l(L). A Man with Too Long a Day

14 February 2010 at 01:33 | Posted in Circadian rhythm | 18 Comments
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The Physiological Society is an venerable British scientific society dating from the time of Darwin.   Articles in their journal, Proceedings of the Physiological Society, normally have rather obscure titles like “Synaptic connexions of serotonin-containing neurons in Planorbis Corneus.”  But in 1970 a paper from three scientists at  the University of Manchester appeared with a title that reads more like that of a science fiction story: “A Man with Too Long a Day”.   The man who was the subject of the paper claimed that he was unable to live on a 24-hour day.  Instead his sleep wake cycle followed a 26-hour pattern.  While humans in isolation experiments sometimes followed non-24 hour schedules, this was the first report of someone who followed such a pattern in normal life, and, more importantly to him, he was unable to live on 24 hours however hard he tried.  The scientists were able to confirm the reality of his complaint by a clever experiment.

He was then confined in an isolation unit, without a timepiece, and his
habits were recorded by a remote signalling device; he there followed an
activity cycle of 26 hr. After 5 days a clock, which he knew could be
adjusted to gain or lose several hours a day, was started, and he was asked
to try to conform his habits to the time recorded on the clock; unknown
to the subject, this clock was running at a normal rate, though its absolute
time was in error since it was started at the time which he believed it to be.
He was still unable to conform his habits to a 24 hr cycle, just as when
living in nychthemeral surroundings.

This was the first report of what is now known as Non-24 Hour Sleep Wake Cycle Disorder, more concisely N24.  The authors did not report any attempt to treat his condition.

Eight years later, doctors at the Albert Einstein College of Medicine reported another case of what they called “hypernychthemeral syndrome” after the Greek hyper (over) + nychthemeron (24-hour period of night and day).  Long-term temperature monitoring recorded his rhythms for several months.   In 1980 a third case was reported, this time of a man “John” and his partner “Mary”.  John had N24 while Mary’s sleep had previously been  normal but at times followed Johns N24 schedule.  Charts of their sleep show a kind of circadian dance as their rhythms would coincide for a while and then diverge.

None of these early cases were successfully treated.  In 1983 the Clinical Psychobiology Branch at the US National Institutes of Health reported the first successful treatment of N24, by using vitamin B-12.  Subsequent cases have reported N24s who respond to B-12 although many do not.  (It makes me much worse!)

The next known case, in 1985, responded to clonazepam but the subject reported he felt worse on the drug despite his normalized schedule and chose to stop the drug and resume an N24 schedule.  This was a pattern often found in later N24 cases — sometimes the cure is worse than the disease.

Three reports in the late 80s studied the effects of light, with differing results.   Light successfully treated one person.  Another N24 was initially able to entrain with light, but a later Internet report seems to say she (by the way the first woman with true N24) had to stop it due to migraines.  But a Japanese study found that an N24 person was resistant to the normal phase shifting effects of light, suggesting that some N24s develop the condition due to insensitivity to light.

A few more reports appeared in the early 1990s.  The NIH published a detailed study of a second patient, showing endocrine abnormalities, some of which were corrected by light treatment while others were not.  And researchers in Japan published a growing number of case reports and pioneering studies.

What’s striking about these early cases of N24 is how few of them there were: eight years between the first and second cases!  N24 appeared to be a very rare disorder, and it’s probable no N24 ever met anyone else with N24.

Then came the Internet.

As with many conditions, the Internet has broken the isolation of N24s.  It’s still a rare condition by any measure, but not as rare as once thought.  On Internet sites and mailing lists such as the NiteOwl list for DSPS and N24, more and more N24 people are popping up to say “I’m here” and the talk about the difficulties of living with and/or trying to treat their condition.  And that’s why I’m here on this blog, to talk about N24, what N24 folks say, what the science says.   This post has been about the past of N24, but we are here to make a better future for those whose sleep follows a “different drummer”.  Great thanks to delayed2sleep for inviting me on this blog.  Let’s see what we can do!

Postscript:

I classified “A Man with Too Long a Day” as the first medical report of a person with N24, and that is accurate and how it is generally cited in the medical literature.   However a few years ago I was reading Sylvia Nasar’s biography of John Nash, A Beautiful Mind. She devotes a chapter to Nash’s friend, the brilliant mathematician and game theorist Lloyd Shapley.  Shapley and Nash met at Princeton in 1950 when both were graduate students.  In describing Shapley, Nasar says this:

Shapley’s greatest eccentricity at the time was his claim that he was on a
twenty-five-hour sleep cycle. He worked and slept at extremely odd hours, often
transposing night and day. “Every once in a while he’d disappear from sight.”
another student recalled. “That’s what he said. We accepted anything.”

It’s not clear if Shapley’s schedule was voluntary or involuntary.  The latter would make him the first known N24.

Posted by LivingwithN24 (James Fadden).

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Next post:  51. Melatonin: Less Is (Sometimes) More

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18 Comments »

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  1. Hi LivingWith, and welcome!

    I was thinking of asking you about N24 and blind people. And a commenter on an older post happened to ask yesterday: Why are blind people prone to N24? My question is: Why does the literature seem to suggest that the blind are the only people with N24? Are you blind?

  2. Interesting question(s). The existence of free-running rhythms in blind people had been suspected for a very long time (possibly as early as the 1940s) but was only confirmed in 1977 by Miles et al. at Stanford.
     

    It soon became apparent that as many as 50% of blind people have free running rhythms and up to 80% have some circadian disturbance such as DSPS. This statistic; however led to confusion among at least some (but not all) reviewers of the field. The idea that few sighted people had N24 but most blind people did became twisted around to the idea that *only* blind people had N24. That is clearly not true.
     

    The tendency to N24 among the blind is the result of the important role of light in resetting the circadian rhythm. Usually blind people’s endogenous period is very close to 24 hours, but without light very close is not good enough. They will often drift just a few minutes a day, but after a few months their sleep is completely inverted and stays that way for quite a while until the cycle comes around again. Sighted N24 people under natural conditions (outside a lab) tend to live on 25-27 hour cycles.
     

    I am a sighted person, but of course we welcome the comments of both sighted and blind people with circadian problems.
     

    Like many sighted people I tend to think of blindness as one of the most frightening things that could happen to a person. (I’m not saying that idea is correct, just the viewpoint of a typical sighted person). Thus I found the following passage quite, well, enlightening. The doctor mentioned is Robert Sack, an expert on N24 in the blind. He treats some with melatonin and advises others to just go with their N24 rhythm.
     

    Some patients, Sack said, find circadian
    rhythm disruptions the most burdensome
    part of their blindness. “Being
    blind is okay, although something of an
    inconvenience,” one woman told him.
    “Having a free-running sleep cycle,” she
    said, “can be awful.”
    –JAMA, October 7, 1995–VoI280, No_ 13 p1123-6

  3. I’m also N24 and this blog has been a very interesting and reassuring source of information. Thanks for your long-standing effort in documenting and analyzing this little-known condition.

    I also found the quote above – re: blindness being something that can be accomodated, but not free-running sleep, accurate and scary.

    Again, there is some comfort in finding intelligent kindred approaches.

  4. Thanks for the excellent blog! About two years ago I realized I’ve had DSPS since I was about 13, and like everyone else who finds this diagnosis at last, I was relieved and excited. I was able to pursuade my employer to let me work from noon to 7 pm, a schedule I have followed for the past year and a half. This allows me to sleep when my body naturally wants to from 3 to 11 am. I feel WONDERFUL, alert, young, vibrant, and cheerful now. I encourage DSPS folks to find a job that will accomodate their natural rythms and live with it!!

    Anyway, my question is this: after living according to my body’s preferred sleep cycle for a year and half, I find it significantly harder to change my sleep schedule, even more than before. If I’m forced to catch an early flight, for instance, it’s simply torture, and I have to resort to having someone else get me out of bed. Which was true when I tried to work 9 to 5, but now it’s actually painful to force myself to do it, and not even three alarms does the trick! I’m wondering if others who used to work 9 to 5, then changed to a more accomodating schedule, have experienced this?

  5. […] DSPS – A Sleep Disorder: Melatonin: Less Is (Sometimes) More DSPS – A Sleep Disorder: A Man with Too Long a Day DSPS – A Sleep Disorder: Light therapy: white, blue or maybe […]

  6. I have had this problem since my early 20s. I am now 41 and it seems to be getting worse. Over the years I have researched to find out what I actually had but I had never come across such an explanation. It always seemed to me as if no one understood my problem. Unfortunately I gather from what you write that there seems to be no effective treatment.

  7. There are treatments although the effectiveness varies. The most effective treatment is the use of light and dark (photoherapy and scototherapy). One uses a light box in the morning for an hour or more and avoids light in the evening. Other treatments are melatonin or melatonin-like drugs such as ramelteon or tasimelteon.

    The odds and degree of success with treatment vary from person to person and the treatment can be complicated. The details are too complex to go into in one reply. One place to ask questions is the Nite Owl mailing list.

    http://lists.circadiandisorders.org/listinfo.cgi/niteowl-circadiandisorders.org

  8. And, if I may add, you may want to look at http://www.circadiansleepdisorders.org for information. Circadian Sleep Disorders Network is a not-for-profit organization of, by and for people with problematic circadian rhythms.

  9. I appreciate your replies. I will look into it although I can’t help but to be rather pessimistic about it. I have tried so many things and nothing has worked so I have pretty much convinced myself I will have to deal with this issue my whole life. Please forgive the pessimistic view… my hours are currently all screwed up and it does affect my mood.

  10. […] am only borrowing the knowledge that’s been shared there. I’d especially like to thank James Fadden and Sparrow Rose Jones for the knowledge and experience they’ve shared about N24, DSPS, and […]

  11. There’s a point in my N24 cycle every month or two where I will sleep well (8- 10 hours) and wake around 4AM — there are, say, 3 or 4 days like this every month. On these days, my mood is one of pure happiness. For these few days a month, I understand what it is for those who seem to breeze through life; happy, normal and unworried. In contrast a couple of weeks or so later, as I wake around 4PM, my mood is bleak. No matter the circumstances, I wake up reminding myself it will be over one day (when I die). It’s like I am a different person subject to a completely different experience of life. It is almost a direct index of my mood. Does anyone else suffer the same situation?

    This is my first public post on the subject and I want to say how revelatory it is to have found you after all these years (in the dark :P) without understanding of our N24 situation.

  12. I know all too well what you mean Anthony. The exact same things happens to me – although the specifics of the hours are different – on the rare occasions when I sleep really well and through out the night. At those times I wake up thinking “So this is what it is like for ‘normal’ people. Wow, what a difference.”. The most exasperating circumstance for me in this condition is the total unpredictability of my sleep schedule. Unfortunately I have no hope of ever controlling this sleep beast so I have just given up trying to fight it and I go with the flow. The other issue that I have a very hard time dealing with is that it seems absolutely no one around me understands this condition. That makes me feel totally alone and I often think “why me?”.

  13. Hi Anthony – I meant to reply to this right away but life gets in the way. Yes I feel like you do right now in fact. I’m awake, it’s daytime, and I’m not exhausted, but I know collapse is imminent and so it doesn’t offer too much comfort. N24 is destroying what little chance I have to raise a family and be a contributing member of society. No one aside from this tiny group will ever understand what it’s like. Even my wife is starting to lose patience and I can’t blame her. oh well, that’s life, justone of the many ways of experiencing the human condition I guess?

  14. Oh,my, Anthony, I apologize. You got answers to your comment, by ‘Bruno’ and ‘calydon’, and I forgot to approve them. Apologies to Bruno and calydon as well!

  15. Hi there,

    I’ve tried almost my whole life to adjust to the “normal schedule” but in vain since as early as I was 10 years old. I have been long suspecting that I have somewhere close to “25 hours” each day. My bed time normally falls between 2:00 am to 2:30, but will gradually goes forward to 3:00, then 4:00 during a week. (then by willpower I just push it back to 2:00 am, which restarts the whole cycle again. Yes, it’s like I’m fighting against an unrelenting beast!) It’s so frustrating living a life like this, feeling abnormal and different from other people around you. I just can’t fit in! So, thanks for this blog that at least I can find someone who can understand my problem.

  16. Welcome and thanks for commenting, Christy. To me it sounds like you have something in between Non-24 and Delayed Sleep-Phase Disorder — which some may say is an impossibility. It sounds reasonable to me as Non-24 sometimes develops from (or after) DSPD, so an in-between phase sounds unsurprising.
    .
    I’ve long since adopted the term “abnormal” (not necessarily a negative word) for myself. Also, after I learned that I wasn’t alone with DSPD and continued working days, I called myself a “shift worker”. Finding others who can understand is one great benefits of the Internet, IMO! If you’re on Facebook you can find groups for Non-24 and DSPS as well as one called niteowl.

  17. You say you “push it back”? That sounds lovely to me. Wish I could do that but apparently, and I suspect this is the way with everyone else who has these problems, I am only able to “push it forward”.


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