Skip to main content
SpringerLink
Log in

Irregular Sleep-Wake Rhythm Disorder

  • Chapter
  • First Online:
Circadian Rhythm Sleep-Wake Disorders

  • 880 Accesses

Abstract

Irregular sleep-wake rhythm disorder (ISWRD) is characterized by a dysrhythmic sleep-wake pattern with multiple cycles across the 24-hour day. It is a rare condition that occurs predominantly among children with neurodevelopmental disorders, older adults with neurodegenerative diseases, patients with traumatic brain injury, and some individuals with schizophrenia. The exact pathophysiology of ISWRD is not known, but weak zeitgeber input, abnormal functioning of the endogenous circadian clock, and irregular behavioral patterns are all thought to play a role. Although few evidence-based treatments exist, morning bright light exposure improves behavioral symptoms such as nocturnal wandering and restlessness among elderly patients with dementia and exogenous melatonin improves select sleep parameters among children with neurodevelopmental disorders.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 16.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Stopa EG, Volicer L, Kuo-Leblanc V, Harper D, Lathi D, Tate B, Satlin A. Pathologic evaluation of the human suprachiasmatic nucleus in severe dementia. J Neuropathol Exp Neurol. 1999;58(1):29–39.

    Article  CAS  PubMed  Google Scholar 

  2. Hattar S, Liao HW, Takao M, Berson DM, Yau KW. Melanopsin-containing retinal ganglion cells: architecture, projections, and intrinsic photosensitivity. Science. 2002;295(5557):1065–70.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Berson DM, Dunn FA, Takao M. Phototransduction by retinal ganglion cells that set the circadian clock. Science. 2002;295(5557):1070–3.

    Article  CAS  PubMed  Google Scholar 

  4. Schmoll C, Lascaratos G, Dhillon B, Skene D, Riha RL. The role of retinal regulation of sleep in health and disease. Sleep Med Rev. 2011;15:107–13.

    Article  PubMed  Google Scholar 

  5. La Morgia C, Ross-Cisneros FN, Koronyo Y, et al. Melanopsin retinal ganglion cell loss in Alzheimer disease. Ann Neurol. 2016;79:90–109.

    Article  PubMed  CAS  Google Scholar 

  6. Drouyer E, Dkhissi-Benyahya O, Chiquet C, et al. Glaucoma alters the circadian timing system. PLoS One. 2008;3(12):e3931.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  7. Berry RB. Circadian rhythm sleep disorders. In: Berry RB, editor. Fundamentals of sleep medicine. 1st ed. Philadelphia: Elsevier; 2012. p. 515–43.

    Chapter  Google Scholar 

  8. Figueiro MG. Light, sleep and circadian rhythms in older adults with Alzheimer’s disease and related dementias. Neurodegener Dis Manag. 2017;7(2):119–45.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Skene DJ, Vivien-Roels B, Sparks DL, Hunsaker JC, Pevet P, Ravid D, Swaab DF. Daily variation in the concentration of melatonin and 5-methoxytryptophol in the human pineal gland: effect of age and Alzheimer’s disease. Brain Res. 1990;528:170–4.

    Article  CAS  PubMed  Google Scholar 

  10. Abbott SM, Zee PC. Irregular sleep-wake rhythm disorder. Sleep Med Clin. 2015;10(4):517–22.

    Article  PubMed  Google Scholar 

  11. Kripke DF, Youngstedt SD, Elliott JA, et al. Circadian phase in adults of contrasting ages. Chronobiol Int. 2005;22:695–709.

    Article  CAS  PubMed  Google Scholar 

  12. Yoon IY, Kripke DF, Elliott JA, et al. Age-related changes of circadian rhythms and sleep-wake cycles. J Am Geriatr Soc. 2003;51:1085–91.

    Article  PubMed  Google Scholar 

  13. Hofman MA, Swaab DF. Living by the clock: the circadian pacemaker in older people. Ageing Res Rev. 2006;5:33–51.

    Article  CAS  PubMed  Google Scholar 

  14. Mander BA, Winer JR, Walker MP. Sleep and human aging. Neuron. 2017;94(1):19–36.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Coppola G, Di Renzo A, Ziccardi L, Martelli F, Fadda A, Manni G, et al. Optical coherence tomography in Alzheimer’s disease: a meta-analysis. PLoS One. 2015;10:e0134750.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  16. Koronyo-Hamaoui M, Koronyo Y, Ljubimov AV, et al. Identification of amyloid plaques in retinas from Alzheimer’s patients and noninvasive in vivo optical imaging of retinal plaques in a mouse model. NeuroImage. 2011;54:S204–17.

    Article  CAS  PubMed  Google Scholar 

  17. Rosenwasser AM, Turek FW. Neurobiology of circadian rhythm regulation. Sleep Med Clin. 2015;10(4):403–12.

    Article  PubMed  Google Scholar 

  18. Bunger MK, et al. Mop3 is an essential component of the master circadian pacemaker in mammals. Cell. 2000;103:1009–17.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Song H, et al. Aβ-induced degradation of BMAL1 and CBP leads to circadian rhythm disruption in Alzheimer’s disease. Mol Neurodegener. 2015;10:13.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  20. Cermakian N, Lamont EW, Boudreau P, Boivin DB. Circadian clock gene expression in brain regions of Alzheimer’s disease patients and control subjects. J Biol Rhythm. 2011;26:160–70.

    Article  Google Scholar 

  21. Logan RW, McClung CA. Rhythms of life: circadian disruption and brain disorders across the lifespan. Nat Rev Neurosci. 2019;20(1):49–65.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Van Someren EJW. Circadian rhythms and sleep in human aging. Chronobiol Int. 2000;17(3):233–43.

    Article  PubMed  Google Scholar 

  23. Ancoli-Israel S, Clopton P, Klauber MR, Fell R, Mason W. Use of wrist activity for monitoring sleep/wake in demented nursing-home patients. Sleep. 1997;20(1):24–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Gehrman P, Marler M, Martin JL, Shochat T, Corey-Bloom J, Ancoli-Israel S. The relationship between dementia severity and rest/activity circadian rhythms. Neuropsychiatr Dis Treat. 2005;1(2):155–63.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Tranah GJ, Blackwell T, Stone KL, et al. Circadian activity rhythms and risk of incident dementia and mild cognitive impairment in older women. Ann Neurol. 2011;70(5):722–32.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Rogers-Soeder TS, et al. Rest-activity rhythms and cognitive decline in older men: the osteoporotic fractures in men sleep study. JAGS. 2018;66:2136–43.

    Article  Google Scholar 

  27. Marco EM, Velarde E, Llorente R, Laviola G. Disrupted circadian rhythm as a common player in developmental models of neuropsychiatric disorders. Curr Top Behav Neurosci. 2016;29:155–81.

    Article  CAS  PubMed  Google Scholar 

  28. Pat-Horenczyk R, Klauber MR, Shochat T, et al. Hourly profiles of sleep and wakefulness in severely versus mild-moderately demented nursing home patients. Aging Clin Exp Res. 1998;10:308–15.

    Article  CAS  Google Scholar 

  29. ICSD-3. The international classification of sleep disorders: diagnostic and coding manual. 2nd ed. Darien (IL): American Academy of Sleep Medicine; 2014.

    Google Scholar 

  30. Witting W, Kwa IH, Eikelenboom P, Mirmiran M, Swaab DF. Alterations in the circadian rest-activity rhythm in aging and Alzheimer’s disease. Biol Psychiatry. 1990;27(6):563–72.

    Article  CAS  PubMed  Google Scholar 

  31. Okawa M, Mishima K, Hishikawa Y, Hozumi S, Hori H, Takahashi K. Circadian rhythm disorders in sleep-waking and body temperature in elderly patients with dementia and their treatment. Sleep. 1991;14(6):478–85.

    Article  CAS  PubMed  Google Scholar 

  32. Lim AS, Yu L, Costa MD, et al. Increased fragmentation of rest activity patterns is associated with a characteristic pattern of cognitive impairment in older individuals. Sleep. 2012;35(5):633B–40B.

    Article  Google Scholar 

  33. Esbensen AJ, Schwichtenberg AJ. Sleep in neurodevelopmental disorders. Int Rev Res Dev Disabil. 2016;51:153–91.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Takaesu Y, Komada Y, Inoue Y. Melatonin profile and its relation to circadian rhythm sleep disorders in Angelman syndrome patients. Sleep Med. 2012;13(9):1164–70.

    Article  PubMed  Google Scholar 

  35. Potocki L, Glaze D, Tan DX, et al. Circadian rhythm abnormalities of melatonin in Smith-Magenis syndrome. J Med Genet. 2000;37(6):428–33.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Heikkila E, Hatonen TH, Telakivi T, et al. Circadian rhythm studies in neuronal ceroid-lipofuscinosis (NCL). Am J Med Genet. 1995;57(2):229–34.

    Article  CAS  PubMed  Google Scholar 

  37. Santoro SD, Giacheti CM, Rossi NF, Campos LM, Pinato L. Correlations between behavior, memory, sleep-wake and melatonin in Williams-Beuren syndrome. Physiol Behav. 2016;159:14–9.

    Article  CAS  PubMed  Google Scholar 

  38. Okawa M, Nanami T, Wada S, et al. Four congenitally blind children with circadian sleep-wake rhythm disorder. Sleep. 1987;10(2):101–10.

    Article  CAS  PubMed  Google Scholar 

  39. Maaskant M, van de Wouw E, van Eijck R, Evenhuis HM, Echteld MA. Circadian sleep-wake rhythm of older adults with intellectual abilities. Res Dev Disabil. 2013;34:1144–51.

    Article  PubMed  Google Scholar 

  40. Afonso P, Brissos S, Figueira ML, et al. Schizophrenia patients with predominantly positive symptoms have more disturbed sleep-wake cycles measured by actigraphy. Psychiatry Res. 2011;189(1):62–6.

    Article  PubMed  Google Scholar 

  41. Bromundt V, Koster M, Georgiev-Kill A, et al. Sleepwake cycles and cognitive functioning in schizophrenia. Br J Psychiatry. 2011;198(4):269–76.

    Article  PubMed  Google Scholar 

  42. Vigano D, Lissoni P, Rovelli F, et al. A study of light/ dark rhythm of melatonin in relation to cortisol and prolactin secretion in schizophrenia. Neuro Endocrinol Lett. 2001;22(2):137–41.

    CAS  PubMed  Google Scholar 

  43. Ayalon L, Borodkin K, Dishon L, Kanety H, Dagan Y. Circadian rhythm sleep disorders following mild traumatic brain injury. Neurology. 2007;68(14):1136–40.

    Article  CAS  PubMed  Google Scholar 

  44. Duclos C, Dumont M, Blais H, Paquet J, Laflamme E, de Beaumont L, et al. Rest-activity cycle disturbances in the acute phase of moderate to severe traumatic brain injury. Neurorehabil Neural Repair. 2014;28(5):472–82.

    Article  PubMed  Google Scholar 

  45. DelRosso LM, Hoque R, James S, et al. Sleep-wake pattern following gunshot suprachiasmatic damage. J Clin Sleep Med. 2014;10(4):443–5.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Borodkin K, Ayalon L, Kanety H, et al. Dysregulation of circadian rhythms following prolactin-secreting pituitary microadenoma. Chronobiol Int. 2005;22(1):145–56.

    Article  CAS  PubMed  Google Scholar 

  47. Mishima K, Okawa M, Hishikawa Y, Hozumi S, Hori H, Takahashi K. Morning bright light therapy for sleep and behavior disorders in elderly patients with dementia. Acta Psychiatr Scand. 1994;89:1–7.

    Article  CAS  PubMed  Google Scholar 

  48. Skjerve A, Holsten F, Aarsland D, Bjorvatn B, Nygaard HA, Johansen IM. Improvement in behavioral symptoms and advance of activity acrophase after short-term bright light treatment in severe dementia. Psychiatry Clin Neurosci. 2004;58(4):343–7.

    Article  PubMed  Google Scholar 

  49. Satlin A, Volicer L, Ross V, Herz L, Campbell S. Bright light treatment of behavioral and sleep disturbances in patients with Alzheimer’s disease. Am J Psychiatry. 1992;149:1028–32.

    Article  CAS  PubMed  Google Scholar 

  50. Van Someren EJ, Kessler A, Mirmiran M, Swaab DF. Indirect bright light improves circadian rest-activity rhythm disturbances in demented patients. Biol Psychiatry. 1997;41:955–63.

    Article  PubMed  Google Scholar 

  51. Ancoli-Israel S, Martin JL, Kripke DF, Marler M, Klauber MR. Effect of light treatment on sleep and circadian rhythms in demented nursing home patients. J Am Geriatr Soc. 2002;50:282–9.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Ancoli-Israel S, Gehrman P, Martin JL, et al. Increased light exposure consolidates sleep and strengthens circadian rhythms in severe Alzheimer’s disease patients. Behav Sleep Med. 2003;1:22–36.

    Article  PubMed  Google Scholar 

  53. Fetveit A, Skjerve A, Bjorvatn B. Bright light treatment improves sleep in institutionalised elderly—an open trial. Int J Geriatr Psychiatry. 2003;18:520–6.

    Article  PubMed  Google Scholar 

  54. Fetveit A, Bjorvatn B. The effects of bright-light therapy on actigraphical measured sleep last for several weeks post-treatment. A study in a nursing home population. J Sleep Res. 2004;13:153–8.

    Article  PubMed  Google Scholar 

  55. Dowling GA, Burr RL, Van Someren EJ, et al. Melatonin and bright-light treatment for rest-activity disruption in institutionalized patients with Alzheimer’s disease. J Am Geriatr Soc. 2008;56:239–46.

    Article  PubMed  Google Scholar 

  56. 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):1199–236.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Singer C, Tractenberg RE, Kaye J, Schafer K, Gamst A, Grundman M, Thomas R, Thal LJ. Alzheimer's disease cooperative study. A multicenter, placebo-controlled trial of melatonin for sleep disturbance in Alzheimer's disease. Sleep. 2003;26(7):893–901.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Riemersma-van der Lek RF, Swaab DF, Twisk J, Hol EM, Hoogendijk WJ, Van Someren EJ. Effect of bright light and melatonin on cognitive and noncognitive function in elderly residents of group care facilities: a randomized controlled trial. JAMA. 2008;299(22):2642–55.

    Article  CAS  PubMed  Google Scholar 

  59. Wright B, Sims D, Smart S, et al. Melatonin versus placebo in children with autism spectrum conditions and severe sleep problems not amenable to behaviour management strategies: a randomised controlled crossover trial. J Autism Dev Disord. 2011;41:175–84.

    Article  PubMed  Google Scholar 

  60. Pillar G, Shahar E, Peled N, Ravid S, Lavie P, Etzioni A. Melatonin improves sleep-wake patterns in psychomotor retarded children. Pediatr Neurol. 2000;23:225–8.

    Article  CAS  PubMed  Google Scholar 

  61. Gringras P, Nir T, Breddy J, Frydman-Marom A, Findling RL. Efficacy and safety of pediatric prolonged-release melatonin for insomnia in children with autism spectrum disorder. J Am Acad Child Adolesc Psychiatry. 2017;56(11):948–57.

    Article  PubMed  Google Scholar 

  62. Braam W, van Geijlswijk I, Keijzer H, Smits MG, Didden R, Curfs LM. Loss of response to melatonin treatment is associated with slow melatonin metabolism. J Intellect Disabil Res. 2010;54(6):547–55.

    Article  CAS  PubMed  Google Scholar 

  63. Braam W, Keijzer H, Struijker Boudier H, Didden R, Smits M, Curfs L. CYP1A2 polymorphisms in slow melatonin metabolisers: a possible relationship with autism spectrum disorder? J Intellect Disabil Res. 2013;57(11):993–1000.

    CAS  PubMed  Google Scholar 

  64. Kennaway DJ. Potential safety issues in the use of the hormone melatonin in paediatrics. J Paediatr Child Health. 2015;51(6):584–9.

    Article  PubMed  Google Scholar 

  65. De Leersnyder H, Bresson JL, de Blois MC, Souberbielle JC, Mogenet A, Delhotal-Landes B, et al. Beta 1-adrenergic antagonists and melatonin reset the clock and restore sleep in a circadian disorder, Smith-Magenis syndrome. J Med Genet. 2003;40(1):74–8.

    Article  PubMed  PubMed Central  Google Scholar 

  66. Murray G, Harvey A. Circadian rhythms and sleep in bipolar disorder. Bipolar Disord. 2010;12(5):459–72.

    Article  PubMed  Google Scholar 

  67. Logan RW, McClung CA. Rhythms of life: circadian disruption and brain disorders across the lifespan. Nat Rev Neurosci. 2019;20(1):49–65.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of Arizona College of Medicine, Phoenix, AZ, USA

    Danielle Goldfarb

  2. Department of Medicine and Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA

    Katherine M. Sharkey

Authors
  1. Danielle Goldfarb
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Katherine M. Sharkey
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Katherine M. Sharkey .

Editor information

Editors and Affiliations

  1. Mayo Center for Sleep Medicine, Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN, USA

    R. Robert Auger

Rights and permissions

Reprints and permissions

Copyright information

© 2020 The Author(s)

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Goldfarb, D., Sharkey, K.M. (2020). Irregular Sleep-Wake Rhythm Disorder. In: Auger, R. (eds) Circadian Rhythm Sleep-Wake Disorders. Springer, Cham. https://doi.org/10.1007/978-3-030-43803-6_10

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-43803-6_10

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-43802-9

  • Online ISBN: 978-3-030-43803-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation