Regulation of circadian period in humans was thought to differ from that of other species, with the period of the activity rhythm reported to range from 13 to 65 hours (median 25.2 hours) and the period of the body temperature rhythm reported to average 25 hours in adulthood, and to shorten with age. However, those observations were based on studies of humans exposed to light levels sufficient to confound circadian period estimation. Precise estimation of the periods of the endogenous circadian rhythms of melatonin, core body temperature, and cortisol in healthy young and older individuals living in carefully controlled lighting conditions has now revealed that the intrinsic period of the human circadian pacemaker averages 24.18 hours in both age groups, with a tight distribution consistent with other species. These findings have important implications for understanding the pathophysiology of disrupted sleep in older people.

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Stability, Precision, and Near-24-Hour Period of the Human Circadian Pacemaker

The circadian rhythm of pineal melatonin is the best marker of internal time under low ambient light levels. The endogenous melatonin rhythm exhibits a close association with the endogenous circadian component of the sleep propensity rhythm. This has led to the idea that melatonin is an internal sleep ‘facilitator’ in humans, and therefore useful in the treatment of insomnia and the readjustment of circadian rhythms. There is evidence that administration of melatonin is able: (i) to induce sleep when the homeostatic drive to sleep is insufficient; (ii) to inhibit the drive for wakefulness emanating from the circadian pacemaker; and (iii) induce phase shifts in the circadian clock such that the circadian phase of increased sleep propensity occurs at a new, desired time. Therefore, exogenous melatonin can act as soporific agent, a chronohypnotic, and/or a chronobiotic. We describe the role of melatonin in the regulation of sleep, and the use of exogenous melatonin to treat sleep or circadian rhythm disorders.

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Role of Melatonin in the Regulation of Human Circadian Rhythms and Sleep

Melatonin as a chronobiotic.

Melatonin signals time of day and time of year in mammals by virtue of its pattern of secretion, which defines 'biological night.' It is supremely important for research on the physiology and pathology of the human biological clock. Light suppresses melatonin secretion at night using pathways involved in circadian photoreception. The melatonin rhythm (as evidenced by its profile in plasma, saliva, or its major metabolite, 6-sulphatoxymelatonin [aMT6s] in urine) is the best peripheral index of the timing of the human circadian pacemaker. Light suppression and phase-shifting of the melatonin 24 h profile enables the characterization of human circadian photoreception, and circulating concentrations of the hormone are used to investigate the general properties of the human circadian system in health and disease. Suppression of melatonin by light at night has been invoked as a possible influence on major disease risk as there is increasing evidence for its oncostatic effects. Exogenous melatonin acts as a 'chronobiotic.' Acutely, it increases sleep propensity during 'biological day.' These properties have led to successful treatments for serveal circadian rhythm disorders. Endogenous melatonin acts to reinforce the functioning of the human circadian system, probably in many ways. The future holds much promise for melatonin as a research tool and as a therapy for various conditions.

Melatonin and Human Rhythms

Melatonin, the chief secretory product of the pineal gland, is a direct free radical scavenger, an indirect antioxidant, as well as an important immunomodulatory agent. In both in vitro and in vivo investigations, melatonin protected healthy cells from radiation-induced and chemotherapeutic drug-induced toxicity. Furthermore, several clinical studies have demonstrated the potential of melatonin, either alone or in combination with traditional therapy, to yield a favorable efficacy to toxicity ratio in the treatment of human cancers. This study reviews the literature from laboratory investigations that document the antioxidant and oncostatic actions of melatonin and summarizes the evidence regarding the potential use of melatonin in cancer treatment. This study also provides rationale for the design of larger translational research-based clinical trials.

Melatonin: From Basic Research to Cancer Treatment Clinics

The hormone melatonin is currently proposed by some investigators to be an efficient means for decreasing the impairing effects of jet lag. Eight healthy male subjects, aged 20 to 32, underwent a 9-hr advance shift in the isolation facility of our institute during two periods each of 15 days' duration. In a double-blind, crossover design, subjects took either melatonin or placebo at 1800 hr local time for 3 days before the time shift and at 1400 hr for 4 days afterwards. The time shift was simulated on days 7 and 8 by shortening the sleep period by 6 hr and the following wake period by 3 hr. Body temperature was recorded every 90 min, and urine was collected at 3-hr intervals all day and night. Melatonin treatment enhanced the resynchronization speed of some, but not all, hormone and electrolyte excretion rates for several days after the time shift. The adaptation speed of the temperature rhythm significantly increased during one postshift day. In addition, the circadian temperature rhythm had a significa...

Influence of melatonin treatment on human circadian rhythmicity before and after a simulated 9-hr time shift.

In response to eastbound transmeridian flights, which result in zeitgeber phase advance shifts, adaptation of the circadian system to the new time zone by phase delays and advances are observed. The delay response to an advance zeitgeber shift has been called an antidromic response. For the shift at which the transition from an advance to an antidromic response occurs, the term critical shift is introduced.For the study of critical shifts, a flight experiment across nine time zones and numerical simulations of a van der Pol equation have been evaluated. The interest is focussed on the determination of a range for critical abrupt shifts. An abrupt shift means that the ensemble of zeitgebers including geophysical zeitgebers and the rest-activity cycle is shifted immediately in the new time zone. The range of critical advance shifts has been estimated to reach from + 7 to + 10 hr. In the literature, results were reported which would imply a much wider range. The discussion of these observations shows that th...

Transition Between Advance and Delay Responses to Eastbound Transmeridian Flights

A mathematical model of the circadian system is described that is appropriate for application to jet lag. The core of the model is a van der Pol equation with an external force. Approximate solutions of this equation in which the external force is composed of a constant and an oscillating term are investigated. They lead to analytical expressions for the amplitude and period of free-running rhythms and for the frequency limits of the entrainment region. The free-running period increases quadratically with stiffness. Both period and amplitude depend on the value of the constant external force. The width of the range of entrainment is mostly determined by the external force, whereas the relative position of this range follows the intrinsic period of the oscillator. Experiments with forced and spontaneous internal desynchronization were evaluated using these analytical expressions, and estimates were obtained for the intrinsic period of the oscillator, its stiffness, and the external force. A knowledge of th...

A Mathematical Model of the Human Circadian System and Its Application to Jet Lag

A model based on the van der Pol equation has been developed to predict the pattern of adaptation of aircrew and other travellers to rapid time-zone transitions, when the exposure to light cannot be quantified. The parameters of the model include the stiffness (mu) and the intrinsic period (T0), which together define the free-running period, and the external force (F). The parameter values were estimated by using a simplex minimization technique to fit the output from the model to body temperature data from 12 individuals before, and over a 12-day period immediately after, a 10-h eastward transition between London and Sydney. Data were collected at three equally spaced points during each sleep period and at the end of four 45-min rest periods during the day. The fitting procedure enabled the parameters of the temperature rhythm to be estimated after correcting for the masking effect of sleep. The average estimates of mu (0.38 h) and T0 (24.24 h) were close to earlier estimates based on forced desynchronization experiments, and the mean free-running period, calculated from these, was 24.50 h. The mean value of the external force F (0.54) was surprisingly high, and this may reflect the strong outdoor light levels during the days in Sydney. Estimates of phase, based on the model solutions, suggested that 11 subjects adapted by a phase delay and 1 by a phase advance. However, the amplitude of the rhythms was much reduced at times when the phase was changing rapidly. Simulations using the range of the model parameters for the 12 individuals predicted that adaptation to within 1 h after a 10-h eastward transition would be achieved within between 3 and 11 days. However, since these predictions are dependent on the choice of external force, estimates may need to be more conservative in real-life situations when light exposure cannot be measured.

Alexander Gundel

Papers

Influence of melatonin treatment on human circadian rhythmicity before and after a simulated 9-hr time shift.

Transition Between Advance and Delay Responses to Eastbound Transmeridian Flights

A Mathematical Model of the Human Circadian System and Its Application to Jet Lag

A circadian oscillator model based on empirical data.

Consensus report prepared by ECASS: Scientific and medical evaluation of flight time limitations. Gutachten für EASA