睡眠・覚醒リズムの持続性障害と心身医学(生体リズムと心身症第30回日本心身医学会総会)

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"The diagnostic classification of sleep and arousal disorders" was proposed as a new sleep disorders nosology by the Association of Sleep Disorders Centers and the Association of the Psychophysiological Study of Sleep in the North America 1979. It has been commonly used for the research of sleep disorders and for the coding of diagnosis in the clinical practice, and has the succeeding four major clusters of disorders within the classification system : Insomnias, Hypersomnias, Sleep-Wake Schedule Disorders and Parasomnias. Sleep-wake schedule disorders such as the delayed sleep phase syndrome (DSPS) and the non-24-hour sleep-wake syndrome (hypernychthemeral syndrome) have been described as new types of sleep-wake disorders in the last decade. It has also been reported that nondrug "chronotherapy" can reset the circadian clocks of patients with DSPS and that the administration of vitamin B_<12> : a was effective in maintaining the circadian rhythms of patients with hypernychthemeral syndrome. We treated 11 patients (8 adults; 3 adolescents) of DSPS with chronotherapy which could reset the circadian clocks of all of the patients, but it is not so easy to maintain the reset rhythm without any other therapy. We tried to maintain the circadian rhythm after resetting with pharmacotherapy using some agents such as triazolam and methylphenidate, considered to advance the biological rhythm. DSPS patients had some characteristics of behavior and personality. All of them were extreme "evening" individuals from their early childhood prior to chronotherapy. Although clinical observations have failed to relate this specific insomnia to psychiatric diagnocis, some specific personality traits were confirmed by the study using Rorschach test. A 17-year-old high school student with hypernychthemeral syndrome complained of not being able to attend school was treated with vitamin B_<12> 3000 μg per day. His γ before administra-tion of the drug was 24.6 hours and it was reset to 24.02 hours after treatment, computed by a periodogram. Every period when a gradual delay reappeared in his sleep-wake cycle, phototherapy of 2500 lux or more was added in the early morning. The patient reported a slightly depressive mood during phototherapy. After the administration of Vitamin B_<12> the patient's body temperature cycle became more regular and more distinct than before treatment. This patient was finally able to return to his classes after a year's absence. All the psychosomatic symptoms such as headache, headheaviness, appetiteloss, gastrointestinal discomfort, general fatigue, ruminative thinking, attention deficit, etc. disappeared or ex-tremely reduced after resetting the circadian clocks in every case of these sleep-wake schedule disorders. The investigation of relationships between psychological and chronobiological aspects of the sleep-wake disorders may be an important subject in psychosomatic medicine.
日本心身医学会の論文
1990-04-01

睡眠・覚醒リズムの持続性障害と心身医学(生体リズムと心身症第30回日本心身医学会総会)

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