Non-24 disorder is an intrinsic circadian rhythm disorder characterized by cyclic desynchronization between the patient’s endogenous physiologic rhythms and the earth’s 24-hour light/dark cycle.1,2 Although most affected individuals are totally blind and completely lack the daily entrainment signal provided by light, recent research has suggested that the disorder is more common than previously appreciated in partially blind patients, and—albeit still rare—in sighted teenagers and young adults.3,4 Delays or even complete failures in the diagnosis of non-24 disorder are all too common, in part because patients do not proactively discuss sleep problems with their clinicians.5,6 Time-constrained providers also may not specifically probe for the presence of the cardinal symptoms of excessive sleepiness and insomnia, even in high-risk cohorts.5,7 Clinicians are further challenged to individualize evidence-based treatment regimens, especially because the recently updated national practice parameters on managing intrinsic circadian rhythm disorders do not fully integrate the only agent that has been approved by the US Food and Drug Administration for the treatment of non-24 disorder.8,9 This online Point-of-Care 101 (POC101) program has been built around a 3D animation and lively discussions between 2 sleep medicine experts on the pathophysiologic basis of non-24 disorder, actionable diagnostic recommendations, nonpharmacologic treatment approaches, and the latest evidence for pharmacologic modalities.
1. Zee PC, et al. 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, Second Edition (ICSD-3). 3rd ed. Westchester, IL: American Academy of Sleep Medicine; 2014.
3. Hayakawa T, 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.
4. Lockley SW, et al. Visual impairment and circadian rhythm disorders. Dialogues Clin Neurosci. 2007;9(3):301-314.
5. Uchiyama M, Lockley SW. Non-24-hour sleep-wake syndrome in sighted and blind patients. Sleep Med Clin. 2015;10(4):495-516.
6. National Sleep Foundation. 2009 Sleep in America Poll: Health and Safety. National Sleep Foundation. 2009:1-55.
7. Sorscher AJ. How is your sleep: a neglected topic for health care screening. J Am Board Fam Med. 2008;21(2):141-148.
8. Auger RR, et al. 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: an American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med. 2015;11(10):1199-1236.
9. Lockley SW, 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.