Behaviorally and environmentally induced non–24-hour sleep-wake rhythm disorder in sighted patients

Abstract

Study Objectives: To determine whether there was evidence of circadian or sleep-regulatory dysfunction in sighted individuals with non–24-hour sleep-wake rhythm disorder. Methods: Three sighted individuals with signs and/or symptoms of non–24-hour sleep-wake rhythm disorder were studied. Thirty-five- to 332-day laboratory and home-based assessments of sleep-wake and circadian timing, endogenous circadian period, photic input to the circadian pacemaker, and/or circadian and sleep-wake–dependent regulation of sleep were conducted. Results: No evidence of circadian dysfunction was found in these individuals. Instead, sleep-wake timing appeared to dissociate from the circadian timing system, and/or self-selected sleep-wake and associated light/dark timing shifted the circadian pacemaker later, rather than the circadian pacemaker determining sleep-wake timing. Conclusions: These findings suggest that the etiology of this disorder may be light- and/or behaviorally induced in some sighted people, which has implications for the successful treatment of this disorder.