2018 issue 2


Volume 34, issue 2

Review article

Pharmacotherapy of circadian rhythm sleep-wake disorders

Michał Dermanowski1, Adam Wichniak2, Julita Kuczyńska1, Alicja Zakrzewska1, Marcin Wojnar1
1. Zakład Farmakologii i Fizjologii Układu Nerwowego, Instytut Psychiatrii i Neurologii w Warszawie
2. III Klinika Psychiatryczna, Instytut Psychiatrii i Neurologii w Warszawie
Farmakoterapia w Psychiatrii i Neurologii 2018, 34 (2), 109–118
Date of publication: 04-09-2018
DOI: http://dx.medra.org/10.17393/fpn.2018.08.001
Keywords: melatonin, insomnia, hypnotics, circadian rhythm disorders, chronobiotics


Circadian rhythm sleep-wake disorders are characterized by an incorrect regulation of sleep and wakefulness, and a lack of synchronization with the 24-hours rhythm. Circadian rhythm sleep-wake disorders are an increasing civilizational problem related to both the aging of the population, as old people suffer from the deregulation of homeostatic processes, as well as exposure to artificial environmental conditions such as night lighting, reduced exposure to sunlight, and limited physical activity.

The increasing knowledge about the mechanisms regulating the circadian rhythm allows for individualized diagnostics and therapy for people with sleep problems. Our centre specializes in this field by offering innovative diagnostic and therapeutic methods based on objective biological markers, including polysomnography, actigraphy, and the monitoring of melatonin concentrations in saliva.

The aim of this article is to discuss the mechanisms of circadian rhythm regulation, as well as the diagnostic possibilities, and review the drugs available for use in the treatment of circadian rhythm sleep-wake disorders.

Particular attention is paid to the discussion of chronobiotics: this involves melatonin, which is a natural synchronizer of sleep and wakefulness, as well as synthetic drugs such as Ramelteon, Tasimelteon, Agomelatine, which are agonists of melatonin receptors. Symptomatic treatment also includes sleep-promoting drugs, such as benzodiazepines and non-benzodiazepines (“Z-drugs”), antihistamines and, recently introduced to treatment but not available in Poland, suvorexant, an OX1 and OX2 orexin receptor antagonist.

Address for correspondence:
Paweł Mierzejewski
Zakład Farmakologii i Fizjologii Układu Nerwowego, Instytut Psychiatrii i Neurologii w Warszawie
ul. Sobieskiego 9, 02-957 Warszawa, Poland
email: mierzeje@ipin.edu.pl