[The biological clock in health and illness]

The biological clock in mammals is located in the suprachiasmatic nuclei of the hypothalamus. The combined output of multiple neuronal cellular oscillators determines the master circadian rhythm, which paces the myriad periodic functions of the organism, including, to a certain degree, the sleep-wake rhythm. The intrinsic master circadian rhythm, which is slightly longer than 24 hours, is synchronized daily to the extrinsic 24-hour day by the entrainment process, governed mainly by exposure to the environmental light at specific times. The pineal hormone melatonin is a specific and sensitive marker of the circadian clock activity, and its secretion is tightly coupled to the output of the biological clock and the circadian phase. Chronobiology is a young scientific discipline which deals with research of the biological clocks and its implication to the clinical medicine. Circadian rhythm disorders are manifest mainly as inappropriate sleep-wake timing, and patients complain about various combinations of insomnia or excessive sleepiness at inappropriate times. Treatment of circadian rhythm disorders by sleeping pills or wake-promoting agents, without taking chronobiological considerations into account, may be futile, or even detrimental to a patient's well-being. The current issue of "Harefuah" includes a review by Doljansky and Dagan, which exemplifies the chronobiological approach to sleep-wake rhythm disturbances in patients with Alzheimer's disease. Adoption of this approach to other disorders of the circadian clock may benefit care of patients.