l(L). A Man with Too Long a Day14 February 2010 at 01:33 | Posted in Circadian rhythm | 18 Comments
Tags: Chronobiology, Non-24, Sleep research
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!
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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