Scientific References

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DLMO patterns have been shown to reliably predict circadian timing and help clinicians more accurately assess sleep behavior and sleep phase shifts (Murray et al., 2017), (Burgess et al., 2016; Burgess et al., 2015). Determining DLMO is also relevant in discriminating circadian rhythm related sleep issues from other non-circadian related sleep disorders or establishing the timing of exogenous melatonin administration when treating delayed sleep phase disorders (Lewy et al., 1995). Check out the scientific publications below that highlight the value of DLMO for improving healthy sleep outcomes.

1. Auger, R. R., Burgess, H. J., Emens, J. S., Deriy, L. V., Thomas, S. M., & Sharkey, K. M. (2015). Clinical Practice Guideline for the Treatment of Intrinsic Circadian Rhythm Sleep-Wake Disorders: Advanced Sleep-Wake Phase Disorder (ASWPD), Delayed Sleep-Wake Phase Disorder (DSWPD), Non-24-Hour Sleep-Wake Rhythm Disorder (N24SWD), and Irregular Sleep-Wake Rhythm Disorder (ISWRD). An Update for 2015: An American Academy of Sleep Medicine Clinical Practice Guideline. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 11(10), 1199–1236.
2. Keijzer H, Smits MG, Duffy JF, Curfs LM (2014). Why the dim light melatonin onset (DLMO) should be measured before treatment of patients with circadian rhythm sleep disorders. Sleep Med Rev, 18(4), 333-9. PMID: 24388969
3. Cipolla-Neto, J., Gaspar do Amaral, F., (2018). Melatonin as a Hormone: New Physiological and Clinical Insights. Endocrine Reviews, 39(6), 990–1028. PMID: 30215696
4. Burgess, H.J., Park, M., Wyatt, J.K., and Fogg, L.F. (2016). Home dim light melatonin onsets with measures of compliance in delayed sleep phase disorder. Journal of sleep research 25, 314-317.
5. Fishbein, A. B., Knutson, K. L., & Zee, P. C. (2021). Circadian disruption and human health. The Journal of clinical investigation, 131(19), e148286
6. Burgess, H.J., Wyatt, J.K., Park, M., and Fogg, L.F. (2015). Home Circadian Phase Assessments with Measures of Compliance Yield Accurate Dim Light Melatonin Onsets. Sleep 38, 889-897. Challet, E. (2015). Keeping circadian time with hormones. Diabetes Obes Metab 17 Suppl 1, 76-83.
7. Pandi-Perumal, S. R., Smits, M., Spence, W., Srinivasan, V., Cardinali, D. P., Lowe, A. D., & Kayumov, L. (2007). Dim light melatonin onset (DLMO): a tool for the analysis of circadian phase in human sleep and chronobiological disorders. Progress in neuro-psychopharmacology & biological psychiatry, 31(1), 1–11. https://doi.org/10.1016/j.pnpbp.2006.06.020
8. Dollish, H.K., Tsyglakovam, M., McClung, C.A. (2024). Circadian rhythms and mood disorders: Time to see the light 024 Neuron. 2024 Jan 3;112(1):25-40.
9. Lewy, A.J., Sack, R.L., Blood, M.L., Bauer, V.K., Cutler, N.L., and Thomas, K.H. (1995). Melatonin marks circadian phase position and resets the endogenous circadian pacemaker in humans. Ciba Found Symp 183, 303-317; discussion 317-321.
10. Molina, T.A., and Burgess, H.J. (2011). Calculating the dim light melatonin onset: the impact of threshold and sampling rate. Chronobiol Int 28, 714-718.
11. Murray, J.M., Sletten, T.L., Magee, M., Gordon, C., Lovato, N., Bartlett, D.J., Kennaway, D.J., Lack, L.C., Grunstein, R.R., Lockley, S.W., et al. (2017). Prevalence of Circadian Misalignment and Its Association With Depressive Symptoms in Delayed Sleep Phase Disorder. Sleep 40(1), 10.1093/sleep/zsw002.
12. Wright, H., Lack, L. & Bootzin, R. Relationship between dim light melatonin onset and the timing of sleep in sleep onset insomniacs. Sleep Biol. Rhythms 4, 78–80 (2006).
13. Nagtegaal, E., Peeters, T., Swart, W., Smits, M., Kerkhof, G., and van der Meer, G. (1998). Correlation between concentrations of melatonin in saliva and serum in patients with delayed sleep phase syndrome. Ther Drug Monit 20, 181-183.
14. Voultsios, A., Kennaway, D.J., and Dawson, D. (1997). Salivary melatonin as a circadian phase marker: validation and comparison to plasma melatonin. J Biol Rhythms 12, 457-466.
15. Zelinski, E.L., Deibel, S.H., and McDonald, R.J. (2014). The trouble with circadian clock dysfunction: multiple deleterious effects on the brain and body. Neurosci Biobehav Rev 40, 80-101.
16. Brown, T. M., Brainard, G. C., Cajochen, C., Czeisler, C. A., Hanifin, J. P., Lockley, S. W., Lucas, R. J., Münch, M., O’Hagan, J. B., Peirson, S. N., Price, L., Roenneberg, T., Schlangen, L., Skene, D. J., Spitschan, M., Vetter, C., Zee, P. C., & Wright, K. P., Jr (2022). Recommendations for daytime, evening, and nighttime indoor light exposure to best support physiology, sleep, and wakefulness in healthy adults. PLoS biology, 20(3), e3001571.