INTRODUCTION to NON-24

Non-24 Sleep-Wake Disorder is a rare disorder of the circadian rhythm (the body’s internal clock). It is not the same as insomnia, apnea, or other sleep disorders because the sleep itself isn’t typically disordered, the circadian rhythm is. (The circadian rhythm affects more than just sleep and is governed by neurological, hormonal, steroidal, chemical, and environmental processes). When Non-24 patients follow a strict sleep-wake schedule, they often experience the disabling symptoms of sleep deprivation. Because of this, Non-24 patients often require accommodation to work, to go to school, and more. Below, you will find possible accommodations for Non-24 Sleep-Wake Disorder

If a patient with Non-24 is not responsive to treatment, their only option is to follow a “free-running” sleep-wake schedule. Free-running is when you sleep when sleepy and wake when refreshed. For someone with Non-24, their wake time and sleep period typically shifts forward every day and is likely to be unpredictable.

As an example, someone with free-running Non-24 may never be awake on the same schedule for more than a few days at a time.

So, someone with Non-24 who is working a flexible job might work 1^st shift, then 2^nd shift, and then 3^rd shift … all in the course of two or three weeks. Many cases are even less predictable.

The circadian rhythm cannot be reliably or safety controlled with willpower alone. Asking someone with Non-24 to control when they sleep is very similar to asking someone with a fever to control their body temperature with willpower. Requiring someone with Non-24 to wake up at the same time every day may cause serious side-effects of sleep deprivation and is typically neither healthy nor feasible.

According to the Sleep Foundation, in the short run, sleep deprivation can cause:

Poor or risky decision-making
Lack of energy
Mood changes, including feelings of stress, anxiety, or irritability.

For many with Non-24, the effects of sleep deprivation may be heightened and can include:

Nausea
Weakness
Headaches
Photosensitivity
Joint/muscle pain
And more here.

Someone with Non-24 might also experience the effects of long-term sleep deprivation from working an inflexible schedule for weeks or months at a time. According to the Sleep Foundation, these increased health risks can include:

Cardiovascular diseases
Diabetes
Obesity
Hormone imbalances
Mental health disorders
Chronic pain
Compromised immune system

Several websites also offer similar pages on understanding and accommodating this disorder:

Sleep Foundation HERE
Circadian Sleep Disorders Network HERE

NOTE: Accommodations can and will often look different for each individual with Non-24. While these are helpful suggestions, it’s important to remember employers, educators, caregivers, and loved ones should always work with the Non-24 individual to develop the best possible accommodations.

WORK ACCOMMODATIONS for NON-24

In the U.S., Non-24 Sleep-Wake disorder qualifies as a disability under the terms of the American Disabilities Act. Under the terms of the ADA, most employers are legally obliged to make reasonable accommodations for Non-24, as long as the patient is broadly qualified to do the work. (Source: ADA).

For those with Non-24, flexible work hours are critical. The ability to set your own schedule is important, but, if this schedule is still “set” and required to be followed for any extended period of time, it is not truly flexible. This often cannot be a “set your own schedule” role where the employer requires that same schedule at all times. True work flexibility would allow the employee with Non-24 to be able to change their work hours from day to day or week to week.

Likewise, being required to work only within certain hours is also limiting. As an example, only being able to set a schedule between 9 – 5 limits a free-running person’s work hours by half if they are awake at night the other half of the time.

Many with Non-24 can work more efficiently when they simply need to meet a deadline rather than work certain hours at specific times of day. Project work, freelance work, remote work, and jobs with truly flexible hours will best suit those with free-running Non-24.

People with Non-24 can be productive workers when employers make appropriate accommodations.

SCHOOL ACCOMMODATIONS for NON-24

Similar to work accommodations, flexibility is key. Students with free-running Non-24 need to be able to work on the schedule that is healthiest for their unique circadian rhythm.

Educational accommodations for Non-24 Sleep-Wake Disorder include:

Extra time to complete assignments (flexible deadlines).
Waived penalties for missing lectures/classes.
Recorded lectures for later viewing.
Exceptions for group projects with set meeting times.

Allowing flexible test-taking times helps accommodate students with Non-24. For example, a student who is required to take a test at 9 AM when their body wants to fall asleep at 7 AM will have an unfair disadvantage than if they could take the test a couple hours after their 4 PM wake time. (Imagine a typical person being asked to wake up and take a chemistry final at 3 AM).

It’s one thing if a student feels unwell occasionally when taking a test or trying to pay attention in class, but when a student experiences slowed thinking, reduced attention span, and worsened memory due to sleep deprivation at least half the time, their academic experience will not be beneficial.

ACCOMMODATIONS for HOME

This section is in three parts: 1) Family & Friends, 2) Living Together, and 3) Romantic Relationships.

FAMILY & FRIENDS

For many people with Non-24, they and their doctors have not yet found an effective treatment, let alone a cure. This is a difficult disorder to live with as it often limits a person’s ability to lead a normal life—or, at least, it changes what their life looks like. Many times, this is difficult for family and friends to accept. It’s important to remember, the time of day a person with Non-24 sleeps is not under their control. Healthy sleep cannot be controlled with willpower.

The circadian rhythm controls many other aspects of the body, such as our body temperature fluctuations, our guts, and our hunger.

Accommodations for Non-24 Sleep-Wake Disorder go a long way to show you care.

Make your schedule known to your loved one with Non-24.
- This makes it easier to set up times when they know you’ll both be free to spend time together. When a Non-24 patient knows when you’ll be free, then they can better know when to reach out.
Set up a means of communication that isn’t disruptive.
- A person with Non-24 might want to tell you something but won’t be awake when you are. Have a means of communication they know for sure is silent and won’t disrupt you if they want to leave a message for you at 3 AM, for example, that you’ll see in the morning. Likewise, ensure the app or means of communication won’t disrupt them, too, even if you reach out at an hour that is “typically social.”
Be kind if group gathering times don’t always line up.
- Be sure to let your loved one with Non-24 know they’re welcome to show up anytime between the hours of the gathering. Be sure to always let them know the timeframe they’re welcome so they feel confident showing up late or early if needed.
If you ask, “Are you going to be awake next Saturday?” Be prepared that someone with Non-24 may not know yet, if at all.
- Wake and sleep times are often variable and can change quickly. A person with Non-24 may not know if they can attend or not until about 2 – 3 days in advance. Predicting when a Non-24 patient will be awake is even more variable than a future weather report.

LIVING TOGETHER

It can help to make accommodations for Non-24 sleep-wake disorder to the home to help when people living together are sleeping on different schedules.

Acoustic panels may help keep the living and sleeping areas quieter. These vary in price and material and can be hung on the walls to help keep sound from traveling.
TV headphones. Devices like a Roku may offer a remote app for a smartphone that allows you to direct the TV sound through the phone and any connected headphones. Headphones that connect directly to a TV are also available.
Consider assigning chores depending on the time of day they can be done and how disruptive they might be.
If earplugs are regularly used, consider getting smoke alarms designed for the hearing impaired.

ROMANTIC RELATIONSHIPS

Accommodations for Non-24 Sleep-Wake Disorder in romantic partners will vary a lot based on personal preferences. Romantic partners may need separate beds and/or separate rooms to sleep different hours without disruption. While one partner might prefer to wake with the morning light, the other may need blackout curtains when sleeping during the day. Sleeping in separate beds or separate bedrooms should not be taken as a sign of an unhealthy relationship, as some might think; rather, it shows a willingness to compromise and maintain a balanced relationship.

On this topic, a few Non-24 patients in relationships were surveyed for helpful accommodation ideas. They said,

“I don’t like being alone. Usually when we are on completely different sleep hours, I come in the bedroom, either in bed or in an armchair. He wears a sleep mask and I can do what I want and leave the lights on. My goal would be to put a TV in the bedroom so I could watch series or movies more comfortably in the same room while he sleeps.”
- For the patient above, a Roku or similar TV device which allows for wireless headphones may be beneficial.
“We tend to split household chores according to our sleeping/waking/working patterns. I tend to do the chores that can be done late at night (washing up, baking, cleaning, washing clothes) and he tends to do more of the things that need to be done earlier (shopping, phone calls to services, cooking meals, noisy DIY repairs, etc).”
Finally, two comments on having a healthy relationship: “The most important thing to me is that my husband believed my diagnosis was real even before I got an official diagnosis. My family didn’t believe me, and having his support has meant a lot.” Similarly, another patient said, “The main thing I really appreciate is that he doesn’t treat my sleep/wake patterns like some kind of problem or inconvenience. Rather he just accepts it as a difference.”

Accommodations for Non-24 Sleep-Wake Disorder vary from case to case. The most appropriate path is to openly discuss what will help improve work, school, and home life for someone with Non-24. To better understand Non-24, visit our FAQ page and then visit our Resources page.