Talk:Non-24-hour sleep–wake disorder

Not light-dark cycle, but LUNAR cycle

I have been dealing with non-24-sleep for decades.

This morning I read this article about earth organisms (including humans) timing cycles with the lunar gravity cycle. Despite the lunar gravity being small, its rhythm is impactful. The lunar cycle times to about 24.6 hours per day (between 24.4 and 24.8).

https://www.studyfinds.org/sun-and-moon-impact-behavior/

My suspicion is: for whatever reason, my light-dark cycle doesnt work at all. So, my body defaults to the gravitational cycle instead. During the week, I have observed my cycle will "roll forward", delaying for upto an hour later compared to the previous day. As an experiment, I will try time my sleeping schedule with the local sea tides, as convenient way to stay in sync with the lunar schedule. I suspect I wake up fresh at about every other low tide. (There are about two low tides per day. My body picks one of them each day.)

Apparently, people with normal light-dark sleeping schedules, also periodically adjust their circadian rhythm to resynchronize with the lunar schedule.

Perhaps, people without the light-dark regulation, simply use the lunar day (about 24.6 hours) instead?

Anyway, I am mentioning this in case it turns out to be useful to any sleep researchers. I am hoping people like me with non-24-hour sleep can find a healthy way to regulate and schedule our routines based on the timing of tide instead of the timing of sunrise.

— Preceding unsigned comment added by 2603:9001:6B0D:E73A:C2F:97DD:52DF:5B77 (talk) 17:48, 9 January 2022 (UTC)

Reference for "Symptoms?

Anyone able to give a reference for the 'symptoms'? I can personally vouch for a few of them, but the plural of anecdote isn't Wikipedia ;) 82.22.141.131 (talk) —Preceding undated comment added 05:01, 11 February 2011 (UTC).

SO... any successes in treating it?

As someone with a 28-hour sleep-wake cycle, I'm beyond curious. And it isn't like there's a lot of information available... Aadieu (talk) 18:39, 6 October 2009 (UTC)

That's a forum-type question, so someone's likely to archive us. I'll write on your talk page. - Hordaland (talk) 05:27, 7 October 2009 (UTC)

I'll add what I know here so that others that are better at finding sources can know what to look for.

"Non-24-hour sleep–wake disorder" also includes cases with less than 24 hours circadian rhythm, that is also fairly common. We should make that clearer in the article.

Unfortunately, at the moment this article doesn't talk about people that have 27 hours or longer circadian rhythm. Also most of the available sources out there doesn't talk about it, probably because it is so rare. (I am talking about non-blind people here, since totally blind people usually "only" have the 24-26 hours rhythm, same as normal seeing people when they are not exposed to daylight.)

I myself have 28 to 36 hours rhythm (it varies) since the year 2000. During 2000-2006 I read up on what was available and also got thoroughly evaluated by the sleep department at a major hospital here in Sweden. The doctors there said the same things I had found online. So my knowledge is a bit old, but here is what I learnt:

There is a common mistake that many people do that can temporarily cause longer day rhythm and several other sleeping problems. Many people think that sleeping eight hours is good, and sleeping nine hours is even better. (I mean on average over time.) So they use all kinds of tricks to force themselves to sleep more, like using meditation and even taking sleeping pills etc. But grown-ups usually only need about seven hours of sleep per night (but it varies a lot from person to person). When you go to a sleep doctor this is usually the first thing they ask you about. This mistake should probably be mentioned in the different articles about sleep disorders. But note: For us that have really long circadian rhythm, it probably is normal to sleep a bit longer per "night". I sleep seven hours when I am at 26 hours rhythm. But when I am at 36 hours rhythm I sleep nine hours, but that corresponds to just six hours per 24 hours. So I actually sleep fewer hours per week, when I am at a longer rhythm. (I use no tricks to cause longer sleep, I just sleep until I wake up.)

Apart from the just mentioned mistake, there are two kinds of actual long rhythm: The ones caused by bipolar disorder (and perhaps some other mental disorders), and those that are not. If you treat such a mental disorder the circadian rhythm disorder usually also goes away. Thus, when I got to the sleep clinic, they first sent me to psychologists and psychiatrists for a full mental health check. Their conclusion was: "Unfortunately you are mentally healthy, so we can't cure your circadian disorder".

From here on I am talking about the other variant: No bipolar disorder but anyway a very long circadian rhythm:

If treatment is applied within the first two years, they have occasionally managed to cure some patients. (Cure, as in not needing life long treatment.) But if treatment has been tried after two years they have never been able to cure it (no known successful cases in the world as of 2006).

And the available treatment (light therapy in the morning and melatonin in the evening) can only back regulate your rhythm at most 2 hours. So if you have more than 26 hours rhythm there is no treatment that can keep you at 24 hours. There are now (2024) some alternative medicines to melatonin but they are not better than melatonin. (But as usual, for some people they might have less side effects or work better.) All of these medicines have very bad side effects for most patients, so most have to stop the treatment. Thus even those with only 25 to 26 hours rhythm can often not use the treatment. Also: For those that don't get to much side effects from the medicine: To back regulate 2 hours does in it self cause side effects, which for many causes to much health problems.

Pretty much all known cases in the world with really long rhythm (the literature didn't say exactly how long but I think it means from about 27 hours and up) have one thing in common: We have gone through at least two years of hell (extreme negative stress), then the very long circadian rhythm kicks in. The circadian rhythm disorder is usually chronic (as in life long) and doesn't go away when the initial stress that caused it goes away.

People with long circadian rhythm on average have 2 years shorter life span, same as with people that work night shifts or varying shifts. And just like shift workers we also have a slightly higher risk of cancer (just very slightly). It is believed to have the same causes: Just like shift workers, we who have a longer circadian rhythm often have to violate our internal clock since we sometimes have to go to an appointment or don't want to miss some event, and skipping sleep or sleeping in the wrong time is detrimental for your health.

And here's a thing that my sleep doctor told me (but that we probably shouldn't add to the article since they don't have that good statistics on this): Very long circadian rhythm is the second most unusual sleep disorder. The only more uncommon disorder is when people don't sleep at all (two or three cases in the world).

Sorry that I don't still have links to the sources, but it was about 20 years ago I read most of it.

--David Göthberg (talk) 13:56, 25 December 2024 (UTC)

link doesn't work

the reference link about the study of sighted patients leads to a webpage that says the 'session has timed out'. just fyi —Preceding unsigned comment added by 68.102.166.2 (talk) 21:55, 5 January 2010 (UTC)

Not necessarily a disorder?

yo why is this a disorder and not just a thing? growing up i always did this during summers, when i wasn't in school, and since i've graduated i do it year-round. what's the problem? just the "gets in the way of social obligations and normal work hours" thing? is doing this by choice different than the disorder? v curious — Preceding unsigned comment added by 172.7.241.1 (talk) 22:45, 18 April 2013 (UTC)

A couple of major features of these circadian rhythm sleep disorders are:

1. The person cannot "make up for lost sleep" in the same way as healthy sleepers do. Normal people who stay out way too late and get way too little sleep one night, just go to sleep early the next day and they are back on track. People with circadian rhythm sleep disorders can't get to sleep earlier to make up for lost sleep.
2. The person has not chosen this sleep schedule; it is "hard-wired" and very difficult to impossible to change it to match nature's 24-hour day. People who, with treatment, do manage this for a while usually can't keep it up for more than a few days, and it easily leads to illness.

--Hordaland (talk) 08:57, 12 May 2014 (UTC)

The question seems to assume the premise that if someone had, for example, a 25-hour rhythm, and was able due to circumstances to adopt a 25-hour schedule that ignored the 24-hour clock, he would be all right; is that true? It seems like it should be according to the explanation given in the article, but I could be missing some subtlety. Double sharp (talk) 05:53, 24 October 2017 (UTC)

@Double sharp: Yes, you understood it right. I have 28 to 36 hours per day+night (it varies over time). If we let our internal clock decide and sleep as our bodies tell us to, then we have almost no negative side effects, provided we do certain other things according to this rhythm. For most of us: We need to eat breakfast, lunch and dinner counted from when we woke up, not synced with other people. Many people (even those without this disorder, if they slept at an unusual time) do the mistake of waking up and then immediately eating a heavy dinner with their family because it is dinner time. Of course, some (young) people have a robust stomach and don't need to bother about that.

Another thing that many have a problem with is the amount of light in the different times they are awake. They have to use lights and window blinders to regulate amount of light, otherwise they feel confused and get a feeling of "unreal". For some this is so confusing that they don't function properly. Thankfully I don't have that problem, I can be at a sunny beach without problems even though my body clock says it is midnight. That just felt a bit odd the first year, until I got used to it. And the opposite: It being dark in the middle of the day I am used to since I live in northern Europe (long dark winters). As a northerner I know to use enough lamps so I don't get drowsy in the day and not get depressed in winter.

This is the same things that normal people experience when they travel to other time zones. Stepping out of the air plane in a bright sunny day when your internal clock says it is midnight can cause the same feeling of confusion and "unreal". It is a known phenomenon at airports, even though the person is not tired since it is not that late for the person, they can become so confused that they can't function.

--David Göthberg (talk) 16:29, 25 December 2024 (UTC)

@Davidgothberg: Wow, thanks for the very detailed answer! Never expected to get one, having asked the question over seven years ago. :) Double sharp (talk) 01:55, 26 December 2024 (UTC)

Editing in progress

I have plans to do quite a bit of editing on this page. It does not conform as well as it might to the Manual of Style for medicine related articles. Wikipedia:Manual_of_Style/Medicine-related_articles It does not emphasize the information about the disorder in blind people, and does not discuss melatonin treatment in enough detail. My first edit was done today. Campbellsack (talk) 17:45, 27 August 2013 (UTC)

Thanks for the heads up; would that everyone did that! I'll be watching ((smile)). I agree that the occurrence of Non-24 in the blind deserves emphasis, but please don't underplay its occurrence in the sighted! About 100 cases are mentioned in the literature and I'm in contact with about 30 more; it is not as rare as it may seem, and it is usually very debilitating for the sighted.

In case you haven't seen it, National Organization for Rare Disorders (NORD) has a good article on Non-24, with sources. You have to register, free, to get the full text at: http://www.rarediseases.org/rare-disease-information/rare-diseases/byID/1275/viewAbstract

The definition "a chronic steady pattern comprising one- to two-hour daily delays in sleep onset and wake times in an individual living in society" is/was found on page 137 in the ICSD of 2001; the 2005 edition is apparently not online (do you have access to it?). I find that definition much easier to follow than the one you have chosen. On page 131 of the same document it says: "...non-24-hour sleep-wake syndrome, in which incremental sequential delays of the sleep phase occur...". This is perhaps even quicker/easier to understand!

As you probably know, the ICSD of 2001 (PDF) is at: http://www.esst.org/adds/ICSD.pdf

And, as you may know, the non-profit Circadian Sleep Disorders Network has information, brochures and many links. http://www.circadiansleepdisorders.org

Best wishes, Hordaland (talk) 13:14, 28 August 2013 (UTC)

Hordaland, thanks for your encouragement. I am rusty on editing procedures -- didn't master them in the first place. I just did some work on the Treatment section, but got interupted before I cleaned it up. I will work on it some more tomorrow. 71.236.237.17 (talk) 19:36, 28 August 2013 (UTC)

Some bits aren't really correct.

"For instance, a person with a 25-hour body clock would have a 25-day cycle with two weeks of good sleep and two weeks of poor sleep. But a person with a 24.1-hour circadian rhythm would drift only six minutes per day and take 241 days, or eight months, to go around the clock."

This is not how it works. It is completely wrong - I'd delete it but I am not familiar with the literature, just what it like to live like this. I've been "around the clock" a few times. When on a regular day job (only two years of my life) I stayed up too late by Weds, Thu, Fri, and then slept till noon on Saturday and Sunday. Monday was never fun.

My point is that the bit I quoted is pure crap. One's body clock does not "store up" hours lost or gained. Huw Powell (talk) 02:25, 26 October 2013 (UTC)

I believe the quoted bit is correct. Why do you think it indicates "storage" of hours? If I understand your 2nd paragraph correctly, it sounds as though you may have DSPS/DSPD rather than Non-24? --Hordaland (talk) 05:48, 26 October 2013 (UTC)

A "sleep disorder" or not?

This article defines non-twenty-four ("nine-twenty-four?) as a "sleep disorder". However, a long-running radio public service announcement about the condition explicitly states that non-twenty-four is not a sleep disorder. Well, which is it? (Unsigned comment by 67.206.162.105 at 09:26, 7 March 2014)

I suspect that the radio "announcement" you have heard is advertising by Vanda Pharmaceuticals about their new drug Tasimelteon (trade name Hetlioz) which recently was approved (in the USA, at least) solely for Non-24-hour sleep–wake disorder (Non-24) in totally blind people. It is unfortunate that Non-24 in sighted people and in blind people have the same name, as they have different causes; the cause of blind Non-24 is known. In any case, Non-24 is listed as a sleep disorder in DSM-5 and in the ICSD.

I suppose I understand the thinking behind saying that Non-24 in the totally blind is not (primarily) a sleep disorder. These people's primary diagnosis is blindness. The c. 50% of totally blind people who have Non-24 wouldn't have it if they weren't blind. Their circadian rhythms are presumably entirely normal.

Non-24 in the sighted is a neurological failure of any ability to entrain to the 24-hour cycle in nature. It appears to be a more severe and debilitating version of DSPD. The best explanation of Non-24 that I know about is here.

--Hordaland (talk) 10:56, 7 March 2014 (UTC)

Copy/Edit

The format of this article is good. It is a bit strange how it bounces back and forth from "sighted" and "blind" information, but I think it is the best way for the article to be set up. That could be opened for discussion though. The only parts of the article that bugged me from time to time were the short paragraphs. There are a few paragraphs that contain one or two sentences. For example, in the Characteristics section under "sighted", there is a two sentence paragraph starting with "Non-24 can begin...". I just feel like this fragment should either be expanded on, or tied into another paragraph. That's very nit-picky though, overall the article is constructed well. Cjohnso4 (talk) 02:37, 30 April 2014 (UTC)

Yes, it "bounces back and forth" between "sighted" and "blind" information. I've tried to explain the reason for that in my comment in the section below. --Hordaland (talk) 09:34, 12 May 2014 (UTC)

NPOV alert

This article is messy and poorly formatted but also suffers from lack-of NPOV in my opinion. It could use an overhaul, especially since a new drug treatment has been approved in Jan. of 2014, and this drug is being heavily marketed, along-with this condition.24.0.133.234 (talk) 15:59, 7 May 2014 (UTC)

Note that Vanda Pharmaceuticals' ads as well as their new drug concern only Non-24 in the totally blind. Sighted non-24 does not have the same cause and it's too bad the two conditions share the same name. The formatting of the article (blind->sighted, blind->sighted, if that's what you meant) is designed to contrast the two conditions. Much that is said about the one does not apply to the other.

It may be assumed that (most or all of the) people with the blind form actually have perfectly normal circadian rhythms; they just cannot adjust them daily because of the lack of light signals. Sighted people with non-24 have something wrong with their circadian rhythms, neurologically.

As to NPOV, specific instances may be tagged. --Hordaland (talk) 09:18, 12 May 2014 (UTC)

Prevalence

I moved some of the sighted-N24 prevalence data to a more general section. The sources don't distinguish whether they're discussing sighted or Blind N24. In fact, the 140,000-in-the-EU source specifically says most of the cases are in blind people ("Epidemiology: N24HSWD is an orphan indication affecting ~140,000 in EU [1]. It occurs mainly in totally blind pple"). The article was written in such a way to say there were 140,000 SIGHTED cases in the EU and I thought that was misleading. 81.107.48.231 (talk) 12:28, 8 August 2014 (UTC)

A new study

Primary sources are not allowed as references, but I think that editors watching DSPD, Non-24 and/or Bipolar will be interested in seeing this paper Just FYI. --Hordaland (talk) 12:24, 17 December 2014 (UTC)

9-24

Despite being a hat-noted redirect to here, nowhere in the article prose does 9-24 appear, nor is it explained. In fact, the word "nine" currently only appears in the phrase "mean habitual sleep duration of nine to ten hours", which doesn't seem to have any connection to "9-24". So here's the explanation.

Apparently there was a radio commercial in the U.S. that advertised treatment for "non-24" sleep disorder, but which was easily heard as "nine twenty-four", as if it were a code or short for something (unexplained) involving the normal 24-hour day.

Once the redirect of 9-24 to this article was created, a deletion discussion ensued and was eventually closed without consensus, so it's still here.

I've never heard the commercial, but it'd be useful if someone could dig up at least one reliable source that might make it reasonable to add a mention of this oddity in the article itself. ~ Jeff Q (talk) 03:57, 5 April 2016 (UTC)

Thanks for your comment, Jeff Q. Can anyone in the states confirm that the radio commercial is still being aired? I would doubt that it is; it was an intense campaign quite a while ago. I looked at your linked deletion discussion and one !voter there commented on 23 October 2014: "But it appears to be useful at least for the fleeting moment," ("it" being the redirect). That was one and a half years ago.

I'd suggest that the fleeting moment has passed and a renewed deletion discussion is in order. Do you know how to start one? --Hordaland (talk) 03:14, 30 April 2016 (UTC)

Since I have no experience with deletion discussions, I've posted a query on the Help Desk and indicated that I hope that someone else will follow up. :) Here's hoping. --Hordaland (talk) 04:35, 30 April 2016 (UTC)

@Graham87: It looks like you are taking care of this. And so quickly. Thanks so much! --Hordaland (talk) 10:42, 30 April 2016 (UTC)

I've gone andnominated at RFD; the discussion is at Wikipedia:Redirects for discussion/Log/2016 April 30#9-24. Graham87 10:50, 30 April 2016 (UTC)

@Hordaland: No worries. Lol I hadn't noticed your message before. Graham87 10:54, 30 April 2016 (UTC)

The deletion discussion about the redirect has concluded. The result was Delete. I have removed "9-24 redirects here. For the day, see September 24." from the top of the article. (9-24 is now a redlink.) --Hordaland (talk) 07:49, 10 May 2016 (UTC)

Changes to the lead

I've made fairly major changes. While the body of the article (at least, mostly) keeps separated the information about Non-24 in the sighted, which is a primary disorder, and Non-14 in the totally blind, a condition secondary to their blindness, the lead did not make this separation plain at all. Also, technical terms were used to excess without plain language clarification.

In my opinion, it is unfortunate that these two disorders, with their very different causes, symptoms, and populations, share the same name. It is understandable that they do, as very little was known when they were named and they do share that non-24-hour aspect, though to different degrees. I'm tempted to suggest that the article might better be split in two: Non-24-hour sleep-wake disorder in the blind and Non-24-hour sleep-wake disorder in the sighted. That can't happen without discussion! (You think those titles are long? It gets worse. The latest version of the name is Non-24-hour sleep-wake rhythm disorder.)

I have tried to separate the blind version from the sighted in the lead and make it more understandable to the uninitiated. I'll take another look after sleeping on it and also check to see if refs are missing.

If you don't like something, or have any suggestions, please let me know!

Thanks, Hordaland (talk) 17:02, 30 April 2016 (UTC)

Thank you for the changes, I agree that they might be very different disorders (and actually the AASM agrees), but there is currently no proof, only hypotheses. I will add what the AASM says, but we can't do much more until there is more research done in this area, so for the time being I think we should keep both sighted and blind N24 in the same article. --Signimu (talk) 02:08, 5 November 2018 (UTC)

Major overhaul following AASM 2015 clinical guidelines

I updated the whole article following AASM 2015 clinical guidelines. There are several sections that are still full of original research, or not properly referenced, but they make sense so I leave them here for the time being (if someone has more time to research for example the mechanisms and causes, and particularly some good systematic review), but it would be good to do, we are about halfway to a WP:MEDRS quality sufficient article . --Signimu (talk) 02:10, 5 November 2018 (UTC)

Non-24 in sighted as a result of light hypersensitivity and slow somnolence buildup?

A master work on 17 subjects concluded that sleep-phase delayed subjects might be light hypersensitive and have a slow somnolence buildup: [1]. The methods are sound (they used DLMO and melatonin suppression to respectively assess melatonin and light PRC on a subject basis), but it's only a master work. This hypothesis is I think very interesting and it's surprising noone has yet investigated it (since it is assumed that for blind people it's rather a light insensitiveness issue, but maybe for sighted it's actually the opposite?). It would be interesting I think to watch the future research on this topic. --Signimu (talk) 22:42, 5 November 2018 (UTC)

Condensation of DPSD and Non-24 SWD (not merging)

DPSD and Non-24-hour_sleep–wake_disorder have an enormous amount of overlapping information, which could / will be confusing to newcomers. Given that these are rarely diagnosed, largely ignored syndromes that may not be currently broadly circumscribed as such for the foreseeable future, editors should be cautious to maintain a neutral attitude towards those who may suffer from this syndrome or others similar. Sleep hygiene and exercise (increased heart rate to zone 2-4 for 20-60 min / week) are almost universally accepted remedies, but many cannot achieve these. Perhaps further discussion of efficacy with regards to evidence-based therapies is warranted, along with a significant slimming of prose otherwise.

Volunteering for this by the way, just want to understand if there's any dissident. Darkskysunflowers (talk) 10:28, 18 September 2022 (UTC)

"Total blind" probably isn't good grammar

The box at the side of the top has the words "total blind" at the bottom, under frequency.

I didn't like to correct it in case it is correct technical language somewhere in the world, but, unless that is the case, perhaps it could be corrected to "totally" or "completely"?

Or, indeed, to, "Blind people without light perception," which seems to be what it means in this context. That might be clearer, as "totally blind" could be interpreted comparatively subjectively. FloweringOctopus (talk) 18:01, 19 December 2022 (UTC)