Chapter Eleven - Sleep and Circadian Rhythm Disruption in Social Jetlag and Mental Illness
Section snippets
The Biology of Sleep
Sleep is a highly complex behavior arising from an interaction between multiple neural circuits, neurotransmitters, and hormones, none of which are exclusive to the generation of sleep.1 The major brain structures and neurotransmitter systems involved in the sleep/wake cycle are summarized in Fig. 11.1.
The sleep systems illustrated in Fig. 11.1 are controlled by three key drivers that interact and collectively determine the duration, quality, and efficiency of sleep. Two of these drivers are
Sleep and Circadian Rhythm Disruption Arising from Social Timing
As described above, efficient sleep depends upon complex biological drivers in the form of the circadian system and the homeostatic hourglass oscillator (Fig. 11.2). In real life, however, an additional critical factor—social timing—influences sleep opportunities and thereby sleep duration, quality, and efficiency, potentially resulting in sleep and circadian rhythm disruption (SCRD). A large database (≈ 150,000 entries) has been established on sleep-activity behavior in the general population2
SCRD and Psychoses
SCRD is a common comorbidity in numerous psychiatric disorders.1 The greatest focus has been on mood disorders, especially unipolar and seasonal affective subtypes, yet SCRD is also prominent in the more severe, psychotic disorders such as schizophrenia.19, 20, 21 The relationship between schizophrenia and abnormal sleep was first described in the late nineteenth century by the German psychiatrist Emil Kraepelin.22 Today, SCRD is reported in 30–80% of patients with schizophrenia and is
A Conceptual Framework for SCRD in Psychiatric Illness
The association of mental illness and SCRD has until recently been considered to arise from exogenous factors including social isolation, antipsychotic medication, and/or activation of the stress axis.1 Such a linear relationship between psychosis and SCRD is illustrated in Fig. 11.7A. Some recent studies20 have addressed this hypothesis by examining SCRD in patients with schizophrenia and unemployed control subjects (Fig. 11.6) and showed that severe SCRD exists in schizophrenia and persists
Conclusions
In this chapter, we have considered the exogenous and endogenous origins of SCRD with reference to social time and mental illness. The association between SCRD and mental illness is well recognized, but the causes, correlates, and effects of SCRD in mental illness have been poorly understood and its treatment often neglected. Recent advances in our appreciation of the endogenous mechanisms that generate sleep and circadian rhythms, and in the emerging understanding of the neurobiology of
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