the significant danger and mass of side effects.
- Antihypertensive. As needed. ACE inhibitors, calcium antagonists, centrally acting agents, diuretics with a mild, potassium-sparing effect. The names are selected by the doctor. With illiterate therapy, rapid development of heart failure and death of the patient in the short term is possible.
- Beta blockers. They help lower blood pressure and stop tachycardia. Increased frequency also occurs, but less frequently. If the normal functioning of the heart is disrupted, such as bradycardia, they are never prescribed.
- Cardiac glycosides. If there are no symptoms of coronary insufficiency, ischemia of cardiac structures.
If necessary, statins are also indicated to dissolve cholesterol plaques and eliminate excess low-density lipids. Antiplatelet agents, special agents for normalizing the rheological properties of blood and preventing the formation of blood clots.
The operation is prescribed in extreme cases, strictly according to indications. These are considered to be heart defects. Congenital and acquired. Aortic, mitral, tricuspid valves, the vessels themselves, during the formation of aneurysms and other conditions.
Up to the destruction of chambers, for prosthetics or mechanical expansion of arteries (stenting, ballooning), creating bypass paths of blood flow (bypass surgery).
Radiofrequency ablation is possible for blockades of the conduction system (cauterization of an excessively active area).
The choice of the optimal direction of therapy is decided at the discretion of the doctor. The patient is instructed to limit himself for the rest of his life. But these are reasonable limits that will not cause much discomfort.
Quit smoking, alcohol, no drugs, no anti-inflammatory drugs without a doctor’s prescription, less fatty and fried foods in the diet. Get adequate sleep and at least minimal physical activity.
This is quite enough. Not a high price to pay for health, and possibly life.
Types of violations
There are several types of disorders:
| Variety | Peculiarities |
| Jet lag syndrome | Appears when fast moving across 2 or more time zones. According to the observations of somnologists, a person’s transfer to an earlier time is worse tolerated than a few hours ahead. |
| Distress related to changes in work schedule | A forced change in daily routine leads to disruption of the circadian rhythm. |
| Sleep phase delay syndrome | With this disorder, patients regularly fall asleep and wake up at late hours, and a steady shift in sleep phase is observed. |
| Phase advance sleep | This is the name of the condition when the biological clock is “in a hurry.” A person goes to bed early and gets up early, but he cannot change his wakefulness on his own. |
| Non-circadian sleep-wake cycle mode | Characterized by a daily change in the cycle by 1-2 hours, it is observed in blind people. |
Norms and calculation formula
The formula for obtaining the circadian index in adults is calculated simply: you need to take the average heart rate in the period from 6 to 22 hours and divide it by the heart rate level in the period from 22 to 6.00. The resulting number will be the desired one.
The circadian index norm is determined in the form of a decimal coefficient. An adequate value is in the range from 1.2 to 1.4, plus or minus 0.3.
- The growth of the conditional level is considered not such a dangerous indicator. Occurs in athletes and people of physical labor. Less often for pathogenic reasons.
- A decrease in numbers is the result of pathology of the cardiovascular system. The rate of fall directly correlates with the likelihood of death. It is considered an important prognostic point.
It is possible to carry out repeated daily monitoring and, accordingly, calculate the circadian index. The frequency of changes depends on the likely pathological process.
The classic scheme is a study before the start of treatment, during, approximately a week after the start of therapy, and after the course. This will allow you to see the picture in dynamics and evaluate the effectiveness of the measures.
The norm as a percentage is rarely calculated, because the level is difficult to perceive and is not widely used in medical practice. Standard values are from 120 to 140%, perhaps a little higher, but not lower.
Causes of Circadian Rhythm Disorder
A shift in the rhythm of the biological clock in relation to the light-dark cycle is provoked by internal and external factors. The latter include:
- moving across several time zones (air travel from West to East);
- permanent work with irregular work schedule;
- lack of a routine when a person falls asleep and wakes up at different times;
- long bed rest;
- total visual impairment;
- taking medications.
Sleep disorders are often observed in hospitalized patients with frequent periods of wakefulness at night.
Pathological causes of failure of the circadian system:
- brain damage after injury, stroke;
- Alzheimer's disease, Parkinson's disease;
- encephalitis, meningitis;
- mutation of the circadian clock gene CRY 1;
- age-related changes.
Hereditary predisposition plays a major role when a person’s individual “genetic clock” is “fast” or “lagging behind.”
Prospects for further research
With its growing reputation as an effective marker of recovery status and a likely marker of illness and injury, future research should be directed toward elucidating the true potential of HRV. This means that future research should explore:
- relationship between HRV and diseases
- relationship between HRV and trauma
- strength and power training based on HRV
- acute and chronic effects of HRV monitoring on performance
- reliability of HRV for children
- How accurately does HRV reflect recovery status in various athletic populations (endurance, strength/power, group sports athletes) and various other populations (men, women, geriatric and pediatric).
How are circadian disorders treated?
Our center’s somnologists have extensive experience in correcting circadian rhythms, including managing non-standard cases of the disease. The list of therapeutic measures in most cases is individual.
Basic therapy includes:
- Phototherapy with sunlight. This is not always associated with exposure to the sun; fluorescent lamps are also used to correct the circadian system. When you need to stay awake, experts recommend being in bright light. Before falling asleep, carefully darken the room, curtain the windows with thick curtains, and put on glasses with dark lenses before going to bed.
- Regularly performing a set of simple physical exercises helps set your internal biological clock.
- The synchronization of biorhythms with the daily period is affected by food intake. Therefore, it is important to establish a proper diet. Most of the diet is recommended to be consumed in the morning and afternoon. In the evening, the serving size is reduced.
- If, after changes in behavior, symptoms of circadian rhythm disorder persist, the somnologist prescribes drug therapy. The effective dosage, frequency and duration of use of the drug is determined by the doctor, taking into account concomitant diseases.
During the elimination of circadian disorders, patients at the South Clinic are under the close supervision of a competent specialist who promptly assesses changes and, if necessary, adjusts prescriptions.
