Circadian Rhythm Disorders - Asking the Right Questions

Jeffrey S. Luther, MD; Larry Culpepper, MD, MPH
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This CME activity is jointly sponsored by the California Academy of Family Physicians and Asante Communications, LLC.

This activity is made possible by an independent educational grant from Cephalon, Inc.

Intended Audience

This activity is designed to meet the needs of family physicians, primary care physicians, and related health care providers.

Needs Assessment and Learner’s Gap

Circadian rythym disorders (CRDs) are prevalent, underrecognized, and inadequately treated, in part because of their varied symptomatology and the lack of assessment skills among clinicians in the family medicine and primary care settings. CRDs reflect misalignment between the biologic sleep/wake cycle and environmental demands, and/or between the biologic clock and societal norms for bedtime and wake time. Characterized by excessive sleepiness and insomnia, circadian dyssynchrony is debilitating across numerous cognitive, affective, and physiologic domains. Consequently, the etiology of a patient’s symptoms can be confusing and incorrectly or incompletely identified, resulting in suboptimal treatment strategies. Thus, clinicians must be familiar with circadian rhythms and how they relate to the pathophysiology manifested in their patients.

CRDs comprise several distinct subtypes, including shift work disorder (the most clinically significant and prevalent), advanced sleep phase disorder, and delayed sleep phase disorder. Short-term consequences stemming from CRDs can be severe, including impaired cognition, motor vehicle accidents, and medical errors among healthcare professionals. Perhaps even more alarming are recent studies among patients with CRDs suggesting an important link to cardiometabolic dysfunction, gastrointestinal disturbances, and mood/affective disorders. Primary care clinicians are faced with the need to provide an accurate diagnosis and initiate appropriate treatment for CRDs to avoid the long-term health implications associated with these disorders, and to ensure patient and public safety.


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  • Sack RL, Auckley D, Auger RR, et al; American Academy of Sleep Medicine. Circadian rhythm sleep disorders: part I, basic principles, shift work and jet lag disorders. An American Academy of Sleep Medicine review. Sleep. 2007;30(11):1460-1483.
  • Sack RL, Auckley D, Auger RR, et al; American Academy of Sleep Medicine. Circadian rhythm sleep disorders: part II, advanced sleep phase disorder, delayed sleep phase disorder, free-running disorder, and irregular sleep-wake rhythm. An American Academy of Sleep Medicine review. Sleep. 2007;30(11):1484-1501.

Learning Objectives

At the conclusion of this program, participants should be better prepared to:

  • Recognize excessive sleepiness, insomnia, and mood and performance impairments as surrogate markers for CRDs commonly encountered by family physicians and primary care providers
  • Integrate findings from an initial and longitudinal sleep history to establish a differential diagnosis for patients with CRDs
  • Formulate and adjust a therapeutic plan for patients with shift work disorder based in part on realistic treatment goals and patient function across quality of life, cognitive, and mood domains

Accreditation Statement

The CAFP is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. CAFP takes responsibility for the content, quality, and scientific integrity of this CME activity.

Credit Designation Statement

This Enduring Material activity, Circadian Rhythm Disorders: Asking the Right Questions, has been reviewed and is acceptable for up to 2 Prescribed credit(s) by the American Academy of Family Physicians. AAFP accreditation begins July 15, 2011. Term of approval is for one year from this date with the option of yearly renewal. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Method of Participation

There are no fees for participating in this CME activity. To receive credit, participants must (1) read the learning objectives and disclosure statements, (2) complete the Pre-Activity Questionnaire, (3) participate in the educational activity, (4) complete the Post-Activity Questionnaire (Posttest), and (5) click on “Get Credit” to complete the Evaluation and request credit. A score of at least 70% is required to successfully complete this activity.

Conflict of Interest and Conflict Resolution Policy

CAFP has a long-standing policy in place to address declaration and notification of interest. We require staff members, Officers, Board and Committee members, curriculum development team members, master faculty members and speakers to complete a Disclosure of Interest statement.

ACCME policy requires identification, management and resolution of conflict. In the simplest of terms: Identification requires that we know about potential conflicts BEFORE an invitation is issued. Management can include a number of tactics, including changing topics, changing content, peer review of content, or encouraging evidence-based CME. Resolution can include “uninviting” the speakers, or asking the speaker to “sell stock, discontinue speakers’ bureau activities, etc.”

The CAFP Committee on Continuing Professional Development (CCPD) and CAFP Board of Directors have adopted policies and procedures to meet these requirements. For a copy of these policies, please contact Shelly Rodrigues, CAE, at

All individuals with potential to influence content of this program have submitted Conflict of Interest declarations that have been reviewed according to policy. Learner notification of declarations is included in this syllabus. All individuals with potential conflicts have been contacted by CAFP staff or CCPD members, and issues of conflict have been discussed, managed, and resolved.

Faculty Disclosure Statement

Participating faculty will disclose any industry affiliations, sponsorships, honoraria, monetary support, and other potentially biasing factors to the audience.
Larry Culpepper, MD, MPH - AstraZeneca Pharmaceuticals LP (Consultant); Labopharm Inc. (Consultant, Stock owner); Merck & Co., Inc. (Consultant); Pfizer Inc. (Consultant); Trovis Pharmaceuticals, LLC (Consultant)
Jeffrey S. Luther, MD - No financial interests to disclose
The staffs of CAFP and Asante Communications have no conflicts of interest with commercial interests related directly or indirectly to this educational activity

Disclaimer Statement

The opinions and recommendations expressed by faculty and other experts whose input is included in this program are their own. This enduring material is produced for educational purposes only. Use of the CAFP or Asante Communications, LLC name implies review of educational format design and approach. Please review the complete prescribing information for specific drugs or combinations of drugs, including indications, contraindications, warnings, and adverse events before administering pharmacologic therapy to patients.

Copyright Information

© 2011 California Academy of Family Physicians and Asante Communications, LLC. All rights reserved. No part of this syllabus may be used or reproduced in any manner whatsoever without written permission except in the case of brief quotations embedded in articles or reviews.


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