What is it? Irregular sleep-wake rhythm is one of several circadian rhythm disorders. People with these disorders have sleep times that seem to be out of alignment. Their sleep patterns do not follow the “normal” sleep times at night. The sleep of patients with irregular sleep-wake rhythm is so disorganized that there is no clear sleep or wake pattern. People with irregular sleep-wake rhythm may sleep off and on in a series of naps over a 24-hour period. The sleep pattern is broken up into pieces. This is similar to infants who may sleep for a few hours and then be awake for a few hours. If you add up all of the sleep times, the total sleep time may be normal for that age. During the day, it may seem like they are sleepy because they nap so much. During the night, it may seem like they have insomnia because they are awake for long periods of time during the night. Their sleep is broken up into pieces all day and all night. There is not one main sleep time that occurs at any time of day.
Irregular sleep-wake rhythm is one of several circadian rhythm disorders. People with these disorders have sleep times that seem to be out of alignment. Their sleep patterns do not follow the “normal” sleep times at night. The sleep of patients with irregular sleep-wake rhythm is so disorganized that there is no clear sleep or wake pattern.
People with irregular sleep-wake rhythm may sleep off and on in a series of naps over a 24-hour period. The sleep pattern is broken up into pieces. This is similar to infants who may sleep for a few hours and then be awake for a few hours. If you add up all of the sleep times, the total sleep time may be normal for that age. During the day, it may seem like they are sleepy because they nap so much. During the night, it may seem like they have insomnia because they are awake for long periods of time during the night. Their sleep is broken up into pieces all day and all night. There is not one main sleep time that occurs at any time of day.
Who gets it? Irregular sleep-wake rhythm is rare. We do not even know how many people have it. It is believed that some people may have it because they have a weak body clock. This may happen in neurological conditions like the following: Dementia Brain damage Mental retardation This can also happen in people who do not have a neurological problem. There are conditions that may make it easier for this problem to occur. Daily light and other activities are important in resetting our sleep clocks. Bad sleep habits may allow this disorder to occur in people who have weaker clocks. This is especially true for people who do not get proper exposure to daily light
Irregular sleep-wake rhythm is rare. We do not even know how many people have it. It is believed that some people may have it because they have a weak body clock. This may happen in neurological conditions like the following:
This can also happen in people who do not have a neurological problem. There are conditions that may make it easier for this problem to occur. Daily light and other activities are important in resetting our sleep clocks. Bad sleep habits may allow this disorder to occur in people who have weaker clocks. This is especially true for people who do not get proper exposure to daily light
How do I know if I have it? Do you sleep off and on in a series of naps during the day and at night? Is there no regular pattern of when you sleep and are awake? Is it hard for you to sleep well, or are you very sleepy when you are awake? If you add together all of the time you sleep in a 24-hour period, is the total sleep time normal for your age? If your answer to these questions is yes, then you might have irregular sleep-wake rhythm.
If your answer to these questions is yes, then you might have irregular sleep-wake rhythm.
Do I need to see a sleep specialist? Yes. You should seek a doctor’s advice. This disorder causes problems with work and family. There is no schedule or pattern for when you are asleep or awake. Your sleep time is out of line with others. This makes it hard for you to maintain relationships and responsibilities. This disorder may make you home bound and isolated. Being home bound can make this problem worse. Some people try behaviors or medicines to correct the problem. This may only worsen the problem. They may get into trouble if they try to fix this problem on their own by taking pills or alcohol.
Yes. You should seek a doctor’s advice. This disorder causes problems with work and family. There is no schedule or pattern for when you are asleep or awake. Your sleep time is out of line with others. This makes it hard for you to maintain relationships and responsibilities. This disorder may make you home bound and isolated. Being home bound can make this problem worse. Some people try behaviors or medicines to correct the problem. This may only worsen the problem. They may get into trouble if they try to fix this problem on their own by taking pills or alcohol.
What will the doctor need to know? 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 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.
Will I need to take any tests? The diagnosis of irregular 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 research. Your doctor may suspect that a neurological condition or another 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 irregular sleep-wake rhythm.
The diagnosis of irregular 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 research.
Your doctor may suspect that a neurological condition or another 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 irregular sleep-wake rhythm.
How is it treated? Treatment for irregular 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. Light treatment is one 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. Melatonin, vitamin B12, sleep aids, awake aids, and other medications may also be used. A doctor may monitor your progress by having you complete sleep logs during treatment. As research studies continue, more information will become available about the causes and other future treatments of this uncommon sleep disorder. By Sharon L. Schutte-Rodin, MD Updated March 27, 2006
Treatment for irregular 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.
Light treatment is one 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. Melatonin, vitamin B12, sleep aids, awake aids, and other medications may also be used.
A doctor may monitor your progress by having you complete sleep logs during treatment. As research studies continue, more information will become available about the causes and other future treatments of this uncommon sleep disorder. By Sharon L. Schutte-Rodin, MD Updated March 27, 2006
