Circadian Interventions as Adjunctive Therapies to Cognitive-Behavioral Therapy for Insomnia

Disease Conditions

Since clock genes are involved in all physiological systems, their role in most disease conditions is not surprising. To complement the information reviewed in Part II for each physiological system considered separately, this chapter illustrates the interdigitating network of interactions taking place within multiple physiological systems in any given disease condition. Circadian disruption, a common factor in disease, is almost inseparable from disturbed sleep, which is present in conditions ranging from psychological to cardio-metabolic and neurodegenerative conditions. Sleep disruption also modifies the immune system. Herein, we highlight the pervasive role played by the circadian system in pathology based on a few examples of selected disease conditions, including some sleep disorders, mental disorders, neurodegenerative conditions, and cancer.

Effects of BXSMD on ESR1 and ESR2 expression in CSD female mice

ETHNIC PHARMACOLOGICAL RELEVANCE

Due to the rapid pace of modern society, chronic insomnia has become universal phenomenon. In China, Banxia Shumi Decoction (BXSMD) has been used in treating chronic insomnia for thousands of years, but its chemical composition and action mechanism are still unknown.

AIM OF THE STUDY

This study aims to explore the chemical composition of BXSMD and its effects on Estrogen receptor 1 (ESR1) and Estrogen receptor 2 (ESR2) in mice with chronic sleep deprivation (CSD).

MATERIALS AND METHODS

UHPLC-Q-Orbitrap-MS/MS was applied in determining the chemical composition of BXSMD. After 21-day sleep deprivation (SD) in platform water environment, CSD mice model was prepared. By conducting open field test, 24-h autonomic diurnal and nocturnal activity of mice in each group was detected. ELISA was employed to measure the contents of 5-HT, DA, NE, GABA, Glu, and MT. With RT-PCR, Western blot (WB), and immunohistochemistry (IHC), mRNA and protein expressions of ESR1 and ESR2 in the hypothalamus and hippocampus were tested.

RESULTS

BXSMD included ferulic acid, kaverol, daidzein, apigenin, berberine, adenosine, aesculin, vanillin, naringin, and glycine, which might constitute the material basis forthe improvement of chronic insomnia. With BXSMD, the total moving distance and the rest time in dark period of CSD mice were shortened, while its rest time in light period was increased. Besides, BXSMD enhanced the contents of 5-HT, GABA, and MT in CSD mice, and decreased the contents of Glu, NE, and DA. BXSMD elevated the mRNA of Esr1 and Esr2, and elevated the protein expressions of ESR1 and ESR2 in the hypothalamus and hippocampus of CSD mice.

CONCLUSIONS

BXSMD contains various chemical components for sleep-wake regulation, with the mechanism of stimulating estrogen signaling pathway by regulating the expressions of ESR1 and ESR2, ultimately realizing the regulation to sleep-wake disorder caused by CSD.

Circadian aspects in the aetiology and pathophysiology of insomnia

Because the endogenous circadian pacemaker is a very strong determinant of alertness/sleep propensity across the 24 h period, its mistiming may contribute to symptoms of insomnia (e.g., difficulties initiating sleep and maintaining sleep) and to the development of insomnia disorder. Despite the separation of insomnia and circadian rhythm disorders in diagnostic nosology implying independent pathophysiology, there is considerable evidence of co-morbidity and interaction between them. Sleep onset insomnia is associated with later timed circadian rhythms and can be treated with morning bright light to shift rhythms to an earlier timing. It is also possible that the causal link may go in both directions and that having a delayed circadian rhythm can result in enough experiences of delayed sleep onset to lead to some conditioned insomnia or insomnia disorder further exacerbating a delayed circadian rhythm. Early morning awakening insomnia is associated with an advanced circadian phase (early timing) and can be treated with evening bright light resulting in a delay of rhythms and an improved ability to sleep later in the morning and to obtain more sleep. There is some evidence suggesting that sleep maintenance insomnia is associated with a blunted amplitude of circadian rhythm that may be treated with increased regularity of sleep and light exposure timing. However, this is an insomnia phenotype that requires considerably more circadian research as well as further insomnia clinical research with the other insomnia phenotypes incorporating circadian timing measures and treatments.

Heatwaves and human sleep: Stress response versus adaptation

The World Meteorological Organization considers a heatwave as "a period of statistically unusual hot weather persisting for a number of days and nights". Accompanying the ongoing global climate change, sharp heatwave bouts occur worldwide, growing in frequency and intensity, and beginning earlier in the season. Heatwaves exacerbate the risk of heat-related illnesses, hence human morbidity and mortality, particularly in vulnerable elderly and children. Heat-related illnesses present a continuum from normothermic (prickly heat, heat edema, heat cramps, heat tetany) to hyperthermic syndromes (from heat syncope and heat exhaustion to lethal heat stroke). Heat stroke may occur through passive heating and/or exertional exercise. "Normal sleep", such as observed in temperate conditions, is altered during heatwaves. Brisk excessive heat bouts shorten and fragment human sleep. Particularly, deep N3 sleep (formerly slow-wave sleep) and REM sleep are depleted, such as in other stressful situations. The resultant sleep loss is deleterious to cognitive performance, emotional brain function, behavior, and susceptibility to chronic health conditions and infectious diseases. Our group has previously demonstrated that sleep constitutes an adaptive mechanism during climatic heat acclimatization. In parallel, artificial heat acclimation procedures have been proposed in sports and military activities, and for the elderly. Other preventive actions should be considered, such as education and urban heat island cooling (vegetation, white paint), thus avoiding energy-hungry air conditioning.