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The authors report a case in which a non-24-h (hypernychthemeral) sleep-wake cycle appeared as a late complication of a more fundamental disturbance in the quality of sleep (difficulty falling asleep, frequent awakenings, nonrefreshing sleep). The sleep disturbance began abruptly after a series of stressful events. The patient reported that he extended his hours of bedrest in the morning in order to increase his total sleep time and feel mor rested, and that he gradually extended his hours of activity in the late evening in order to increase his drowsiness and ability to fall asleep. At first this behavior, which was a deliberate attempt to compensate for inefficient nighttime sleep, led to a delayed sleep period, as also occurs in the delayed sleep phase syndrome. After several years in which sleep efficiency progressively deteriorated, this behavior led to a non-24-h free-running sleep-wake cycle. After the patient was treated with thyroxine for borderline hypothyroidism, and then flurazepam and finally vitamin B12, his sleep disturbance progressively improved and his sleep-wake cycle shortened. After B12 treatment he was able to advance the timing of ;his sleep period for the first time in nearly 10 years and to follow a normal 24-h sleep-wake regimen.

Successful Treatment of Human Non-24-Hour Sleep-Wake Syndrome