Improving Outcomes in Non–24-Hour Sleep-Wake Disorder
Identifying Patients and Tailoring Therapy
Guidelines
International Classification of Sleep Disorders – Third Edition (ICSD-3).
The ICSD-3 is the authoritative clinical text for the diagnosis of sleep disorders. Updated in 2014, the third revision to the ICSD features significant changes, including new nomenclature, classifications, and diagnoses. The book also includes current and accurate diagnostic and treatment reimbursement codes (eg, ICD-10). Disorders are grouped into 6 major categories, one of which is circadian rhythm sleep-wake disorders.
American Academy of Sleep Medicine. 2014; Westchester, IL.
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.
The American Academy of Sleep Medicine has recently updated clinical guidelines for the treatment of intrinsic circadian rhythm sleep-wake disorders. These guidelines were created using a systematic literature review, assessment of evidence using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, and meta-analyses.
Auger RR, et al. J Clin Sleep Med. 2015;11(10):1199-1236.
Patient and Caregiver Resources
2009 Sleep in America Poll: Summary of Findings.
The National Sleep Foundation’s 2009 Sleep in America™ poll of 1000 respondents highlights behaviors that adversely impact sleep and the consequences of insufficient sleep.
Information on Non–24-Hour Sleep-Wake Disorder From the National Sleep Foundation.
The National Sleep Foundation website offers patient-centered information regarding symptoms, diagnosis, pharmacologic therapies, other management modalities, and associations between non–24-hour sleep-wake disorder and other medical/psychiatric conditions.
Circadian Sleep Disorders Network: Advocating for People With Misalligned Body Clocks.
The Circadian Sleep Disorders Network is a volunteer-driven nonprofit organization that is dedicated to increasing awareness of chronic circadian rhythm disorders, advocating for accommodations, and providing support for those living with these conditions.
Clinical Tools
Epworth Sleepiness Scale.
The Epworth Sleepiness Scale (ESS) is a self-administered questionnaire that quantifies an individual’s general level of sleepiness. The total ESS score can range between 0 and 24. A score >12 indicates a significant amount of sleepiness.
Johns MW. Sleep. 1991;14(6):540-545.
National Sleep Foundation Sleep Diary.
The National Sleep Foundation’s sleep diary can help patients and clinicians track and evaluate sleep habits and problems over time, thereby standardizing an essential step in the diagnosis and management of circadian rhythm sleep-wake disorders.
The Insomnia Severity Index.
The Insomnia Severity Index is a validated instrument used to assess the degree of insomnia and treatment responses. A score of 8 to 14 indicates subthreshold insomnia, whereas a score of ≥15 indicates clinical insomnia.
Morin CM, et al. Sleep. 2011;34(5):601-608.
Suggested Readings
Non-24-hour disorder in blind individuals revisited: variability and the influence of environmental time cues.
Emens JS, et al. Sleep. 2013;36(7):1091-1100
Non-24-hour sleep-wake disorder revisited: a case study.
Garbazza C, et al. Front Neurol. 2016:7:17.
Safety profile of tasimelteon, a melatonin MT1 and MT2 receptor agonist: pooled safety analyses from six clinical studies.
Leger D, et al. Expert Opin Drug Saf. 2015;14(11):1673-1685.
Alertness, mood, and performance rhythm disturbances associated with circadian sleep disorders in the blind.
Lockley SW, et al. J. Sleep. Res. 2008;17(2):207-216.
Tasimelteon for non-24-hour sleep-wake disorder in totally blind people (SET and RESET): two multicentre, randomised, double-masked, placebo-controlled phase 3 trials.
Lockley SW, et al. Lancet. 2015;386(10005):1754-1764.
Sleep: a health imperative.
Luyster FS, et al. Sleep. 2012;35(6):727-734.
Personality differences in delayed sleep-wake phase disorder and non-24-hour sleep-wake rhythm disorder patients relative to healthy sleepers.
Micic G, et al. Sleep Med. 2016 Jun 16. [Epub ahead of print].
Excessive sleepiness: Under-recognized and essential marker for sleep/wake disorder management.
Roth T, et al. Curr Med Res Opin. 2010;26(suppl 2):S3-S24.
Adverse metabolic and cardiovascular consequences of circadian misalignment.
Scheer FA, et al. Proc Natl Acad Sci U S A. 2009;106(11):4453-4458.
Caffeine does not entrain the circadian clock but improves daytime alertness in blind patients with non-24-hour rhythms.
St Hilaire MA, Lockley SW. Sleep Med. 2015;16(6):800-804
Circadian rhythm abnormalities.
Zee PC, et al. Continuum (Minneap Minn). 2013;19(1 Sleep Disorders):132-147.
Interactive PresentationImproving Outcomes in Non–24-Hour Sleep-Wake Disorder
Karl Doghramji, MD; Paul P. Doghramji, MD, FAAFP
Identifying Patients and Tailoring Therapy
A Case-Based Discussion on Diagnosis and Treatment
Relevant Resources
Practical Diagnostic and Tailored Treatment Strategies
Overcoming Pain and Gastrointestinal Distress to Improve Patient Outcomes
Evidence-Based Strategies for Improved Patient Outcomes
Proactive Diagnosis and Targeted Management
Differential Diagnosis and Comprehensive Management Strategies
Optimizing Maintenance Therapy Across Healthcare Settings
Evolving Strategies for Diagnosis and Long-Term Management
Consensus and Controversies for Responsible Opioid Prescribing
Best Practices in Combination Therapy
Evolving Approaches to Insulin Based Therapy
Improving Outcomes for Patients with COPD
New Strategies for Insulin Replacement Therapy
Clinical Updates in LDL-C Management
Improving Comprehensive Patient Care
Collaborative Approaches to Guideline-Concordant Patient Care
New Strategies for Individualizing Long-term Care
A Focus on Patients With Opioid-Induced Constipation
Consensus and Controversies Across the Spectrum of Patient Presentations
Evolving Treatment Algorithms and Expert Perspectives on Biosimilars
Evolving Best Practices to Optimize Outcomes
The PCP’s Role in Timely Recognition and Referral
Differential Diagnosis, Multidisciplinary Management, and Patient Engagement
Key Issues Impacting OB/GYN Practice
Volume II: Expanding Evidence for the Role of Rapid ART Initiation in HIV Practice
Improving Patient Outcomes Through Shared Clinical Decision Making
Mechanistic Insights and Evolving Treatment Options
Clinical Resource Center
A Case-Based Conversation on Managing Asthma and Chronic Rhinosinusitis With Nasal Polyposis
The Clinical and Utilization Benefits of Exacerbation Prevention
A PrEP Primer
A Foundation for Managed Care
Cardiovascular and Renal Outcomes With SGLT2 Inhibitors
Best Practices for Primary Care
New Paths to Chronic Pain Management
What the Pharmacist Needs to Know about PrEP
Unlocking Novel Paths to Patient Care
The Increasing Role of JAK Inhibitors
Preventing COPD Exacerbations to Improve Outcomes
A Whole Patient Case Series
Getting on the Fast Track to Identify AxSpA
Establishing Clinical Readiness Through Mentored Learning
Interdisciplinary Strategies for Adult and Pediatric Patients
Interdisciplinary Management of Eosinophilic Esophagitis and Hereditary Angioedema
Reducing LDL-C and a Lifetime of Cardiovascular Risk
Updates, Clinical Scenarios, and Future Directions
A Multidisciplinary Look at Early Diagnosis and Management
Best Practices for Diagnosis and Management
An Update on Best Practices
New Avenues to Pre-Exposure Prophylaxis
Are You Aware of New Blood-Based Multi-Cancer Screening Tools
A Look at the Changing HIV Playing Field
A “How To” Series Spanning Policy to Practice
Test Your Mastery!
Building Bridges to Reach People who Inject Drugs with the Goal of Employing PrEP for HIV Prevention
Strengthening Your Knowledge of Blood-Based Screening Tools
Bringing HIV Prevention to a New Level
Optimizing HIV Prevention in Primary Care
What You Need to Know About New Blood-Based Screening Tools
Monoclonal Antibodies for the Prevention and Treatment of COVID-19
Exploring New Treatment Avenues in Nonadvanced Systemic Mastocytosis
Practical Updates on the 2023 GOLD Guidelines
A Phone-a-Friend CME Series – Volume 2
Incorporating New Data and Updated Guidelines Into Daily Practice
Focus on Psoriasis
Capitalizing on BCMA-Directed Therapies
