International Expert Opinions and Recommendations on the Use of Melatonin in the Treatment of Insomnia and Circadian Sleep Disturbances in Adult Neuropsychiatric Disorders

Introduction: Insomnia and circadian rhythm disorders, such as the delayed sleep phase syndrome, are frequent in psychiatric disorders and their evaluation and management in early stages should be a priority. The aim of this paper was to express recommendations on the use of exogenous melatonin, which exhibits both chronobiotic and sleep-promoting actions, for the treatment of these sleep disturbances in psychiatric disorders. Methods: To this aim, we conducted a systematic review according to PRISMA on the use of melatonin for the treatment of insomnia and circadian sleep disorders in neuropsychiatry. We expressed recommendations for the use of melatonin in psychiatric clinical practice for each disorder using the RAND/UCLA appropriateness method. Results: We selected 41 studies, which included mood disorders, schizophrenia, substance use disorders, attention deficit hyperactivity disorders, autism spectrum disorders, neurocognitive disorders, and delirium; no studies were found for both anxiety and eating disorders. Conclusion: The administration of prolonged release melatonin at 2–10 mg, 1–2 h before bedtime, might be used in the treatment of insomnia symptoms or comorbid insomnia in mood disorders, schizophrenia, in adults with autism spectrum disorders, neurocognitive disorders and during sedative-hypnotics discontinuation. Immediate release melatonin at <1 mg might be useful in the treatment of circadian sleep disturbances of neuropsychiatric disorders

Les rapports complexes de l’adolescent avec son sommeil (habitudes de sommeil, utilisation des nouveaux médias, répercussion sur l’activité du lendemain)

À l’adolescence, le sommeil se modifie physiologiquement et biologiquement. C’est à cette période de vie que la personnalité se construit et que les apprentissages se mettent en place. Or se développent de nouveaux comportements de sommeil de l’adolescent. La diminution du temps de sommeil en semaine et un décalage horaire le week-end participent à la degradation du sommeil de l’adolescent. L’utilisation des nouveaux médias sociaux joue un rôle néfaste, avec une correlation négative forte entre le temps passé et le temps de sommeil. La privation de sommeil chez l’adolescent a des conséquences bien identifiées comme la fatigue diurne, le manque d’attention, plus d’anxiété, la mauvaise estime de soi, et aussi des risques d’obésité et de dépression. Le sommeil des adolescents est un veritable enjeu de santé publique

Complex relationships between adolescents and their sleep (sleep patterns, use of new media, and impact on next day’s activity)

During adolescence, sleep changes physiologically and biologically. It is during this period of life that development and learning takes place. However, new teenager sleep behaviors appear. A decrease in weekly sleep time and a jet lag during weekends contribute to the deterioration of teenager’s sleep. The use of new social media plays a detrimental role, with a strong negative correlation between time spent on those and sleep time. Teenagers suffering from sleep deprivation develop well-identified consequences such as diurnal fatigue, lack of attention, more anxiety, poor self-esteem, and also an increased risk of obesity and depression. Teenage sleep is a real public health issue

Comment caractériser et traiter les plaintes de sommeil dans les troubles bipolaires ?

International audienceObjectivesSleep complaints are very common in bipolar disorders (BD) both during acute phases (manic and depressive episodes) and remission (about 80 % of patients with remitted BD have poor sleep quality). Sleep complaints during remission are of particular importance since they are associated with more mood relapses and worse outcomes. In this context, this review discusses the characterization and treatment of sleep complaints in BD.MethodsWe examined the international scientific literature in June 2016 and performed a literature search with PubMed electronic database using the following headings: “bipolar disorder” and (“sleep” or “insomnia” or “hypersomnia” or “circadian” or “apnoea” or “apnea” or “restless legs”).ResultsPatients with BD suffer from sleep and circadian rhythm abnormalities during major depressive episodes (insomnia or hypersomnia, nightmares, nocturnal and/or early awakenings, non-restorative sleep) and manic episodes (insomnia, decreased need for sleep without fatigue), but also some of these abnormalities may persist during remission. These remission phases are characterized by a reduced quality and quantity of sleep, with a longer sleep duration, increased sleep latency, a lengthening of the wake time after sleep onset (WASO), a decrease of sleep efficiency, and greater variability in sleep/wake rhythms. Patients also present frequent sleep comorbidities: chronic insomnia, sleepiness, sleep phase delay syndrome, obstructive sleep apnea/hypopnea syndrome (OSAHS), and restless legs syndrome (RLS). These disorders are insufficiently diagnosed and treated whereas they are associated with mood relapses, treatment resistance, affect cognitive global functioning, reduce the quality of life, and contribute to weight gain or metabolic syndrome. Sleep and circadian rhythm abnormalities have been also associated with suicidal behaviors. Therefore, a clinical exploration with characterization of these abnormalities and disorders is essential. This exploration should be helped by questionnaires and documented on sleep diaries or even actimetric objective measures. Explorations such as ventilatory polygraphy, polysomnography or a more comprehensive assessment in a sleep laboratory may be required to complete the diagnostic assessment. Treatments obviously depend on the cause identified through assessment procedures. Treatment of chronic insomnia is primarily based on non-drug techniques (by restructuring behavior and sleep patterns), on psychotherapy (cognitive behavioral therapy for insomnia [CBT-I]; relaxation; interpersonal and social rhythm therapy [IPSRT]; etc.), and if necessary with hypnotics during less than four weeks. Specific treatments are needed in phase delay syndrome, OSAHS, or other more rare sleep disorders.ConclusionsBD are defined by several sleep and circadian rhythm abnormalities during all phases of the disorder. These abnormalities and disorders, especially during remitted phases, should be characterized and diagnosed to reduce mood relapses, treatment resistance and improve BD outcomes.ObjectifsCette revue propose une synthèse sur la caractérisation et le traitement des plaintes de sommeil dans les troubles bipolaires (TB).MéthodesUne recherche de la littérature scientifique a été effectuée en juin 2016 sur PubMed à l’aide d’une équation de recherche suivante : « bipolar disorder » and (« sleep » or « insomnia » or « hypersomnia » or « circadian » or « apnea » or « restless legs »).RésultatsLes TB présentent des perturbations du sommeil et des rythmes circadiens durant les épisodes aigus mais également au cours des phases de rémission marquées par des anomalies de la qualité et de la quantité du sommeil, et une plus grande variabilité des rythmes veille/sommeil. Ces patients souffrent très fréquemment de troubles du sommeil comorbides : insomnie chronique, hypersomnolence, retard de phase, syndrome d’apnées-hypopnées obstructives du sommeil (SAHOS), et syndrome des jambes sans repos. Ces troubles favorisent les rechutes thymiques, altèrent le fonctionnement cognitif, diminuent la qualité de vie, favorisent une prise de poids et l’apparition d’un syndrome métabolique. Une exploration clinique avec caractérisation de ces troubles est donc indispensable, aidée par des questionnaires, et documentée sur des agendas du sommeil voire des mesures objectives actimétriques. Un bilan plus complet en laboratoire du sommeil peut être nécessaire. Les traitements associés dépendent de la cause. Le traitement de l’insomnie chronique s’appuie sur des techniques non médicamenteuses (restructuration des comportements et rythmes du sommeil), la psychothérapie, et si besoin sur les hypnotiques. Des traitements spécifiques seront proposés dans le syndrome de retard de phase, le SAHOS, ou les autres troubles du sommeil plus rares

Les effets de confinement SARS-CoV-2 sur le sommeil : enquête en ligne au cours de la quatrième semaine de confinement

International audienc