Sleep Education

American Academy of Sleep Medicine 

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Non-24-Hour Sleep-Wake Rhythm – Diagnosis & Treatment


You should seek a doctor’s advice. This disorder causes problems with work and family. Your sleep cycle gradually moves in and out of normal sleep times. There is not one fixed sleep time, either early or late. Sometimes the main sleep time is during the night and sometimes it is during the day. 

People with this disorder have trouble maintaining relationships and responsibilities. This disorder may make you home bound and isolated. Being home bound can make this problem worse. Some people also try behaviors or medicines to correct the problem. This may only worsen the condition. They may get into trouble if they try to fix this problem on their own by taking pills or alcohol. 

The doctor should ask you about your medical, neurologic, and sleep symptoms. The doctor also should ask you about your medications, alcohol, and your family history. Be sure to inform him or her of any past or present drug, alcohol, and medication use. Also tell the doctor if you have ever had any other sleep or neurological disorders.

The doctor should do a thorough medical and neurological exam.

You will be asked to complete a sleep diary to record your natural sleep and wake up times over several weeks. You may be asked to rate your sleep with the Epworth Sleepiness Scale. 

The diagnosis of Non-24-Hour Sleep-Wake Rhythm is made clinically and with the use of the sleep diary. You may be asked to wear an actigraph. This is a device that records inactive and active episodes over a period of one to two weeks. An actigraph looks like a funny wrist watch, and you wear it day and night.

Other testing methods to measure body temperature or melatonin levels may be used. Most often these methods are used for the purpose of research.

Your doctor may suspect that a neurological or other medical problem is involved. In this case, you may be asked to have blood testing performed. You may also need a CT scan or an MRI.

An overnight sleep study is usually not needed to detect this disorder. You may need to do a sleep study if you are at risk for other sleep disorders. The sleep study is called a polysomnogram. It charts your brain waves, heart beat, muscle activity, and breathing as you sleep. It also records how your arms and legs move. This shows if there are other sleep disorders that are causing or increasing your sleep problems. Examples include sleep apnea and periodic limb movement disorder. A sleep study is not used to make the diagnosis of Non-24-Hour Sleep-Wake Rhythm.


Treatment for Non-24-Hour Sleep-Wake Rhythm is aimed at trying to increase stimulation to reset the sleep clock in the brain. The goal is to have one long sleep time at night and one long awake time during the day.

Timed melatonin is one possible treatment for blind adults. Patients should work with their sleep specialist to determine the proper time and dosage of melatonin.

For sighted people, light treatment is a way to help a weakened body clock. Other scheduled behaviors can also help.

Education and behavioral counseling can be helpful. Following the rules of good sleep hygiene is an important way to keep one main sleep time. As research studies continue, more information will become available about the causes and other future treatments of this uncommon sleep disorder.

Reference: Clinical Practice Guideline for the Treatment of Intrinsic Circadian Rhythm Sleep-Wake Disorders

Updated Sept. 30, 2016