Last updated January 14, 2022

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)

Recommendations

ASWPD
  • The TF suggests that clinicians treat adult ASWPD patients with evening light therapy (versus no treatment). [WEAK FOR]

DSWPD
  • The TF suggests that clinicians treat DSWPD in adults with and without depression with strategically timed melatonin (versus no treatment). [WEAK FOR]
  • The TF suggests that clinicians treat children and adolescents with DSWPD (and no comorbidities) with strategically timed melatonin (versus no treatment). [WEAK FOR]
  • The TF suggests that clinicians treat children and adolescents with DSWPD comorbid with psychiatric conditions with strategically timed melatonin (versus no treatment). [WEAK FOR]
  • The TF suggests that clinicians treat children and adolescents with DSWPD with post-awakening light therapy in conjunction with behavioral treatments (versus no treatment). [WEAK FOR]

N24SWD
  • The TF suggests that clinicians use strategically timed melatonin for the treatment of N24SWD in blind adults (versus no treatment). [WEAK FOR]

ISWRD
  • The TF suggests that clinicians treat ISWRD in elderly patients with dementia with light therapy (versus no treatment). [WEAK FOR]
  • The TF recommends that clinicians avoid the use of sleep-promoting medications to treat demented elderly patients with ISWRD (versus no treatment). [STRONG AGAINST]
  • The TF suggests that clinicians avoid the use of melatonin as a treatment for ISWRD in older people with dementia (versus no treatment). [WEAK AGAINST]
  • The TF suggests that clinicians use strategically timed melatonin as a treatment for ISWRD in children/ adolescents with neurologic disorders (versus no treatment). [WEAK FOR]
  • The TF suggests that clinicians avoid the use of combined treatments consisting of light therapy in combination with melatonin in demented, elderly patients with ISWRD (versus no treatment). [WEAK AGAINST]
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Recommendation Grading

Overview

Title

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)

Authoring Organization

Publication Month/Year

October 1, 2015

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

The present document replaces/updates the previous American Academy of Sleep Medicine (AASM) Practice Parameters pertaining to the intrinsic CRSWDs (i.e., ASWPD, DSWPD, N24SWD, and ISWRD). The treatment of remaining CRSWDs is not addressed.

Target Patient Population

Patients with intrinsic sleep wake disorders

Inclusion Criteria

Female, Male, Adolescent, Adult, Child, Older adult

Health Care Settings

Ambulatory, Outpatient

Scope

Management, Treatment

Diseases/Conditions (MeSH)

D012893 - Sleep Wake Disorders, D056508 - Sleep Medicine Specialty, D020919 - Sleep Disorders, Intrinsic

Keywords

sleep wake disorders, sleep medicine, intrinsic sleep disorders

Source Citation

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 Oct 15;11(10):1199-236. doi: 10.5664/jcsm.5100. PMID: 26414986; PMCID: PMC4582061.