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 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 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

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, your 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.

Your provider may ask you to keep a sleep diary. This is a record of what times you go to bed and wake up. The diary allows your provider to assess your sleep-wake cycle patterns.

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. (In older people, especially those with dementia, sedatives such as melatonin are not advised.)
• Making sure the room is dark and quiet at night.

The outcome is often good with treatment. But some people continue to have this disorder, even with treatment.

Most people have sleep disturbances on occasion. If this type of irregular sleep-wake pattern occurs regularly and without cause, see your provider.

Sleep-wake syndrome - irregular; Circadian rhythm sleep disorder - irregular sleep-wake type

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Auger RR, Burgess HJ, Emens JS, Deriy LV, Thomas SM, Sharkey KM. Clinical practice guideline for the treatment of intrinsic circadian rhythm sleep-wake disorders: advanced sleep-wake phase disorder (ASWPD), delayed sleep-wake phase disorder (DSWPD), non-24-hour sleep-wake rhythm disorder (N24SWD), and irregular sleep-wake rhythm disorder (ISWRD). An update for 2015: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2015:11(10):1199-1236. PMID: 26414986 pubmed.ncbi.nlm.nih.gov/26414986/.

Avidan AY. Sleep and its disorders. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff's Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 101.

Updated by: Allen J. Blaivas, DO, Division of Pulmonary, Critical Care, and Sleep Medicine, VA New Jersey Health Care System, Clinical Assistant Professor, Rutgers New Jersey Medical School, East Orange, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.