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What You Need to Know about Chronotherapy

Sometimes, even symptoms have their own schedule. This may be the obvious case in relation to sleep disorders, but even respiratory conditions like asthma have daily phases where the symptoms flare and wane in sync with your biological clock. This is due to your body’s circadian rhythm, which operates down to a cellular level. Certain symptoms can be alleviated or exacerbated in relation to what phase your body is in, especially in the context of your sleep and wake cycles.

Chronotherapy seeks to work with your body’s biological rhythms (chronobiology), to maximize benefit and minimize unwanted side effects. In general, the method strives to schedule treatments to take advantage of your body’s circadian rhythm, to deliver medication when it is most needed in the day to maximize its effectiveness. Its application spans across various fields, but has been proven an especially useful technique in the treatment of sleeping disorders and asthma.

Here is a look at how chronotherapy works, and how it can become a useful treatment tool for you.

How Does Chronotherapy Work?

To understand the principles of chronotherapy, you must first understand the basics of circadian rhythms. A circadian rhythm is any inherent biological process that follows a roughly 24-hour cycle, aligned with the 24 hours in the solar day. While the circadian rhythm is endogenous, or biologically wired, it also adjusts to the environment via external cues such as light and temperature. The circadian rhythm plays an essential evolutionary role in allowing your body to adapt to routine environmental changes, namely day and night, and therefore capitalize on valuable resources such as light and food.

Most of the systems in your body follow their respective biological clocks, which are regulated by a master circadian clock located in the brain called the suprachiasmatic nucleus (SCN). These circadian rhythms dictate your body’s metabolic processes, temperature regulation, hormone release, and most importantly your natural sleep-wake cycle. When your circadian rhythm is misaligned with normal waking hours, it can have disastrous social and medical repercussions. Abnormal circadian rhythms have been linked to sleeping disorders such as insomnia, as well as mental illnesses such as depression and bipolar disorder.

Chronotherapy is a technique which takes into account your body’s natural cycles, scheduling treatment to align with the onset of your symptoms. Asthma patients, for example, have symptoms that are generally worst in the early morning – when treatment would be taken for maximum impact. Chronotherapy, however, isn’t restricted to complying with your natural rhythm – it is also designed to alter it when your circadian rhythm is off. It is thus used as an effective sleep disorder treatment, for treating delayed sleep-phase syndrome and insomnia.

Chronotherapy for Sleeping Disorders

Delayed Sleep-Phase Syndrome (DSPS)  is a common condition where your natural sleep cycle is significantly delayed, preventing patients from sleeping at a reasonable time required to achieve adequate rest before the work day begins. A patient with DSPS, for example, might naturally sleep from 4 a.m. to 12 p.m., severely impairing his or her ability to perform a standard 9 to 5 job.

Since it is physically impossible for the patient to fall asleep earlier, a sleep phase chronotherapy regimen would have the patient delay bedtime by 3-hour increments, setting back each consecutive day until the desired sleep schedule is reached. Once this sleep schedule is achieved, it must be strictly and vigilantly maintained to prevent relapse.

While sleep phase chronotherapy has proven an effective treatment for most patients, it should be done under the guidance and supervision of a trained sleep specialist, ideally within a sleep center. There is potential risk: some DSPS patients who have attempted sleep phase chronotherapy actually had their conditions devolve into Non-24-hour Sleep-Wake Disorder (Non-24), which is much more difficult to cope with.

Non-24 patients have completely irregular sleep schedules which change daily, preventing them from keeping any kind of set schedule. DSPS patients, on the other hand, would have at least been able to hold a night job or similar set hours which worked for their personal sleep-wake cycle.

Chronotherapy for Asthma

Your respiratory function is affected by circadian rhythms, with your lungs at their worst performance in the early morning – this lapse is most pronounced in asthma patients. Chronotherapy, then, is directed at having your medication reach full effect to aid your lungs in these crucial hours.

Studies have found that certain bronchodilators taken near the evening (often after 3 p.m.) have ample time to fully infiltrate the body and reach peak performance during those difficult early morning hours. This is, in part, due to its effectiveness in alleviating nighttime asthma symptoms, which allows patients to get a good night’s rest, and paves the way for better lung function in the morning.

Schedule a Consultation with Dr. Shukla

Your body is complex, and deserves the nuanced understanding of a multitalented medical professional. Schedule a consultation with renowned pulmonologist Dr. Mayank Shukla at the Asthma Allergy Sleep Center of New York today. Dr. Shukla specializes in treating asthma, allergy, and sleep disorders, especially in pediatric patients, with an outstanding record of patient satisfaction and success.

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