Insomnia or hypersomnia may occur in disorders of sleep timing rather than sleep generation. Such conditions may be (1) organic—due to a defect in the circadian pacemaker, or (2) environmental—due to a disruption of exposure to entraining stimuli (light/dark cycle). Examples of the latter include jet-lag disorder and shift work. Shift work sleepiness can be treated with modafinil (200 mg) or armodafinil (150 mg) taken 30–60 min before the start of each night shift as well as properly timed exposure to bright light. Safety programs should promote education about sleep and increase awareness of hazards associated with night work.

Delayed sleep-wake phase syndrome is characterized by late sleep onset and awakening with otherwise normal sleep architecture. Bright-light phototherapy in the morning hours or melatonin therapy during the evening hours may be effective.

Advanced sleep-wake phase syndrome moves sleep onset to the early evening hours with early morning awakening. These pts may benefit from bright-light phototherapy during the evening hours. Some autosomal dominant cases result from mutations in genes (PER2 or casein kinase I delta) involved in regulation of the circadian clock.

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