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Irregular sleep-wake syndrome

  • Definition
    • Irregular sleep-wake syndrome is sleeping without any real schedule.

  • Alternative Names
    • Sleep-wake syndrome - irregular; Circadian rhythm sleep disorder - irregular sleep-wake type

  • Causes
    • This disorder is very rare. It usually occurs in people with a brain function problem who also don't have a regular routine during the day. The amount of total sleep time is normal, but the body clock loses its normal circadian cycle.

      People with changing work shifts and travelers who often change time zones may also have these symptoms. These people have a different condition, such as shift work sleep disorder or jet lag syndrome.

  • Symptoms
    • Symptoms may include any of the following:

      • Sleeping or napping more than usual during the day
      • Trouble falling asleep and staying asleep at night
      • Waking up often during the night
  • Exams and Tests
    • A person must have at least 3 abnormal sleep-wake episodes during a 24-hour period to be diagnosed with this problem. The time between episodes is usually 1 to 4 hours.

      If the diagnosis is not clear, the health care provider may prescribe a device called an actigraph. The device looks like a wristwatch, and it can tell when a person is sleeping or awake.

  • Treatment
    • The goal of treatment is to help the person return to a normal sleep-wake cycle. This may involve:

      • Setting up a regular daytime schedule of activities and mealtimes.
      • Not staying in bed during the day.
      • Using bright light therapy in the morning and taking melatonin at bedtime.
      • Making sure the room is dark and quiet at night.
  • Outlook (Prognosis)
    • The outcome is often good with treatment. But some people continue to have this disorder, even with treatment.

  • When to Contact a Medical Professional
    • Most people have sleep disturbances on occasion. But if this type of irregular sleep-wake pattern occurs regularly and without cause, see your provider.

  • References
    • Abbott SM, Reid KJ, Zee PC. Circadian disorders of the sleep-wake cycle. In: Kryger M, Roth T, Dement WC, eds. Principles and Practice of Sleep Medicine. 6th ed. Philadelphia, PA: Elsevier; 2017:chap 40.

      Chokroverty S, Avidan AY. Sleep and its disorders. In: Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SL, eds. Bradley's Neurology in Clinical Practice. 7th ed. Philadelphia, PA: Elsevier; 2016:chap 102.