Sleep deprivation therapy to reset the circadian pacemaker in a non-24-hour sleep-wake disorder: a case report
Journal of Clinical Sleep Medicine. 2021-07-01; 17(7): 1503-1506
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Guichard K(1)(2)(3), Micoulaud-Franchi JA(1)(2)(4), Philip P(1)(2)(4), Taillard J(2)(4).
(1)Clinique du Sommeil, Bordeaux University Hospital (CHU), Bordeaux, France.
(2)Université de Bordeaux, SANPSY, USR 3413, F-30000 Bordeaux, France.
(3)Nouvelle Clinique Bel Air, Bordeaux, France.
(4)CNRS, SANPSY, USR 3413, F-33000 Bordeaux, France.
None: Non-24-hour sleep-wake disorder (N24SWD) is one of several chronic circadian rhythm sleep-wake disorders (CRSWDs). It is defined as progressive daily shifts in sleep onset and wake times. It mainly affects sight-impaired persons, is relatively rare in sighted patients, and is difficult to treat, with no guidelines. We report a case of N24SWD 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.
© 2021 American Academy of Sleep Medicine.