Difficulties in management of a sighted patient with non-24-hour sleep-wake rhythm disorder

The non-24-hour sleep-wake rhythm disorder (N24HSWRD) is a rare circadian condition, often observed in totally blind individuals but uncommon in those with normal vision. This case report describes a 16-year-old male patient who has exhibited alterations in his sleep rhythm since birth, characterized by progressive sleep delays and a reversal of the sleep-wake cycle. The diagnosis was challenging, involving multiple medical consultations and the necessity for unsuccessful sleep hygiene interventions. Initial treatment with melatonin showed satisfactory results, but the patient developed tolerance over time, particularly during adolescence, when the delay in the cycle increased to three hours per day. Actigraphy confirmed the diagnosis and highlighted the importance of this method in the evaluation of sleep disorders. Although treatment with melatonin and phototherapy is recommended, the lack of standardization and treatment adherence complicate the management of N24HSWRD. This case underscores the complexity of diagnosing and treating circadian sleep disorders, emphasizing the need for increased awareness and adequate diagnostic resources outside major medical centers.