Abstract |
Along with urbanization of the living environment, the number of patients with circadian rhythm sleep disorder ( CRSD) has been increasing. There are several treatment candidates for CRSD, such as light therapy, drugs ( melatonin and vitamin B12), and sleep hygiene education. However, successful treatment method has not been established. In free-running type (FRT) CRSD, the endogenous circadian rhythm cannot be entrained to the 24-h light-dark cycle, resulting in free running on a cycle 0.5-2.5 h longer than the 24-h period. This condition is relatively common in blind individuals and is unusual in sighted individuals. Here we report two sighted patients with FRT, successfully treated with a melatonin receptor agonist, ramelteon. Patient 1 (36-year-old female) had suffered from FRT for nearly 4 months after resigning her job. She was given sleep hygiene education together with ramelteon at first and the free-running cycle stopped after treatment day 15. Triazolam was added from the day 25 to promote earlier sleep onset. And the sleep-wake schedule was normalized by the day 34. Patient 2 (33-year-old male) had suffered from FRT for nearly 8 months after starting to take a leave of absence from his job. He was given sleep hygiene education and was treated with ramelteon and methylcobalamin. His sleep-wake schedule was normalized from the first treatment day. By the combined treatment with ramelteon, both patients have maintained favorable sleep-wake schedules. The agonist action of ramelteon at the melatonin 2 receptor may have primarily contributed to the cessation of the free-running cycle in these patients.
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Authors | Mariko Yanagihara, Masaki Nakamura, Akira Usui, Shingo Nishida, Eiki Ito, Masako Okawa, Yuichi Inoue |
Journal | The Tohoku journal of experimental medicine
(Tohoku J Exp Med)
Vol. 234
Issue 2
Pg. 123-8
(10 2014)
ISSN: 1349-3329 [Electronic] Japan |
PMID | 25253260
(Publication Type: Case Reports, Journal Article)
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Chemical References |
- Indenes
- Receptors, Melatonin
- Triazolam
- ramelteon
- mecobalamin
- Vitamin B 12
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Topics |
- Adult
- Circadian Rhythm
- Drug Therapy, Combination
- Female
- Humans
- Indenes
(administration & dosage)
- Male
- Receptors, Melatonin
(agonists)
- Sleep
- Sleep Disorders, Circadian Rhythm
- Treatment Outcome
- Triazolam
(administration & dosage)
- Vitamin B 12
(administration & dosage, analogs & derivatives)
- Wakefulness
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