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Abstract Introduction Daytime fatigue in teenagers may be hand-waved as hours of screen time the night before and it can be difficult for families to accurately describe sleep habits. These factors quite often obscure an underlying sleep disorder. Here we report the rare case of a sighted teenage patient who presented with sleep disturbance and erratic bedtimes and was found to have non-24-hour sleep wake disorder (N24SWD). Report of case(s) 16-year-old male with a past medical history of ADHD and insomnia, presented to clinic for evaluation of recurrent and inappropriate sleep time with residual hypersomnolence. Pediatrician first saw the patient for difficulty waking up for school as well as trouble falling asleep at night. Initially, it was suspected to be insomnia due to poor sleep hygiene secondary to significant electronic usage prior to bedtime. When symptoms did not improve, the patient was started on hypnotics including clonidine to help with sleep and daytime stimulant medication was adjusted to help with wakefulness. Pharmaceuticals did not help with sleep symptoms, and the patient’s hypersomnolence led to cyclical absenteeism from school and risk for expulsion. On initial presentation to the sleep clinic, patient and family had difficulty describing his erratic sleep routine. Two weeks of sleep diaries were provided to help characterize the patient’s sleep patterns. No suspicion for sleep disordered breathing, parasomnias nor restless leg syndrome were noted. Sleep diary showed a sleep pattern delaying consistently by 1-2 hours each day. Total sleep each night was 7-9 hours, with sleep onset latency of 30 minutes and no significant awakenings. This activity is classic for non-24 sleep-wake phase disorder. This patient was treated with a combination of timed tasimelteon and bright light therapy along with chronotherapy for resynchronization of the intrinsic circadian rhythm. Conclusion N24SWD is commonly seen in blind individuals affecting up to 50% of that population. It is very rare in sighted individuals, and may be harder to discern when confounded with conditions like ADHD or poor sleep hygiene. Having patients complete a sleep diary is a cost effective and low investment intervention that may elucidate their condition and ensure timely treatment. Support (if any)
Nguyen et al. (Sat,) studied this question.