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Irregular sleep–wake rhythm

irregular sleep-wake rhythm disorder, irregular sleep-wake rhythm
Irregular sleep–wake rhythm is a rare form of circadian rhythm sleep disorder It is characterized by numerous naps throughout the 24-hour period, no main nighttime sleep episode and irregularity from day to day1 Sufferers have no pattern of when they are awake or asleep, may have poor quality sleep, and often may be very sleepy while they are awake The total time asleep per 24 hours is normal for the person's age234 The disorder is serious—an invisible disability It can create social, familial, and work problems, making it hard for a person to maintain relationships and responsibilities, and may make a person home-bound and isolated


  • 1 Nomenclature
  • 2 Causes
  • 3 Diagnosis
    • 31 Initial visit with sleep physician
    • 32 Medical testing
  • 4 Management
  • 5 Research
  • 6 See also
  • 7 References
  • 8 External links


The current formally correct name of the disorder is Circadian Rhythm Sleep Disorder: Irregular Sleep Wake Rhythm Type5 This disorder has been referred to by many other terms, including: Irregular Sleep Wake Pattern,6 irregular sleep wake syndrome,7 Irregular Sleep Wake Rhythm ISWRD,8 Irregular Sleep Wake Cycle,9 Irregular Sleep Wake Schedule10 and Irregular Sleep Wake Disorder ISWD4 Sometimes the words sleep and wake are hyphenated sleep–wake Sometimes the words are capitalized and sometimes they are not


ISWD has various causes, including neurological disorders such as dementia particularly Alzheimer's Disease, brain damage, or mental retardation7 It is thought that sufferers have a weak circadian clock34 The risk for the disorder increases with age, but only due to increased prevalence of co-morbid medical disorders7


A sleep diary with nighttime in the middle and the weekend in the middle, to better notice trends

A sleep diary should be kept to aid in diagnosis and for chronicling the sleep schedule during treatment Other ways to monitor the sleep schedule are actigraphy34 or use of a Continuous Positive Airway Pressure CPAP machine that can log sleeping times

The following are possible warning signs:

  • sleeping off and on in a series of naps during the day and at night, with no regular pattern but with normal total sleep time,
  • difficulty getting restorative sleep, and
  • excessive daytime sleepiness34

Because of the changes in sleep/wake time, and because this is a rare disorder, initially it can seem like another circadian rhythm sleep disorder such as non-24-hour sleep–wake disorder or like insomnia

Initial visit with sleep physicianedit

A physician specializing in sleep medicine may ask patients about their medical history; for example: neurological problems, prescription or non-prescription medications taken, alcohol use, family history, and any other sleep problems A thorough medical and neurological exam is indicated The patient will be asked to complete a sleep diary, recording natural sleep and wake up times, over several weeks Sleep rating with the Epworth Sleepiness Scale may be used34

Medical testingedit

A neurological condition or another medical problem may be suspected, in which case, blood tests, a CT scan or an MRI may be used An overnight sleep study is usually not needed to detect this disorder, but may be indicated if other sleep disorders, such as sleep apnea and periodic limb movement disorder, seem likely The overnight sleep study is called polysomnography It charts brain waves, heart beat, muscle activity, and breathing during sleep It also records arm and leg movement It will show if there are other sleep disorders that are causing or increasing the problems with ISWD


Treatment for irregular sleep–wake rhythm tries to enable the body clock in the brain, such that a normal long sleep period at night can be achieved Education about sleep hygiene is important, and counseling can be helpful Melatonin, vitamin B12, sleep aids, wake aids, and other medications may also be used34 Light during the daytime, and activities occurring at regular times each day, may help to restore a normal rhythm34

Because there are different systems in the body that help establish regulation, it's helpful to employ a multi-modal approach A 2008 review states that "each clock is differentially sensitive to zeitgebers The suprachiasmatic nucleus SCN is very responsive to light, the clock in the liver is very sensitive to food, and clocks in muscle are sensitive to exercise"11

Circadian rhythm labeled

The following approaches are recommended by one source:12

  1. Spend <7–8 hours in bed
  2. Add environmental cues such as light and social interactions, regular meal times, and regular sleep–wake times
  3. Morning and eve light at 3000 lux for 2 hours have been shown to improve nocturnal sleep in institutionalized patients and reduce agitation in demented patients
  4. Melatonin at desired sleep time


There is currently a great deal of active research on various aspects of circadian rhythm; this often occurs at major universities in conjunction with sleep research clinics at major hospitals An example is the program with Harvard Medical School and Brigham and Women's Hospital13 This research includes programs that are staffed by researchers from various departments at the university, including psychiatry, neurology, chemistry, biology Other major sleep research centers are in Tel Aviv in Israel, Munich in Germany and in Japancitation needed

A wide variety of sleep disorders are actively being researched Measuring body temperature or melatonin levels may be used Some hospitals do blood tests for melatonin levels Saliva tests for melatonin are now available for online purchase; its metabolites can also be tested in urine34

See alsoedit

  • Advanced sleep phase syndrome
  • Chronobiology
  • Circadian rhythm
  • Delayed sleep phase disorder


  1. ^ http://wwwmedlinkcom requires free trial or subscription search on term: Irregular sleep–wake pattern
  2. ^ Usage of term "Irregular Sleep–Wake Cycle": http://wwwemedicinehealthcom/sleeplessness_and_circadian_rhythm_disorder/article_emhtm
  3. ^ a b c d e f g h http://wwwsleepeducationcom/Disorderaspxid=60 Handbook of Sleep Disorders By Clete A Kushida accessed online Aug 11, 2010 /
  4. ^ a b c d e f g h i Sack RL, Auckley D, Auger RR, et al 2007 "Circadian rhythm sleep disorders: part II, advanced sleep phase disorder, delayed sleep phase disorder, free-running disorder, and irregular sleep–wake rhythm An American Academy of Sleep Medicine review" PDF: full text Sleep 30 11: 1484–501 PMC 2082099  PMID 18041481 
  5. ^ Zee, Phyllis C; Michael V Vitiello June 2009 "Circadian Rhythm Sleep Disorder: Irregular Sleep Wake Rhythm Type" Sleep Med Clin NIH Public Access 4 2: 213–218 doi:101016/jjsmc200901009 PMC 2768129  PMID 20160950 
  6. ^ Dement, William C January 22, 1999 "Circadian Rhythm Information" Retrieved 2010-10-07 
  7. ^ a b c "Irregular sleep wake syndrome" National Center for Biotechnology Information, US National Library of Medicine Reviewed 5/9/2010 Retrieved 2010-10-07  Check date values in: |date= help
  8. ^ Zee, Phyllis C; Vitiello, Michael V 2010 "Circadian Rhythm Sleep Disorder: Irregular Sleep Wake Rhythm Type" Sleep Med Clin 4 2: 213–218 doi:101016/jjsmc200901009 PMC 2768129  PMID 20160950 Irregular Sleep Wake Rhythm Disorder ISWRD is characterized by the relative absence of a circadian pattern  
  9. ^ "Sleeplessness and Circadian Rhythm Disorder" WebMDnewsletter Retrieved 2010-10-07 
  10. ^ Fieve, Ronald R Bipolar Disorder and Sleep http://wwwathealthcom/consumer/disorders/bipolarandsleephtml
  11. ^ Harvey, Allison G July 2008 "Sleep and Circadian Rhythms in Bipolar Disorder: Seeking Synchrony, Harmony, and Regulation" The American Journal of Psychiatry 165 7: 824 doi:101176/appiajp200808010098 PMID 18519522 For the latter, each clock is differentially sensitive to zeitgebers The SCN is very responsive to light, the clock in the liver is very sensitive to food, and clocks in muscle are sensitive to exercise 
  12. ^ From "Ultiimate review for the neurology boards" by Hubert Fernandez p243
  13. ^ http://sleepmedharvardedu/people/faculty

External linksedit

  • Journal of Clinical Sleep Medicine
  • Journal Sleep
  • search on term: Irregular sleep–wake pattern/ MedLink, Abstract of study with lots of information

irregular sleep-wake rhythm, irregular sleep-wake rhythm disorder, irregular sleep-wake rhythm treatment

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Irregular sleep–wake rhythm

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