Note that Circadian Sleep Disorders Network is not affiliated with any pharmaceutical, medical device, or other company.
Circadian Rhythm Sleep Disorders (CRSDs or CRDs) are neurological disorders in which the sleep-wake cycle is out of sync with the day-night cycle. These include in particular Delayed Sleep Phase Disorder and Non-24-Hour Sleep-Wake Disorder. Also included are Advanced Sleep Phase Disorder, Irregular Sleep Wake Disorder, and Shift Work Disorder, which are defined here.
Delayed Sleep Phase Disorder (DSPD), also called Delayed Sleep Phase Syndrome (DSPS), is characterized by an inability to fall asleep until very late at night, with the resulting need to sleep late in the morning or into the afternoon. Questions? See our DSPS Q&A.
Advanced Sleep Phase Disorder (ASPD), also called Advanced Sleep Phase Syndrome (ASPS), is the opposite. It is characterized by falling asleep very early in the evening, and waking up in the wee hours of early morning, unable to sleep further.
Non-24-Hour Sleep-Wake Disorder (Non-24), also called Free-Running Disorder (FRD), is a condition in which a person's day length is significantly longer than 24 hours, so that sleep times get later each day, cycling around the clock in a matter of days or weeks. Questions? See our Non-24 Q&A.
Some people use the term reverse sleep, referring to the fact that sometimes people with DSPD and Non-24 end up sleeping during daylight and being awake at night.
We are asking our members and followers to give our brochure, and/or our Q&A booklets, to their sleep doctors and their general doctors on their next visits. It is vital to all of us suffering from circadian disorders that more doctors and their support staff understand these disorders and how disruptive they can be. The more doctors who know about us, the more patients we can reach, inform, and support. And the larger our membership, the more credible our voice on behalf of all people with circadian sleep disorders.
You can print out the brochure on U.S. letter paper (8½x11) or on A4 paper (non--U.S.). Booklets can be printed for DSPS or for Non-24 (the same file can be printed on either U.S. or A4 paper). Alternatively you can email us at to request a printed copy of any or all these documents (please specify which). Be sure to include your name and full postal address. We will send these at no charge to you.
At the Stanford Medicine X conference in September, CSD-N Board Member Alexandra Wharton gave a talk titled Night Owls and Late Chronotypes Unite — Let's Stop Living Against Our Body Clocks!
During the presentation, she explained what Delayed Sleep Phase Disorder is, the challenges of diagnosing it, and its possible causes including recently discovered genetic variants. Attendees learned that the 2017 Nobel Prize for Medicine was awarded to scientists studying the circadian clock, and that research in how a person's circadian clock affects their physical and mental health is growing.
She stressed that DSPD is intractable and can't be adjusted with willpower or self-discipline; it is a physiological - not a psychological - condition. She described how living against one's body clock is damaging, and that later start times at work and school are imperative for late chronotypes.
The session had a rapt audience of healthcare providers, researchers and patients, and the level of discourse was encouraging. There was a discussion following the presentation about how DSPD is frequently mistreated: SSRIs can make night owls more sensitive to light, phase-delay chronotherapy can turn DSPD into Non-24, and long-term benzodiazepine use is dangerous.
The theme of this year's Medicine X conference, Listening to patient voices drives change in healthcare, aligns with CSD-N's tagline, Together we have a voice. CSD-N's successful letter-writing campaign asking the NIH to include circadian rhythm disorders in its list of sleep disorders exemplifies how a community of patients can bring about change.
Circadian Sleep Disorders Network will be holding elections for its Board of Directors, and is seeking some new faces. Please read the requirements. Meetings are held by online forum, so you can log in at any time of day to read what's been posted and post your replies. Meetings do continue for a month or more, though often not very actively.
If you're interested, please let us know soon (latest Nov 10), following the instructions at the end of the above document. Directors start serving January 15, 2020. Terms generally run for two years. There are five open slots, and only three incumbents are planning to run again, so we encourage interested people to run.
We are also looking for a new secretary and other volunteers willing to help. These officers can be board members but do not have to be. The main duty of the secretary is to write up minutes of the meetings, which are held by online forum. If you're interested, please let us know soon, following the instructions at the end of the above document.
Now there's a respected U.S. government website you can point disbelieving friends and relatives to, that clearly acknowledges our disorders:
The lack of coverage of Circadian Rhythm Sleep Disorders on the NIH website has been a particular concern of our president, Peter Mansbach, who continued raising the issue with NIH every year for the past seven years. Some of you helped with our email campaign several years ago - thank you. And thanks to the NIH Sleep Disorders Research Advisory Board (including our representative Susan Plawsky) who supported our effort. And to Dr Michael Twery, head of the NIH National Center for Sleep Disorders Research, who helped make this happen.
CSD-N president Peter Mansbach has written an Overview of Circadian Rhythm Sleep Disorders for the 2019 Q3 issue of A2Zzz, the magazine of AAST (formerly the American Association of Sleep Technologists).
Among other things, he emphasizes the need for laboratory sleep studies to be performed according the patient's circadian clock rather than expecting the patient to sleep at the lab's normal study time.
Night owls between the ages of 14 and 17 are wanted for a 3-week study to test whether wearing glasses that block different amounts of light in the evening affect your body clock and could help teenagers sleep and feel better. The study is being performed at the Biological Rhythms Research Laboratory, which is affiliated with Rush University and is located in Chicago, IL.
Circadian Sleep Disorders Network is pleased to welcome Dr Elizabeth Klerman to our Medical Advisory Board. Dr Klerman had invited us to participate in the AASM Working Group on circadian rhythm research needs, and has worked with us on a grant application. We welcome her expertise and interest in Circadian Rhythm Sleep Disorders.
The Sleep Disorders Research Advisory Board (SDRAB) of the NIH (U.S. National Institutes of Health) met on Aug 1 and 2 to work on their Sleep Disorders Research Plan. Susan Plawsky, our circadian rhythm disorders (CRD) patient representative, attended both days. She ably represented our interests, again urging that CRDs receive adequate emphasis. She plays an important role in calling attention to places where CRDs are likely to be overlooked. The other participants on the SDRAB were receptive to our point of view.
Our president, Peter Mansbach, and member Alexandra Escalera also attended Aug 1, and made brief statements on behalf of CRD patients during the public comment period.
As some of you know, Circadian Rhythm Sleep Disorders are still not listed (as of Aug 2019, when this article was written) or described on the NIH website. We have been asking for this to be added for seven years now. At this meeting the Web Communications Group reported that a new sleep page is live, and Circadian Rhythm Sleep Disorders will be added in September. We hope so, although we have not yet seen any proposed content. (Note added Sept 30: it has finally been added. See article above.)
On June 8-12 the 2019 SLEEP Conference, the annual meeting of the American Academy of Sleep Medicine (AASM) and the Sleep Research Society (SRS), was held in San Antonio, TX.
The conference presented and discussed the latest developments in clinical sleep medicine, and sleep and circadian research. Alexandra Wharton, a board member for Circadian Sleep Disorders Network, attended the Tuesday sessions on an 'Advocate' pass.
During the four-day event, there were more than 100 sessions, with 24 focusing on circadian rhythms. This is quite an increase from just a few years ago.
UCSF (University of California San Francisco) researcher Dr. Louis Ptacek, a pioneer in establishing genetic studies for sleep behavior, discussed his research on humans, fruit flies, and mice, probing the biology regulating the body clock and sleep.
Dr. Phyllis Zee of Northwestern University spoke about the impact circadian rhythms have on weight gain for children and adults. A new study finds that light exposure overnight during sleep has been shown to influence metabolism and highlighted the importance that properly timed light be considered as part of a healthy lifestyle. Dr. Zee also discussed important advances that were made this year in terms of blood testing to identify gene expression to determine circadian timing.
California State Senator Anthony Portantino received an AASM award for his work developing public policy that moves school start times later so students get adequate sleep. His bill, SB-328, Pupil attendance: school start time, would require the school day for middle schools and high schools in California to begin no earlier than 8:30 a.m.
Other hot topics included how essential proper sleep is to mental health, if cannabis is effective for improving sleep, and the need for standards for measuring sleep cycles with wearables.
We have submitted a Needed Research document to the working group preparing a white paper on circadian rhythm sleep disorders research needs. This is a real opportunity for CSD-N to advocate for the research we keep wishing to be done.
Susan Plawsky, our representative on the NIH Sleep Disorders Research Advisory Board (SDRAB), has been in contact with Dr Elizabeth B Klerman, a sleep research physician and professor at Harvard Medical School. Dr Klerman is on the committee of scientists working on a white paper on needed circadian rhythm research for SRS/AASM (Sleep Research Society/American Academy of Sleep Medicine) and SRBR (Society for Research on Biological Rhythms), at the SLEEP 2019 conference in June. She asked Susan to prepare a list of research issues that CSD-N would like to see addressed.
Susan had previously requested input from our entire community for such a list that she used at the NIH Sleep Disorders Research Advisory Board meetings, and her initial list for Dr Klerman included those suggestions from the community. Time was short, so we have not been able to ask for new input from the community.
James Fadden, Peter Mansbach, and Susan have prepared a document on behalf of CSD-N, elaborating on those suggestions and presenting a more detailed list for Dr Klerman to present to their committee. We apologize if we have overlooked something, but we have worked day and night (mostly night ) to finalize this in time.
You can see our Needed Research document at https://www.circadiansleepdisorders.org/docs/NeededResearch.php .
We appreciate the working group's interest in hearing the patient point of view.
Last week, the U.S. House Appropriations Committee on Labor, Health and Human Services, and Education (LHHS) advanced a key bill that would provide important funding for sleep research and education projects in Fiscal Year (FY) 2020. The bill includes a total of $41.1 billion in funding for the National Institutes of Health (NIH), an increase of $2 billion over FY 2019. Of specific interest to our community, the Committee published a recommendation on Sleep Disorders stating:
The Committee commends the recent expansion and advancement of the sleep and circadian research portfolio under the coordination of the National Center on Sleep Disorders Research (NCSDR). The Committee encourages dedicated research activities on specific sleep disorders, such as narcolepsy and restless legs syndrome, to ensure scientific progress benefits patients impacted by debilitating conditions disordering their sleep and biological rhythms.Language like this has been a driving force behind the recent funding expansion of the sleep and circadian research portfolio at NIH. With additional congressional focus on individual sleep disorders, we should expect to see meaningful investment in specific sleep conditions moving forward.
The bill also includes a total of $8.3 billion for the Center for Disease Control and Prevention (CDC), an increase of $921 million over FY 2019. Importantly, the legislation set aside $3 million for Chronic Disease Education and Awareness, as a new program that would award grants to address chronic diseases and their risk factors. This new program could help to fund critical sleep education and awareness, but more on this effort coming soon!
We note that this is just the start of a long legislative journey. The bill must pass the full house, then pass the Senate, and be signed by the President.
CSD-N board member Alexandra Wharton called our attention to a bill (HB 1602) pending in the Texas legislature that would require schools in Texas to start no earlier than 8:00 a.m. She herself testified at the Texas House Public Education Committee hearing on April 4, 2019 at the state capitol in Austin, and she suggested CSD-N write a letter of support. You can view her testimony here (using her married name Alexandra Spencer), and read our letter here. Unfortunately the bill died in committee. However, there is continuing interest on the part of some of the legislators, and it is expected to be revived in the next session with better chances.
Interesting article in the Washington Post: How living on the wrong side of a time zone can be hazardous to your health.
Last October we reported that Elizabeth McDougall, eighth grader and recipient of the Edward R. Foley Citizenship Prize at Derby Academy in Hingham, Massachusetts, was doing her community project on Circadian Rhythm Sleep Disorders. She sent this progress report:
I just wanted to let you know that, a few weeks ago, I asked students in our upper school to create posters about Circadian Rhythm Sleep Disorders based on information they learned from my presentation or anything they learned from their own research. We hung them in our Brown Art Gallery so that the rest of the school and visitors could see them. I attached a picture of some of them. [Webmaster's note: we do not have permission from the makers of the posters, or their parents, so we have not posted the photo.] The students who created a poster could ignore dress code for a day. They could even wear their pajamas to school, if they wanted to.Thank you again, Ms McDougall!
Also, Will Slotnick, founder of Wellness Collaborative, comes to our school for a couple of weeks each year to provide drug education, stress management, and mindfulness training to students, parents, faculty, and administrators. He is joined, for one of the days, by the local D.A.R.E. officer. This year, my mother and I brought them up-to-date on my brother's diagnosis and how circadian rhythm sleep disorders can appear to be depression, anxiety, or defiance. From now on, they will keep this in mind when when they work with other students.
Tonight is our school's annual talent show. I will be selling refreshments at intermission at a table displaying your poster and pamphlets. We are expecting approximately 250 people so hopefully I will help spread awareness to family and friends of our school community.
I notice on your website that you are working to include Circadian Rhythm Disorders on the National Institutes of Health website. That would bring much more visibility, and hopefully eventually more funding, to these devastating disorders.
Our president, Peter Mansbach, was invited to attend the 2019 World Orphan Drug Congress USA at National Harbor, MD. This is sponsored by companies working on solutions for rare diseases, and rare disease organizations including NORD and EURORDIS. There is increasing emphasis on including patient perspectives in all stages of pharmaceutical research, including setting treatment goals ("endpoints") and finding patients for trials. Peter participated in a round table discussion on endpoints, and attended several talks.
Vanda Pharmaceuticals is planning Phase II trials this year for Hetlioz® as a treatment for DSPD (Delayed Sleep Phase Disorder). Hetlioz is already approved (in the U.S.) for treatment of Non-24-Hour Sleep-Wake Disorder, in both blind and sighted individuals. Hetlioz is the brand name of tasimelteon, which is a melatonin agonist (i.e. it works similarly to melatonin).
CSD-N, along with other sleep organizations, has signed on to a letter requesting the U.S. Congress to restore funding to the CDC (Center for Disease Control and Prevention [U.S.]) dedicated to sleep research and awareness. You can read the letter here. Thanks to Julie Flygare at Project Sleep for pulling together all these sleep organizations.
New CSD-N board member Alexandra Wharton has been appointed as CSD-N's Social Media Liaison. She will take charge of our Twitter feed and LinkedIn page, and may contribute to our Facebook page and other social media outlets as she sees fit. Thanks to Jennifer Silvia, our previous social media liaison, who handled these duties in the past.
For SIX YEARS we have been trying to get Circadian Rhythm Sleep Disorders (CRSDs) listed and documented on the NIH website. That campaign came to a head at the SDRAB (U.S. NIH Sleep Disorders Research Advisory Board) meeting on Friday, Jan 18. We had a half hour segment on the agenda at 1:30 pm to present our case and to hear from the OSPEEC (Office of Science Policy Engagement, Education, and Communications - the office which controls the website) which has in the past been unresponsive. Peter Mansbach (in photo) presented brief arguments and history, which is posted at https://www.circadiansleepdisorders.org/docs/NIH-SDRAB-website.php. That document includes a proposed resolution that was to be presented to the SDRAB, and which included our proposal for minimum web content.
Our arguments were well received, both by the SDRAB and the OSPEEC. The director of OSPEEC assured us that they are in full agreement. Their content person said they are working to make the website more accessible and discoverable, with new central pages to assist navigation. Peter expressed concern that our additions were being deferred for other design goals, when our proposed content can fit seamlessly into the present design and still be used as topics get rearranged. The director assured us that the "process [for including CRSDs] has begun", and our new elements can be develped concurrently. However, it sounded like it would take at least 6 months to get anything posted, and probably longer. It's a large bureaucracy.
Susan Plawsky, our CSD-N representative on the SDRAB, spoke in support. Linda Secretan, the patient representative for Restless Legs Syndrome (RLS), gave a strong statement of how helpful it has been to the RLS community to have RLS on the NIH website - it's validation of a disorder that many people otherwise just find amusing. Dr Sairam Parthasarathy and others spoke in support. It was felt unnecessary to formally vote on our proposed resolution, since we had so much support from the SDRAB.
The bulk of the meeting, of course, was devoted to the details of developing the next Sleep Disorders Research Plan, optimistically scheduled to come out this June. Many thanks to Susan Plawsky for continuing to represent CSD-N and the Circadian Rhythm Sleep Disorders community in this endeavor. The photo is of Dr. Michael Twery, director of NCSDR (National Center for Sleep Disorders Research) addressing the SDRAB. In the foreground are Dr Aaron Leposky, NCSDR staff, and Dr Gabriel Haddad, current chair of the SDRAB.Archived News 2018
This is a free mailing list support group for people with DSPS and Non-24 to share their experiences. It's a good place for people just discovering these disorders to hear how others deal with them, as well as for long-time participants to get support and to provide support to others. There are often discussions of evolving treatment, useful to all. For further information, and to sign up, go to www.circadiandisorders.org/list.
Note that membership in Circadian Sleep Disorders Network and membership on this email list are completely separate.
Circadian Sleep Disorders Network is affiliated with this email list, and our volunteers assist the list administrator with some chores. CSD-N was formed by participants on this list, and many of our members post regularly. But we have no control over what appears or who can join, and list membership is completely separate from membership in CSD-N.
Once you've signed up for the list, you post by sending an email to Everyone on the mailing list receives that post as an email, and you receive everyone else's posts as emails. If you don't like to get separate emails, you can opt to receive in digest form, typically one email a day containing all the day's posts. You make that selection after signing up by logging in (using the password you created when signing up for the email list) at www.circadiandisorders.org/list.
There are some rules:
The rules that the list software enforces are
An additional rule is PLEASE do not just reply to a message with a subject line containing "Niteowl Digest, Vol xxx, Issue xxx". That is obviously not informative and if you aren't careful you may include the whole list of messages in the Digest, making your message too large for the list.
Digest or not, it is a good idea to trim whatever you are replying to leaving just enough for people to know what you are replying to.
Of course, don't be snippy or insulting, and please take off-topic conversations off-list. And no advertising.
Once you've signed up for the list, you can also browse previous posts in the archive at
There is also a mirror of the archive on Yahoo at https://groups.yahoo.com/neo/groups/nite-owl/info. This is useful when the primary archives are not working, as sometimes happens. Login to your Yahoo account, or create one (free) - link is at the top right on that page. Then you have to join the Yahoo copy of the list - this is separate from signing up for the list itself - there is a button on the Yahoo page to do this.
To unsubscribe from the Niteowl email list go to
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If you do not know your list password, send email to
with PASSWORD in the subject line. This email must come from the same email address that you subscribed from (which is the one your incoming Niteowl list emails go to). Your password will be sent to you at that address.
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For more (or more current) help on list commands, send email to
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Our brochure is geared to the general public, to introduce DSPD (DSPS) and Non-24 to people experiencing symptoms of these disorders, and to their families.
Please distribute it to anyone who may be interested.
Print on lightly colored paper for some color, if you like. We used ivory.
|Brochure - web display||
Print on US letter size paper, PDF
Print on A4 size paper, PDF
The web display version shows the brochure panels in easy-to-read order. The print versions are meant to be printed out on both sides of a sheet of paper, then folded in thirds, creating a brochure. (In the print version, the panels will appear out of order on-screen.)
We have posted documents describing DSPD (DSPS) and Non-24, in an easy to read Question-and-Answer format. These are designed to give to family members, friends, employers, and school personnel, to help them understand these disorders. Feel free to print and distribute these. There are two different (but similar) versions, one for DSPD and the other for Non-24:
|DSPD Q&A - web||printer||booklet*|
|Non-24 Q&A - web||printer||booklet*|
The web formats display nicely in your browser.
The printer versions are formatted by your browser for printing a multi-page document.
The booklet forms are pre-formatted PDF files that you can print on two sides of a single sheet of paper, which then folds in half into a booklet.
* When printing the booklet, be sure to flip on the short edge (select this option if you have a double-sided printer).
|Spanish:||DSPS Preguntas y Respuestas - web||printer|
|No-24 Preguntas y Respuestas - web||printer|
|German:||DSPS F&A - web||printer|
|Non-24 F&A - web||printer|
We also have a one page Basic Fact Sheet that introduces DSPD and Non-24 to people who don't know about them. It's a quick and easy read, just the basics.
Former board member and artist Lily Style has created an infographic describing Circadian Rhythm Sleep Disorders. View it in your browser at www.circadiansleepdisorders.org/docs/CRSDGraphic.php. Feel free to repost the graphic to help raise awareness.
You can print it directly from your browser (we suggest making the browser window full screen - the image will resize). We are also posting JPG images in various proportions for printing directly on different sizes of paper:
We are offering merchandise (mugs, T-shirts, tote bags, bumper stickers, and a messenger bag) with our name and logo through CafePress,
www.cafepress.com/circadiansleepdisordersnetwork. (Note: if you just search CafePress you will find this merchandise, but at a higher price!)
Circadian Sleep Disorders Network is a Coalition Partner of Start School Later. We understand only too well the difficulties many teens have with early school start time, and we support the move to start school later.
smile.amazon.com you will be asked to confirm Circadian Sleep Disorders Network as your charity. Amazon will remember your selection. But you do have to go to smile.amazon.com instead of simply amazon.com, for each purchase, if you want 0.5% of that purchase to go to CSD-N. Note that you pay the same amount either way - through Smile the 0.5% goes to us, otherwise it goes to Amazon.
We have already received several contribution checks from Amazon! Please select Circadian Sleep Disorders Network as your charity. smile.amazon.com
Amazon and the Amazon logo and AmazonSmile and the AmazonSmile logo are trademarks of Amazon.com, Inc. or its affiliates.
This is a list of refences added to our Info page since the last newsletter. The newsletter lists references added since the previous newsletter. These are generally available to members only.
This web site is intended to provide generic information about Circadian Rhythm Sleep Disorders, and
is not intended to replace discussions with a healthcare provider.
You should not use the information on this website for diagnosing or treating a medical or health condition.
All decisions regarding patient care should be made with your healthcare provider.
Office: 4619 Woodfield Rd, Bethesda, MD 20814
Phone: By appointment only, please.
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