Sleep deprivation therapy to reset the circadian pacemaker in a non-24-hour sleep-wake disorder: a case report

J Clin Sleep Med. 2021 Jul 1;17(7):1503-1506. doi: 10.5664/jcsm.9294.

Abstract

Non-24-hour sleep-wake disorder is 1 of several chronic circadian rhythm sleep-wake disorders. It is defined as progressive daily shifts in sleep onset and wake times. It mainly affects patients who are sight-impaired, is relatively rare in sighted patients, and is difficult to treat, with no guidelines. This case report discusses non-24-hour sleep-wake disorder in a sighted young man who complained of alternating severe insomnia and excessive sleepiness, with a sleep agenda and actigraphic data showing a daily delay of approximately 2 hours. A novel therapy by total sleep deprivation followed by a combination of morning light therapy and nocturnal melatonin administration was efficient in stopping his free-running sleep-wake pattern both immediately and in the long term. The treatment combination for 6 months resulted in stable circadian entrainment to a 24-hour cycle. Compliance with chronotherapy was maintained over the course of follow-up.

Keywords: N24SWD; circadian rhythm sleep disorders; total sleep deprivation; wake therapy.

Publication types

  • Case Reports

MeSH terms

  • Circadian Rhythm
  • Humans
  • Male
  • Melatonin* / therapeutic use
  • Sleep
  • Sleep Deprivation / complications
  • Sleep Deprivation / therapy
  • Sleep Disorders, Circadian Rhythm* / complications
  • Sleep Disorders, Circadian Rhythm* / therapy

Substances

  • Melatonin