Non-24-hour sleep-wake disorder (N24SWD) is a condition in which a person’s circadian clock does not follow the typical 24-hour-cycle. Individuals with N24SWD typically have bedtimes that get progressively later each day, causing sleep problems and disruptions to daily life.
Though non-24-hour sleep-wake disorder is rare, individuals with the condition can take heart in knowing they are not alone. There is increasing awareness about circadian rhythm disorders within the medical community, as well as the world at large.
Because of their erratic sleep schedules, people with non-24-hour sleep-wake disorder often have trouble meeting school, work, social, or other obligations. They may also have difficulty doing important everyday tasks, such as scheduling doctor’s appointments, going shopping during standard daytime business hours, or using public transport late at night.
Since N24SWD is a relatively rare disorder, there is very little public awareness about it. As such, many people with N24SWD face judgment from family, friends, and coworkers who do not understand the challenges of the disorder. People with N24SWD may be perceived as being lazy, flaky, or not trying hard enough to sleep at normal times.This pressure causes many people with N24SWD to try to force themselves to sleep at times that are not concordant with their innate circadian rhythm. This can cause sleep problems and daytime fatigue, which often lead to erroneous diagnoses like insomnia or other sleep disorders. People with N24SWD may also rely on naps to get through the day, further reducing their sleep drive at night. Without proper diagnosis and treatment, people with N24SWD can experience chronic circadian misalignment and sleep deprivation.
In the short term, studies of shift workers have found that circadian misalignment leaves people vulnerable to problems with attention, memory, and mood. This affects academic and workplace performance and increases the risk of accidents. In the long term, sleep deprivation is associated with many negative health outcomes, including increased risk of obesity, diabetes, cardiovascular disease, depression, anxiety, and other chronic conditions.
Your doctor may be unfamiliar with non-24-hour sleep-wake disorder, but you can help foster a constructive conversation by preparing for your appointment beforehand. As part of that preparation, it is often helpful to keep a sleep journal for a few months with your sleep and wake times. You should also keep track of other symptoms, such as:
Based on further questions about your sleep habits and tests to monitor your circadian rhythm, your doctor will formulate a treatment plan that likely involves melatonin, bright light therapy, or a combination therof. Managing non-24-hour sleep-wake disorder also requires following healthy sleep hygiene practices to reinforce circadian cues. Some tips include:
It’s important to follow your doctor’s treatment plan, but it’s also imperative to tell your doctor if a treatment plan isn’t working for you, so that they can make adjustments as necessary. It may help to ask for a referral to a sleep specialist with a better understanding of circadian rhythm disorders.
Explaining non-24-hour sleep-wake disorder to your friends and family can help them understand why you may appear tired or disinterested, or why you sometimes aren’t able to meet commitments.
Tell them about your experience with N24SWD, perhaps explaining your history of symptoms, such as falling asleep at inappropriate times or feeling irritated due to sleep deprivation. Since non-24-hour sleep-wake disorder can be confusing for someone who has never heard of it before, try comparing it to something they understand, like jetlag. You may also direct them to resources to learn more about the condition.
Many people find validation through online support groups or associations. Sharing thoughts and feelings with other people in the same situation can help you feel less alone and give you new ideas for coping with non-24-sleep-wake hour disorder.
It can be difficult to manage a healthy social life while experiencing N24SWD. However, there are certain things you can try to make it easier.
Ask your friends and family to be more flexible with meeting times, perhaps suggesting activities that can be done at any time of day, such as going for a walk.
Those with a strong understanding of their sleep schedule can try scheduling activities for weeks when they know they will sleep better. Making friends with other people in similar situations, such as shift workers or freelancers, may also open up more scheduling possibilities.
There are plenty of alternative options for keeping in touch with friends outside “regular” hours, though some of these might not be appropriate if you are on strict therapy to keep a 24-hour schedule. For example, bars, nightclubs, and other places that stay open late can be an enticing option, but the late-night stimulation (and alcohol consumption) may make it even more difficult to sleep afterward. Likewise, social media can be used at any time of the day or night to answer messages from friends or chat with friends in other time zones, but using screens at night can interfere with sleep.
Whatever method you choose should be chosen with your therapy in mind. Try not to increase or adopt behaviors that will negatively impact your N24SWD treatment.
Non-24-hour sleep-wake disorder qualifies as a disability under the terms of the American Disabilities Act (ADA) in that it can substantially limit major life activities such as concentrating, interacting with others, and working. Under the terms of the ADA, most employers are legally obliged to make reasonable accommodations for you, as long as you are broadly qualified to do the work.
Allowances under the ADA are worked out on a case-by-case basis, and employers are not obliged to make accommodations if these are considered to pose “undue hardship” to the company. Depending on your line of work, you may need to hire a lawyer to represent your case. Accommodations your employer may be able to arrange and offer you include working part-time or modified hours or working partially or totally from home.
When approaching your employer, cite the ADA, be clear about how N24SWD affects your ability to work and suggest accommodations that would help you be more productive. Consider consulting your lawyer. You may also choose to share the particularities of your case with your colleagues if you think it would help create a better working relationship.
Certain jobs are naturally well-suited to people with irregular sleep schedules. Though you shouldn’t have to limit your career path based on your N24SWD, you may find you gravitate towards jobs that allow you more flexibility in your working hours. Examples of flexible jobs include:
These jobs may be especially attractive for people who have difficulty maintaining a 24-hour cycle, or for those who still feel unwell even when they adhere to a standard “day and night” schedule.
As outlined under Section 504 of the 2008 Disabilities Act Amendment Act, students with disabilities also have the right to an education that meets their needs, whether in elementary, secondary, or post-secondary school. Examples of reasonable accommodation for students might include taking classes online, allowing students to miss some classes and make up the work at another time, or taking a lighter course load.