Biology of Sleep Our “master clock” and the difference between day and night The word “circadian” literally means a period of approximately 24 hours. Circadian rhythms influence a wide range of biologic functions, but the influence on the sleep-wake mechanism is the most familiar. Circadian rhythms are influenced by the light-dark cycle, but are generated by the expression of “clock” genes in the body’s internal master clock, which is located in the suprachiasmatic nucleus, or SCN.1-4 |
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During the day, the SCN emits an alerting signal that stimulates the circadian wake system. This process is directly opposed by the homeostatic process, which increases the need for sleep the longer a person is awake. With the onset of darkness, the pineal gland releases melatonin, thus suppressing the SCN alerting signal and allowing sleep to occur.3,5,6 | ||
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Roll over an arrow to see what happens when we sleep.  Rozerem™ is indicated for the treatment of insomnia characterized by difficulty with sleep onset. Rozerem should not be used in patients with hypersensitivity to ramelteon or any components of the formulation. Rozerem can be prescribed for long-term use. However, failure of insomnia to remit after a reasonable period of time, worsening of insomnia, or the emergence of new cognitive or behavioral abnormalities after taking Rozerem should be evaluated, as such symptoms may be the result of an unrecognized underlying medical disorder. In primarily depressed patients, worsening of depression, including suicidal ideation, has been reported in association with the use of hypnotics. Rozerem should not be used by patients with severe hepatic impairment, or in patients in combination with fluvoxamine. Rozerem has not been studied in subjects with severe sleep apnea or severe COPD and is not recommended for use in those populations. Patients should be advised to exercise caution if they consume alcohol in combination with Rozerem. Rozerem has been associated with decreased testosterone levels and increased prolactin levels. As a result, healthcare professionals should be mindful of any unexplained symptoms possibly associated with such changes in these hormone levels. Rozerem has not been studied in children or adolescents, and the effects in these populations are unknown. Rozerem should be taken within 30 minutes before going to bed and activities should be confined to those necessary to prepare for bed. Rozerem should not be taken with or immediately after a high-fat meal. Engaging in hazardous activities that require concentration (such as operating a motor vehicle or heavy machinery) after taking Rozerem should be avoided. The most common adverse events seen with Rozerem that had greater than 2% incidence difference from placebo were somnolence, dizziness, and fatigue. References:
1. Turek FW, Dugovic C, Zee PC. Current understanding of
the circadian clock and the clinical implications for neurological
disorders. Arch Neurol. 2001;58:1781-1787.
2. Edgar DM, Dement WC, Fuller CA. Effect of SCN
lesions on sleep in squirrel monkeys: evidence for opponent
processes in sleep-wake regulation. J Neurosci.
1993;13:1065-1079. 3. Roth T, Roehrs T.
Insomnia: epidemiology, characteristics, and consequences. Clin
Cornerstone. 2003;5:5-15.  Home  Prescribing
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