Non-24 Hour Sleep Wake Syndrome

Non-24-hour sleep-wake syndrome, also called free-running type or non-24-hour circadian rhythm disorder, is one of many circadian rhythm disorders and probably the rarest and most difficult to correct of all of them. Most people have an internal biological clock, or circadian rhythm, that roughly adheres to a 24 hour schedule. There may be slight daily variances in waking and sleeping onset times, but these all generally even out over a longer stretch of time. Even those with advanced or delayed circadian rhythm disorders function within this 24 hour schedule.

What is Non 24 Sleep Wake Disorder?

Those with non-24-hour sleep-wake syndrome do not have internal clocks that reset and stay balanced within a 24 hour schedule. In most cases, their circadian rhythms are set on longer loops, usually resulting in 25 or 26 hour cycles, or even more in some cases. There have documented cases of people having as dramatic as 72 hour cycles, in which they would stay awake for 48 straight hours, and then sleep for 24 straight hours as a regular sleeping pattern. There are only a few known dramatic cases such as that though, and most cases fall within the 25 or 26 hour range.

What this means for these individuals is that their sleep and wake times are pushed back by 1 or 2 hours every day. This leads to a constant cycle between sleep times that are considered unconventional by society’s standards, with occasional short stops in conventional time frames before progressing on again into unconventional. This extremely unbalanced sleeping schedule makes it all but impossible for the subject to hold a traditional job, or attend regularly scheduled school classes unless they fight the disorder, which is not easy without the proper treatment. individuals living with this have often found their ‘calling’ working in a self employed capacity, or in a number of other fields of work where they can effectively set their own work schedule. Those still attending school may find it necessary to take home schooling through the internet or other avenues.

Apart from the social stress or depression that living with non-24 hour disorder may cause, the disorder itself is not considered harmful. The actual quality of sleep, and more importantly deep sleep, is equal or in many cases better, than those without the disorder.

Who gets Non 24 Sleep Wake Disorder?

Non-24-hour sleep wake disorder is very common among blind people, with more than 50% of blind people having it. Though they have fully functioning biological clocks, without the light cues to balance and reset it on, the circadian rhythm often becomes unbalanced. This condition is quite rare in those with sight, but can occur. Having unstructured or irregular daily routines, bad sleeping habits, and poor exposure to sunlight on a consistent basis can all be factors in the development of this disorder.

There are also studies showing a link between delayed sleep phase disorder and non-24-hour sleep-wake syndrome, in that those with delayed sleep phase are at a higher risk of developing free-running type.
In most cases, a doctor should be consulted regarding this disorder. Even if it is not causing conflict with work or other activities, it may be that it is affecting your relationships with family or friends, which could lead to stress and depression, and other sleeping problems or mental health issues as a result.

How is Non-24 Disorder Diagnosed?

A doctor will need to have a history of your past sleeping routines, as well as your medical history and be informed of any recent changes in your life that may be contributing to the disorder. Any drug or medication use will also need to be documented. You may be subjected to a neurological test as well. Additionally, you may need to have your body temperature and melatonin levels examined.

Treatments for Non-24  Disorder

Once the disorder has been diagnosed, which will not require an overnight sleep study, the treatment plans can begin. The first area will target changes you can make in your routine in an attempt to reset and balance your circadian rhythm. This will include incorporating fixed events into your schedule at set times no matter when you wake up, to try and root your internal clock to a 24 hour rhythm.

Melatonin is the most widely used treatment, and is typically ingested within a few hours of the desired bedtime. This can be helpful in rooting your bedtime. Light treatment for sighted people, chronotherapy and acupuncture have all been used as well with varying results.

It is common of all treatment methods that they take a long process before showing any results, and some subjects have shown extreme resistance to all therapies. Like many sleeping disorders there is no cure in a traditional sense, and the disorder must be constantly monitored and effective treatments for the patient actively continued. Maintaining a sleep diary after starting on any treatment plan will help a doctor in determining the success rate of the plan, and whether it should be maintained, abandoned in favor of another treatment option, or merged with another plan.

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36 thoughts on “Non-24 Hour Sleep Wake Syndrome

  1. Tia Reply

    I’ve read each of these comments and FINALLY I feel validated because there are actually other people out there like me! I’m awake for a day or more but still not sleepy. I “force” myself to sleep most days with over the counter medicine or a prescription pill. When I finally do sleep I can sleep for up to 24 hours. My question is what doctor can actually help me??

    • Jason Reply

      Same here! Definitely speak to your primary care physician. I just spoke to mine a couple of weeks ago. She is sending me to do a sleep study. Fingers crossed and good luck!

  2. Jackie R Campa Reply

    I’m awake for 24-72 hours, then crash for 24. Then the cycle repeats. What’s wrong with me? This has been going on fy several years.

    • Christopher Reply

      I’m usually awake for around 24 hours then sleep for about 4-5 hours. Then I’m up again. Melatonin didn’t work for me. I have no clue how to fix it. That being said, I’ve never had issues mentally. I’ve just always been like this. I’m just never tired.

  3. Hackberry Reply

    Anyone else have a head injury/car accident/fall that may have resulted in a Traumatic Brain Injury? My beloved child was accidentally pushed off play equipment at 5 years old. Since then, we’ve been chasing the clock together (or as much as I can with them).

    Using a 10,000 Lux LED Lightbox for 1 hour immediately after waking daily, the shift has moved from 120 minutes daily to just 20-30 minutes. Still, we chase the clock, but 75% more slowly.

    Melatonin increased my child’s already horrid nightmares.

    When my child experiences anxiety, they are “afraid to sleep” and may stay awake for 24 hours, sleep 7, and adjust a few more times before settling on a new not-normal rhythm.

    We both have hyper mobile EDS.

    • Emmarie Reply

      I have the same symptoms as your child and also got non24 from a head injury (I was 27 though).

    • Liv Reply

      Yes. Was in a car accident when I was 7 (and 14), had a fall on my head when I was 9.
      Also have EDS (same as my mother and her mother)

      My circadian clock is out of order. When I was younger I was afraid to sleep because it “kidnapped my brain” (would sleep 10-14 hours) so I’d rather stay awake for 48 hours. (As an adult, Im awake 10-15 hours & sleep 16-20 hours) Tried Melatonin & Ritalin but didn’t like them. Made me feel like a zombie.

      I also have ASD, ADD, Hashimotos & Tinnitus. Friends call me Sleeping Beauty. I’m always tired & I sleep A LOT. I’ve found help online, from social media where other people share how they manage their lives.

    • Ceejay Reply

      I can stay awake for 38 hours and sleep for 14 hours thats my routine, Is it alright?

  4. Thomas Reply

    I’ve been awake for 15 days without sleeping and I just want to go to sleep,my friend is coming to give me a 2 milligram xanax.. I usually stay awake for 3 or 4 days then sleep maybe 4 or 5 hours then I am wide awake again.. I function fine without sleep.. I use to sleep 10 to 12 hours a day and then I went to not sleeping for days and this started about 2 1/2 years ago.. hopefully the Xanax will make me go to sleep tonight,, I’m going on 16 days without sleeping..

  5. Ian Reply

    So if anyone could help me that would be great! So since quarantine I haven’t been working and so I was napping a lot. I recently moved into my basement room and it only has a little tiny window and that’s where I spend the majority of my time. Not even close to enough light to fill my room. Basically all artificial light. Lately I haven’t really been all that sleep and I would stay up for around 28 hours than maybe sleep 8 the next day. Now my sleep is getting worse and I can’t sleep every night. I’m sleeping only every other day but I than sleep for 8-9 hours and feel fine. I force myself not to sleep to long because I’m not trying to oversleep and waste my day but I’m also worried I’m definitely not getting enough sleep. I don’t feel very tired during my days but I’m worried about the things I can’t see that no sleep every night might be doing to me. If anyone had some advice it would be much appreciated

    • Sarah Reply

      We can clearly see what has destroyed your sleep wake cycle. Get out of your basement. Move upstairs with the normal sunlight, get outside and I guarantee seeing the sunrise, seeing sun all day and then being outside a little before sunset begins WILL reactivate your normal sleep trigger. Keep your bedroom windows uncovered (unless you use a sheer curtain instead of a thick one, then keep the sheer over the window and keep the thick curtains open.

  6. Tina Reply

    My entire life staying awake during the day was difficult. At age 16 my mom was eager to sign me out of school so she didn’t have to deal with the school and my sleeping there. This leads to the most unpredictable sleep. I sleep 4 hours, awake 2, repeat for several days, then up 48 hours (+/-), asleep 48-72 hours. There is no prediction on what today will be like. But I have the worst case of Agoraphobia. I studied myself for years. I see a counselor and from age 22 and current at age 45 I tried all their medications faithfully. They did a medical DNA test, Im compatible with only 3 medications and none of them worked. I’m overly sensitive to side effects. Normal business hours 7am-7pm, those are the hours you wont easily find me, I park in secluded areas and sleep. It’s alway been this way. 45 years and still these Doctors keep feeding me pills instead of accepting it and helping me live with it.

    • Amber Reply

      Hi Tina, I was reading the comments and it made me feel better knowing that I’m not alone. I’ve struggled with sleep issues for years. My dad also had a very different sleep awake cycle, as does my brother and I wonder if it’s not genetic? Anywho, I was diagnosed with borderline narcolepsy 10 years ago where the severity of it comes and goes depending on my stress level. I was also diagnosed with adrenal fatigue after literally working myself to near death when doing my father’s hospice home care while he battled cancer. I was involved with a guy for 5 years who was very strict. And he did everything in his power to put me on a schedule like his… But it didn’t work. Even fits of rage and violence weren’t changing my backwords sleep patterns. He left a few months ago and now for pretty much the first time in my life..I am alone. My daughter is 18 and moved out. And my sleep patterns are all over the place. There is no pattern. Sometimes I can stay awake for 24-48 hours and not feel tired at all… Other times I can sleep for 30 hours straight! And then there’s the out of the blue just falling asleep anywhere, anytime. I don’t do drugs, not even prescription drugs, I don’t drink.. Nothing. I have tried to reset my schedule with no positivr results. It has got to the point that at times I’m Afraid to go to sleep because I don’t want to sleep for 2 days! I don’t know what to do. It’s helpful hearing that other people have these problems… Not just me. I just wanted to thank you for sharing because that alone made me feel better about whatever it is, that’s wrong with me. I’ve thought about just embracing it… Living the way I do and just trying to use it to my advantage in life instead of fighting it. If only society were more supportive of people who live on different schedules than the typical 9-5pm.. Thank you again though, for posting and I hope things get better for you as well!

  7. Ken Pancoast Reply

    I can sleep for 24hrs. easily. I have slept for as much as 30. Its not sleep apnea. I sleep well. I just sleep waaay to long

  8. Pilan Reply

    I’m not sure what is wrong with me lately, but I have a hard time falling asleep. When I do fall asleep it is for 12-24 hours straight except to go to the bathroom. This has been going on for over a month and a half now. Then the next day I can’t fall asleep for another full day. It’s making me so sad and depressed.

  9. Ari October Reply

    I don’t have the extreme hypersomnia I’ve read about in some of these comments but I do have a shifting sleep schedule. My body wants me to go to bed 30-120 min later every day. Then I sleep 7-10 hours like recommended for normies. But that’s when my body is being consistent! Often though I find myself waking up on 3-5 hours of sleep and not being able to fall back asleep for several hours, then I sleep another 3 to 8(!) hours when I inevitably pass out. Unless I go the whole day on 6 or less hours of sleep. I hate days like that because I can feel the effects of sleep deprivation but I desperately want to sleep at a ~regular~ hour and/or I just can’t get back to sleep. So I think I have N24 combined with insomnia. Consistent for me is shifting around the clock, sleeping a regular amount but needing varying time awake, but not 24+ hours awake like some people here. But I often am deprived of sleep by my own stupid body, doesn’t help that I have to pee several times a night because I have a bladder the size of a thimble. I also have EDS and am on the autistic spectrum (Asperger’s in my case) and I’ve noticed these type of sleep difficulties being common with people that have my other conditions. I think the best thing to do is just try to adapt your life to your sleep, Not the other way around. Sleep is one of the most important things your body needs. I recommend experimenting with cutting out caffeine and melatonin supplements (.75mg is actually the most effective dose in adults, skip the 10mg pills ok) but it’s okay if those don’t work for you. Melatonin doesn’t solve all my problems, and cutting caffeine out completely is hard for me because I love coffee, and even decaf has some caffeine. The one blessing of this curse is being able to experience every hour of the day at perfect clarity at one point or another. The cycle of time and seasons is a beautiful thing, navigate them at your own pace!

  10. Kirill Reply

    Found this after waking up from 22 straight hours of sleep. Not the norm for me, but occasionally I’ll be down for 12-16 hours. When I’m not working (which is often) I find myself going to bed 2 hours later every day until I hit “normal” hours. Usually doesn’t last long. It’s also quite taxing on relationships. Nice to know there are others.

    It wouldn’t be surprising if the prevalence is related to distance from the equator. I’m in Alaska and cycling between 22 hours of light on summer solstice to 22 hours of darkness during winter solstice can’t be conducive to “normality”.

  11. Tina Reply

    Why does everything have to be FIXED, only for anyone different than the social norm?! Some of us do NOT want yo be “fixed”. How about society starts understanding that there is no NORMAL! No one should force their natural clocks to do anything as long as it’s not affecting your health.

    I missed a lot of school as a kid because my mother accepted that i would be awake 12-50 hours and sleeping 12-24 hours. Every single time throughout my life that I forced a schedule on myself, I started sleeping more. I’d be up 4 hours. Sleep 8, be up 2 hours, cat nap all night, repeat. Eventually they told me I had depression, anxiety and ADHD lol… No Ok don’t, it’s because you’re forcing me to live on a schedule I’ll cant live on.

    Sure enough, FINALLY came across a Doctor with the same spiritual background as me. She understands beyond medical school so she said “Ok, keep track of your sleep/wake schedule, diet, activities, emotions, and anything else you feel is important for 30 days and we will figure out if its normal for you or a medical issue”… I did exactly what she asked and …. drum roll….. no meds. Im perfectly healthy. The down fall is finding employment because your sleep/wake patterns change according to your natural clock but the basic pattern doesn’t.

    Im 45 now. Raised 5 fantastic children, very supportive family and my husband says “I was born to love you, but you were born to love the earth and that’s why you have a sleep/wake pattern that allows you time to enjoy it while others sleep”.

    I’m happy. Im just so happy all the time. I was always miserable and sick. In the ER a few times a year (at least once a year for lung issues). Not anymore. Im not up during rush hour, when I am Im home working, not as much pollution, flu, none of it. No ER visits for years.

    I’m telling you, if you actually have a natural clock that cycles you differently than the social norm, then please look out for yourself because they always want to change you and drug you, vs help you safely adapt in your own biological patterns.

  12. cris Reply

    Since I was in school, I’ve never been able to sleep every night, I just need to stay awake for 2 days and the next day I want to sleep a lot. It is weird, but is the only way for me, I cant go to sleep normal time two days in a row.

    I remember my parents asking the psychologist in school, if it was ok that I decided to study or do homework al 1:00 am, she said it was ok.

    It is really bad for relationships, people dont understand that

  13. Milad Reply

    I have been having sleep problems forever. I can never get my self to fall asleep ive tried everythin meditation, scheduling, home remedies. They work a little but theyve never been the answer. I guess i have a non 24 hour disorder so i guess i just have to stay awake more than 24 hours to sleep well. One more thing i get super thirsty whenever i sleep. Its like my body burns water in order to maintain sleep and as soon as the water is gone i should wake up and drink water and go back to sleep. Ots so annoying and weird.

  14. David Lee Reply

    Despite their content these comments gave me some joy. It’s nice to know I am not alone in this crazy world of 24hr+ sleep.
    The long “boot-up” times for the brain.
    The unpredictably. The horrible anxiety every damn night. I feel you. I got 30hr on 12-14hr off. It’s maddening. My only advice: try meditation when you want to go to bed. Lights low, no tv, no phone, just think about yoir breathing for 15mins. Better than drugs in the long run!
    (We should start a dating service called “Free-running” so we can date with no judgment)

  15. Maya Reply

    I’m still fairly young but my sleep issues have been affecting me since I was five I won’t sleep at at or very little for days then I will crash for 16+ hours I’m having my mom take to a doctor but it’s affecting my school life .

  16. Veronica Reply

    I stay up for 48 hours then sleep for 3 days and it’s getting worse the older I get. This has been going on since my 20’s I am now 48. Makes me mad because I can’t commit to anything.

    • Tina Reply

      I make no commits. I have a 22 year old daughter and we have a “not sure” policy. Every single time solid plans are made, something goes wrong. I’ve had 6 surgery’s, every single one of them later on a day where plans were made and I was trying to be on a “normal” schedule. ER visit, then surgery (appendix, gallbladder, hernia and more) sure, these things may have happened anyway, but odd it was always on planned events. The last straw was pneumonia, not breathing was something that scared the crap out of me, now we make no solid plans. It works and we stay healthier that way.

      I home schooled one of my kids because he has a backwards clock. He simply couldn’t sleep until daytime. I pulled him out of school and taught him from home. Now he’s 25 and a cop (3rd shift of course).

  17. Nick Reply

    I’m in the. Same boat but have few responsibilities. I need you all to take a look. At what you are responsible for and evaluate if you are lazy like myself or neglecting your problems if you suffer from neglect get up and handle your business and if your lazy motivate yourself because you hopefully just realized your lazy… Set goals force yourself to be up to meet those those goals you will be amazed

  18. Josiah Brooks Reply

    I usually stay awake for 25 to 30 hours sometimes 40 hours, and I sleep for 15 to 20 hours. Last time I slept really long was 25 hours, then one time I think I slept like 35 after being awake for 3 days. Idk wtf is wrong with me.

    • Christine Ryan Reply

      This is new for me and it’s been stressful. I’m afraid to go to sleep bc I know I’ll sleep over 20 hours then I’ll be awake over 24 hours or more. I am otherwise sick too waiting for doctors without s good schedule or much sun. I have a lot of symptoms but this is happening to me and now I have sleep anxiety.

  19. Woke Reply

    Yeah I been doing this for years off and on. I believe the record is up 3 whole days without any help(caffeine) then passed out for 24 hours. Had issues as a kid but in my twenties took a horrible night shift job and been messed up ever since. I’ve done sleep 2hrs up 8. Sleep 12 up 24. Sleep 16 up 30-36. Sometimes I stare at the ceiling for hours and sleep never comes. I’ve zombied through work. Pass out as soon as I get home wake up go to work up all night and all day again. I dont stress it anymore. I wouldn’t mind having that rythym though.

  20. Ben Reply

    I just woke up from a 14 hour sleep and was searching and saw all the other comments. Same here. Doctors have been of little help. I wish there was a place that we could collect these experiences and present them to some experts. It feels more extreme than the 2-3 hour clock getting pushed back.

  21. EmzyT0 Reply

    For the past couple of years I have found myself being awake for 36-48hours and depending on how long I’ve been up sleeping between 12-24hours (minus forcing myself up to let dogs out, feed them in zombie state)!
    Thankfully I’m unable to work due to disability, but trying to organise appointments is a complete pain when I can be awake all night and ready to go in morning one day, but the next passing out at dawn!
    Before disability I managed to switch from being up all night to being able to wake up at 5am when I was working with horses, but over the last 6years my sleep pattern has gone very wrong. I think the worst part is the complete unpredictability of when I will physically and mentally wake up, although regularly being wide awake for 2days straight and being completely incapable of sleeping, when I suffer from pretty horrid chronic fatigue is almost as bad! Granted having long manic episodes when I’m physically exhausted and I can’t go for a run/exercise like I did as a teen is part of the problem lol!

    Quite surprised to see I’m on a pretty extreme end of spectrum! Obviously 36-48hrs between sleeps is extreme, but just assumed there would be plenty of other people going through it lol! Hopefully I should get some sleep at some point in the next 6hours, as body is saying it’s knackered, just got to wait for brain to give in!!

  22. CJ Reply

    Recently, my body has decided that a day consists of 36 hours. I stay up for 24 hours straight and sleep for 10 to 12 hours. It’s ridiculous.

    • Naddy Reply

      CJ, I have experienced this exact thing. Stay up for 20-28, sleep from 10-16 hours, repeat. The bizarre thing is I feel great doing it, better than trying to force 24 hour days. But, obviously, it makes it nearly impossible to keep a regular schedule and have a job….

  23. Kim Reply

    I feel awful when I wake up and it takes Bout 8 hour before I feel ok. I feel great when I’ve been up for 24 hours and don’t want to go to sleep because I know how I’m going to feel when I wake up. This has been a problem for me since i was diagnosed with a traumatic brain injury from a head on collision. After I’ve been up for 24 to sometimes 3 days at a time I sleep for 24 to 30 hours and feel horrible when I get up. No one understands

  24. Anonymous Reply

    I’ve got self-proclaimed hypersomnia where I’ve slept for 20 hours and 14 minutes on may 6th last year and I can have anywhere from 1 hour and 49 minutes of sleep to the very common 14 hours and 48 minute and the slightly more rare 15 hours and 27 minutes and the 2nd most recorded sleep time I have is 19 hours and 14 minutes and my sleep ends on the 14th minute of a hour so often it’s like a pattern literally like 150 times a year or more its weird

    • Grace Reply

      Me too, exactly the same thing. Just woke up from about 12 hours of sleep and feel good. I thought I was the only one with this weird cycle. Yes it makes it hard to socialize or even make appointments or plans. When I was working, I took sleeping pills and was always sleepy. After I retired I discovered this was sleep pattern my body wanted.

  25. Amber Reply

    Ever since I have been little i have slept weird. i have had my tail tore up for not going to bed when i was supposed to it was so much it seemed to be a everyday thing… I’m an adult now and I am afraid of the way i sleep. I can be tired and not fall asleep. So tired I call them sleep tantrums, where out of no where my body would twitch and burn but i still won’t go to sleep at least until i have literally caught my head dropping 5x! Every month i experience a really long sleep episode i always looked at it as my body catching up to the 1 or 2 days i fit fight sleep! But its happening more i just woke up after 13 straight hours of sleep last night well today! And like always It took me a while to realize what day it is. I wake up after 3/4 hours of sleep normally when i do get sleep and stay up 2-3 hours then go back to bed another 4. I been working 12s lately and I be ready to drop dead at work from being so tired, but will get off and get home and stay up another 3/4 hours, mind you i usually get up 2 hours before having to be at work… but thats nothing back in March i slept for exactly 28 hours! not a single person thought to check on me or wake me up when i finally got up i couldn’t breath right my head hurt so bad my body felt like i was beaten i had to use the bathroom immediately both #1#2 and while in the midst of using the bathroom i became nauseous and began vomiting!!! I never want to sleep that long again! I can’t really say if i have a sleep problem or if its something else but as long as i can remember i have been waking up tired and have always been deemed the lazy black sheep of the family cause I’m always up when i should be asleep or always the last to get up! However i just want to sleep like normal people! Its weird and hard trying to explain to people how i didnt get sleep cause i couldn’t or that every day i have a few minutes where i wake up and i forget everything including who i am! I hate it! I wish i could get some real direction and help, no one around here is going to!

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