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Abstract
Irregular Sleep Wake Rhythm Disorder (ISWRD) is characterized by the relative absence
of a circadian pattern in an individual's sleep-wake cycle. Significant changes in
circadian regulation occur with aging and with neurodegenerative diseases, such as
Alzheimer's disease prevalent in older adults, which are likely to contribute to the
prevalence of ISWRD seen in these populations, although ISWRD is also seen in traumatic
brain injury and mental retardation populations. ISWRD is thought to result from some
combination of; degeneration or decreased neuronal activity of suprachiasmatic nucleus
(SCN) neurons, decreased responsiveness of the circadian clock to entraining agents
such as light and activity, and decreased exposure to bright light and structured
social and physical activity during the day. Treatment of ISWRD seeks to consolidate
sleep during the night and wakefulness during the day; primarily through restoring
or enhancing exposure to the various SCN time cues, or "zeitgebers". Studies of the
effectiveness of pharmacologic treatments for ISWRD have generally yielded negative
or inconsistent results. In general multi-modal non-pharmacological approaches involving
increased exposure to light, increased physical and social activities and improved
sleep hygiene have been the most successful therapeutic approaches.