Non-24 disorder is characterized by complaints of insomnia and/or excessive daytime sleepiness that result from a progressive desynchronization of the earth’s usual 24-hour light/dark cycle and the individual’s endogenous circadian rhythms.1,2 As many as half of totally blind patients suffer from non-24 disorder, and the incidence of non-24 disorder also appears to be more common than previously appreciated in sighted individuals in their teens and 20s.3,4 Non-24 disorder is underdiagnosed, in part because patients do not proactively discuss sleep-related issues with their healthcare providers, and time-limited clinicians often do not regularly inquire about insomnia or excessive sleepiness.5,6 Moreover, until recently, treatment recommendations were largely based on case series and clinical experience rather than well-designed clinical trials.6,7 This case-based POC 101 program will educate clinician-learners regarding the pathophysiologic basis of non-24 disorder, current diagnostic criteria, behavioral approaches to improving sleep hygiene and daily scheduling, and evidence-based pharmacologic interventions.
1. Zee PC, Attarian H, Videnovic A.. Circadian rhythm abnormalities. Continuum (Minneap Minn). 2013;19(1 Sleep Disorders):132-147.
2. American Academy of Sleep Medicine. International Classification of Sleep Disorders Diagnostic and Coding Manual, Third Edition (ICSD-3). 3rd ed. Westchester, IL: 2014.
3. Uchiyama M, Lockey SW. Non-24–hour sleep-wake syndrome in sighted and blind patients. Sleep Med Clin. 2015;10(4):495-516.
4. Hayakawa T, Uchiyama M, Kamei Y, et al. Clinical analyses of sighted patients with non-24–hour sleep-wake syndrome: A study of 57 consecutively diagnosed cases. Sleep. 2005;28(8):945-952.
5. National Sleep Foundation. 2009 Sleep in America Poll: Health and Safety. Sleep Health. 2009:1(2)e8.
6. Sorscher AJ. How is your sleep: A neglected topic for health care screening. J Am Board Fam Med. 2008;21(2):141-148.
7. Auger RR, Burgess HJ, Emens JS, Deriy LV, Thomas SM, Sharkey KM. 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. J Clin Sleep Med. 2015;11(10):1199-1236.
8. Lockley SW, Dressman MA, Licamele L, et al. Tasimelteon for non-24–hour sleep–wake disorder in totally blind people (SET and RESET): two multicentre, randomised, double-masked, placebo-controlled phase 3 trials. Lancet. 2015;386(10005):1754-1764.