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This could be related to mental and physical exhaustion at the end of the day, however, reduced light at this time of day could also contribute to impaired levels of cognitive alertness.In addition, patients who are institutionalized show a greater lack of a robust daytime light signal.This lack of a robust signal promotes daytime somnolence and fragmented bouts of sleep at night, predisposes individuals to freerunning sleep patterns, and ultimately results in Riboflavin internal temporal desynchrony, not least in the pattern of melatonin release from the pineal gland.Melatonin release is known to be lower than normal in patients with AD.This shows circadian rhythm disruption with a delayed sleep phase.After melatonin treatment some patients with AD show improved sleep quality, some show no effects on sleep and some become more aggressive.Melatonin effects are, in part, dependent on the phase of the circadian cycle and so the different responses to melatonin treatment may be due to differences in the internal circadian phase of patients when melatonin is administered.This hypothesis is supported by the observation that melatonin administration in combination with light therapy in institutionalized patients with AD results in improved nighttime sleep, higher daytime activity and less daytime sleep.Thus, the use of melatonin in combination with bright light exposure could prove to be a valuable therapeutic tool for the improvement of sleep quality in patients with AD.It has been estimated that of patients with PD have a sleep disorder that affects their ability to fall asleep and stay asleep, their dreams, motor activity during sleep, postsleep behaviour or daytime somnolence.There is also some evidence for a disrupted pattern of melatonin release and that weak light entrainment signals can exacerbate the condition.Pathologically, PD is characterized by neuronal cell loss with lewy body formation in the substantia nigra leading to striatal dopamine deficiency. Degeneration of these nuclei Sodium salicylate appears to lead to the disruption of basic REM and nREM sleep architecture.It might therefore provide a useful marker during the early phase of PD and present an opportunity for early intervention of this disease.Preliminary studies show that the use of melatonin in combination with bright light exposure is useful for improving sleep quality in PD, but more studies are needed to provide statistically robust conclusions.Transgenic R mice that carry the HD mutation have provided important insights into the molecular basis of circadian rhythm disruption in HD. By contrast, brainstem demyelination and midbrain lesions are common in MS and are associated with migraines and headaches but not with sleep disturbance.As the interactions of the multiple neuronal systems that are involved in sleep generation and sleep wake control are complex, demyelination in one or more of these neuronal systems could profoundly affect sleep and arousal in MS.In patients with MS sleep stabilization may improve the quality of life, but to our knowledge no systematic studies have investigated the effectiveness of this treatment. Bipolar disorder type classification is based on the occurrence of at least one manic episode, with or without the occurrence of a major depressive episode.Bipolar disorder type is characterized by at least one hypomania episode and one major depressive state.

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