Sleep Tips for People Who Are Blind or Visually Impaired

Few things are more refreshing and energizing than a good night’s sleep, but that can be elusive for many people who are blind or visually impaired. Do you find it difficult to wind down when it’s time to go to bed? Do you find yourself wanting to sleep during the day? Is it hard to concentrate during waking hours? Do you feel foggy, restless, overtired, or frustrated when you are awake?

Many people who are blind or visually impaired have difficulty sleeping. Currently, about 1 million Americans are legally blind (with corrected vision of 20/200 or worse) – a figure that may double by 2050. Among those, approximately 10% are totally blind, with no light perception at all. And as many as 70% report having trouble sleeping at night as well as trouble staying awake and functional during waking hours.

Individuals who are visually impaired face unique challenges related to sleep, according to sleep scientist Dr. Jing Zhang, so it is important to address these issues in order to improve their sleep quality.

The main cause of sleep problems in blind and visually impaired people seems to be a disruption in circadian rhythm. This rhythm serves humans as an “internal body clock,” regulating the daily cycle of biological processes such as hormone production and sleep.

These processes repeat daily on a cycle that’s close to (but not exactly) 24 hours, synchronized by environmental time cues. Photoreception, or the perception of light, is a primary cue that helps reset a person’s circadian rhythm.

For a person who is totally blind, the inability to perceive light can sometimes prevent the internal body clock from synchronizing and regulating bodily processes on a standard 24-hour day-night cycle. The absence of this major environmental cue can cause a disruption in the circadian rhythm, resulting in inconsistent sleep patterns — usually fluctuating periods of healthy sleep punctuated by periods of poor sleep, and excessive daytime sleepiness. Inconsistent and inadequate sleep can wreak a number of ill effects on a person’s physical and mental functions during both sleeping and waking hours.

This guide is designed to help you understand the human body’s circadian rhythm and how it can be disrupted in blind people, most commonly via a syndrome called “non-24 sleep-wake disorder.” The guide also provides resources to help blind people explore the options for adjusting to and treating their symptoms, as well as for discussing symptoms with others and examining how the effects can be addressed and accommodated.

Visual Impairment and Sleep Disorders

Poor sleep quality, interrupted sleep, and short sleep duration

Several studies published on scholarly journals have found links between visual impairment and poor sleep quality or extremes in sleep duration (in which sleep lasts for excessively short or long periods). The results of one such study indicated that individuals with low vision or visual impairment experienced a high incidence of poor sleep quality, short sleep duration, and sleep apnea (which causes sleep fragmentation or interruptions). For older adults with some light perception, it was found that bright light treatment can be effective in treating insomnia.

In the section below, we recommend tips for addressing and alleviating these types of sleep disruptions, titled Living With and Managing Circadian Rhythm Disorders. Look for answers to the questions “How do I deal with fatigue?” and “How can I improve my chances of getting decent sleep?”

Sleep apnea

Sleep apnea is a condition in which a person’s breathing stops during sleep, sometimes for dangerously long periods of time. Since it occurs during sleep, you may experience apnea without knowing it. Symptoms include:

• Loud snoring (reported by another person)
• Episodes in which you stop breathing during sleep (reported by another person)
• Gasping for air during sleep
• Awakening with a dry mouth
• Morning headache
• Insomnia or difficulty staying asleep
• Hypersomnia or excessive daytime sleepiness
• Difficulty paying attention while awake
• Irritability

During an episode of sleep apnea, the musculature of the airway relaxes excessively during sleep, and the intake of breath pulls in the walls of the relaxed airway, narrowing or obstructing it. This causes an interruption in breathing, which in some sleepers can happen up to 100 times an hour. As a result, the body is intermittently deprived of oxygen, potentially leading to a host of respiratory, circulatory, and neurological problems.

Certain visual conditions have been associated with sleep apnea, according to a 2013 clinical study by the American Academy of Ophthalmology. The study noted links between the detrimental circulatory impact of sleep apnea and several ocular and retinal disorders. Essentially, the oxygen deprivation that results from sleep apnea can damage the circulatory system, creating the perfect conditions for papilledema, glaucoma, floppy eyelid syndrome, optic neuritis, chorioretinopathy, or one of several other diseases of the eye.

Doctors recommand that, if you have symptoms of any of these conditions, you should get an ophthalmic exam immediately, and undergo a sleep study if necessary. An exam can not only detect the circulatory signs in the eyes early enough to determine if the underlying cause is sleep apnea, but it can also head off related conditions such as coronary artery disease.

How Circadian Rhythms Affect Sleep

One major cause of sleep problems in blind and visually impaired people is a disruption in the circadian system. Inside the human brain, the hypothalamus creates an internal “pacemaker” of sorts, generating the circadian rhythms that influence the body’s daily physiological processes, majorly impacting overall health, behavior, and well-being. These processes include the sleep-wake cycle and regulation of daily hormone levels.

If a person’s circadian rhythms are out of sync, hormones can be released at the wrong time of day, causing difficulty sleeping at night and a corresponding urge to sleep during the day. The resulting sleep deprivation may affect alertness, cognitive functioning, and mental performance, making it hard to focus on even simple tasks.

The issue is a slightly complicated matter of cycles. A human’s natural timing mechanism, the “body clock,” runs a little longer than 24 hours for most people, whether sighted or blind. The length of time that each person’s cycle differs from the standard 24-hour period may be a few minutes or much longer (for reasons that are still unknown). In people with properly functioning circadian rhythms, this difference is regulated daily, corrected to synchronize back to a standard 24-hour cycle, helping facilitate sleep at night and wakefulness during the daytime.

For most people, this is how circadian rhythms work to keep their body clocks on track: circadian rhythms, which control the body’s ebb and flow of sleep and wakefulness, are themselves influenced by cues from the environment surrounding a person. One main cue is light. Photoreceptors in the eyes’ retinas receive light cues from the environment; then, the eyes signal the brain what time of day it is — day, night, or in between.

The brain’s hypothalamus uses this information to regulate the person’s natural rhythms, synchronizing them internally as well as externally in relation to the environment, and correcting the non-24-hour body clock to the typical day-night schedule. Much the same as resetting the hands on a clock, this reset is the circadian rhythm’s way of syncing the body’s processes to the 24-hour cycle upon which most people operate.

For more information about circadian rhythms and their effect on sleep, visit:

• National Institute of Health: Visual impairment and circadian rhythm disorders
• NationalInstitute of Health: Association between Visual Impairment and Low Vision and Sleep Duration and Quality among Older Adults in South Africa

The Non-24 Sleep-Wake Disorder

There are several types of disruptions to circadian rhythms that often manifest among specific groups. Teenagers frequently experience delayed sleep phase disorder, falling asleep late and waking late. Elderly people experience advanced sleep phase disorder, which has the opposite effect of early to bed and early to rise. Travelers can suffer from jet lag, a conflict between sleep patterns in their natural time zone and ones they travel to; shift workers often endure insomnia or excessive sleepiness as their work schedules conflict with their natural circadian rhythms.

The non-24 sleep-wake disorder is a serious, chronic circadian rhythm disorder that most commonly affects people visually impaired, especially those who are totally blind. Reports suggest that as many as half to three-quarters of Americans who are totally blind have Non-24, representing up to approximately 95,000 people. The first signs can manifest at any age, usually, after a person is diagnosed with a complete loss of light perception.

Non-24 is common in totally blind people because light does not register through their eyes. In sighted people or those with some light perception, light entering through the eyes signals the time of day to the hypothalamus, prompting the brain to respond by resyncing the person’s body clock to correspond with the standard 24-hour cycle of sleeping and waking.

In a person who’s totally blind, though, environmental factors don’t cue the brain this way, so the person’s internal body clock defaults to its natural non-24-hour cycle. Unchecked, this leads to a phenomenon termed “free-running” by scientists who studied the phenomenon.

The name of the disorder, “Non-24,” indicates a master body clock that is not 24 hours long. This slight difference in timing between the person’s daily rhythm and the 24-hour cycle — a difference which can range from a few minutes up to an hour a day — accumulates day after day, eventually causing a noticeable change in the times of day when the body needs to sleep and to be awake. Eventually, the body comes to operate as if night is day and day is night.

Here’s an example of a “free-running” circadian rhythm: say your body clock naturally runs on a cycle of 24.5 hours, making you want to sleep an extra half-hour each day. This means that on the first day of a cycle, you’d be half an hour behind the norm. The next day, the time would accumulate to put you an hour behind, and so on. Within a month at this pace, your natural rhythms would make you want to sleep during the day and be awake at night. After another month, your sleep-wake cycle might briefly sync up again with the typical 24-hour day-night cycle — but then it would begin to move out of sync again.

A person could cycle through one of these full circadian rhythms in a period as short as a month and a half. For others, it could be several months before their sleep-wake cycles realigns on their own with the 24-hour day. In the intervening weeks, any person with Non-24 will experience solid periods of healthy sleep followed by periods of poor sleep, and excessive sleepiness during the daytime. People in this state constantly struggle to sleep at night and to stay awake or think clearly in the daytime. Over the long term, such disruptions to a person’s sleep cycle can negatively affect their waking performance and behavior in substantial ways.

For more information about the Non-24 sleep-wake disorder and other circadian rhythm disorders, visit:

• Cleveland Clinic: Circadian Rhythm Disorders
• National Organization for Rare Disorders: Non-24-Hour Sleep-Wake Disorder
• National Institute of Health: Visual impairment and circadian rhythm disorders

Non-24 Symptoms and Diagnosis

Non-24 is not technically a sleep disorder. It is a chronic circadian rhythm disorder that can greatly impact your life. The Non-24 experience varies from person to person. Symptoms of the disorder can occur at any age and usually first manifest shortly after a person’s loss of light perception becomes complete. Symptoms can happen at night and during the day, and they can be mild or severe.

The two main areas of life affected by the disorder are the ability to sleep, and the ability to function effectively during waking hours. If you struggle with either of these, either to a mild or intense degree, you may have Non-24.

Nighttime Symptoms

Often, the sleep disturbance caused by Non-24 is less clear than the waking symptoms. Since changes in the timing of sleep can be subtle from night to night, they may even look normal for long periods, even when the circadian clock is still not synchronized with the 24-hour cycle. Patients can suffer periods of sleeplessness over several months with only intermittent relief.

A few of the key nighttime-related symptoms associated with Non-24 are:

• A profound inability to fall asleep at night
• Difficulty staying asleep at night
• Shifting times the body wants to sleep
• Sleep patterns that are different from those of most people you know
• Waking up groggy or not feeling rested enough

• The feeling of fighting a never-ending battle between sleeplessness and exhaustion

Daytime Symptoms

In addition to affecting sleep, circadian rhythm disorders and the resulting lack of solid sleep also impacts waking function. Sleep deprivation can adversely affect mental acuity, concentration, memory, coordination, and mood, as well as a host of physical factors.

A few of the key waking, daytime-related symptoms of Non-24 are:

• An overwhelming urge to sleep during the day
• Falling asleep unexpectedly
• Difficulty functioning at work or at school
• Difficulty concentrating on tasks
• Sluggishness and forgetfulness
• Irritability due to sleep deprivation
• Depression arising from fatigue and frustration
• Strain in relationships
• Frustration because no one seems to understand what you’re going through

For more information about symptoms and diagnosis of the Non-24 sleep-wake disorder, visit:

• VisionAware: Discovering that I had the Non-24 sleeping disorder
• National Organization for Rare Disorders: Non-24-Hour Sleep-Wake Disorder
• National Institute of Health: Visual impairment and circadian rhythm disorders

Living With and Managing Non-24

Sleep deprivation can make it extra difficult for you to address the symptoms and effects of Non-24 in your life. It can be hard to even communicate what’s happening to you, let alone figure out how to get help and start to make the necessary changes. This section of the guide breaks down the questions you might have about managing symptoms, communicating the effects to people in your life, normalizing your daily and nightly routines, and ultimately finding treatment.

How do I start to manage Non-24 in my life?

If the above symptoms describe what you’ve been experiencing, most sources recommend that you start with a medical consultation. The first move is to visit your doctor and get confirmation that you’re suffering from Non-24, then collaborate on strategies for management and treatment.

What should I ask/tell my doctor?

Start by sharing with your doctor the list of symptoms above and discuss your experience with them. Even if they’re well-versed in treating the specific issues of patients who are totally blind, it still may be possible that your doctor is unaware of the Non-24 sleep-wake disorder and its effects. If this is the case, you can introduce and explain the condition.

Start keeping a sleep diary to organize your concerns before having a discussion with your doctor. Use these questions as a starting point:

• When was the last time you had a good night’s sleep?
• When you sleep, do you wake up feeling rested?
• How strong is your desire to sleep during the day, and how does it change from one day to the next?
• How hard is it for you to concentrate?
• What do you do to stay awake during the day?

This information, plus any tests your doctor may want to run, can help you both devise a plan together to help you manage and treat Non-24’s impact on your life.

What should I look out for in the doctor’s office?

There are a few common misdiagnoses that often accompany the Non-24 sleep-wake disorder, especially from doctors who are not familiar with the specific issues of blind people. Vigilance on your part about these common misdiagnoses can help you guide your doctor toward taking a broader— and potentially more effective— approach toward your symptoms.

Non-24 is often misdiagnosed as a sleep disorder— usually primary insomnia, or sometimes, sleep apnea— and inappropriate sleep medication or the use of apparatus like a CPAP machine is prescribed. This treatment of the sleep issue only addresses one single symptom, not the underlying disorder: the misalignment of the master body clock.

Non-24 can be misunderstood as a psychological disorder. This is not the case. Although psychological problems can crop up as a result of sleep deprivation and other symptoms, Non-24 is classified as a circadian rhythm disorder. Letting your doctor know that you believe you have a circadian rhythm disorder can help prompt a correct diagnosis and treatment.

How will my life change with Non-24 sleep-wake disorder?

Non-24 can be deceptive, as the initial disruptions it imposes on your sleep patterns can be gradual, and might even look normal for long periods of time. However, as you increasingly suffer the effects of your sleep times being “out of phase,” you’ll realize the symptoms are not normal, nor are they sustainable.

The effects can be physical, mental, and emotional. Sleep deprivation, fatigue, and the associated problems with concentration, memory, and coordination may make it much more difficult to complete daily tasks. The urge to sleep at “inappropriate” times may be misunderstood by fellow students, co-workers, and others around you, which can be isolating and frustrating.

You will likely find yourself concentrating a great deal of your energy on trying to deal with the symptoms and resume a more manageable pattern of waking, sleeping, and functioning. Make sure you discuss the symptoms you’re dealing with and their effects with the people in your life. Ask for help and understanding, and do not be afraid to seek professional help. In addition to seeing a knowledgeable doctor who can help guide you toward coping techniques and viable physical treatments, consulting a counselor who’s informed, especially about the issues facing many blind people, can provide you the emotional support you may need.

How do I deal with fatigue?

People who suffer from Non-24 fight an almost constant battle with fatigue, and the wide-ranging nature of the condition can hinder the usual methods that would otherwise work to help you through the day. It may suddenly become difficult to wake up on time and stick to a regular schedule. It may feel like your energy has been sapped. You might become very sleepy during the daytime, needing to nap— or even involuntarily falling asleep at inopportune times.

Sleep deprivation may lead to problems with concentration and memory, making crucial daily tasks a challenge and increasing the risk of errors and accidents. This can be especially problematic for blind people, whose daily tasks require alertness and mental acuity just to navigate the world.

Fortunately, there are steps you can take to fight fatigue. Here are some general tips:

• Eat a healthy diet. Keeping your blood sugar in check by eating healthy foods will help you feel more alert. Eat a balanced diet with lots of fruits and vegetables, whole grains, and lean proteins.
• Exercise during waking hours. It has been shown that moderate exercise five times a week can help stabilize your blood sugar and increase energy levels.
• Moderate your caffeine intake. It’s tempting to turn to coffee or tea when you’re dragging and need to get through the next few hours. But long after caffeine gives you that lift, its effects can linger into the hours you should be sleeping. Plus, too much caffeine can lead to anxiety, leading you to feel more fatigued. Limit your caffeine intake to no fewer than 3 hours before bedtime.
• Drink plenty of water. Dehydration can cause fatigue. Make sure you drink plenty of water before and after exercising, and at all times throughout the day.
• Drop excess weight. People who are overweight tend to tire more easily than those whose weight is proportional to their height. Also, excess weight can lead to apnea and other sleeping problems.
• Follow your treatment regimen. Follow your doctor’s treatment plan, and talk to your doctor whenever you’re having difficulty.

How can I improve my chances of getting decent sleep?

Being unable to sleep is the initial symptom of Non-24 that seems to set all the other symptoms in motion. Not getting enough sleep can cause a host of mental problems for a person’s concentration, memory, and mood, as well as physical ailments like indigestion, elevated blood pressure, and an increased tendency toward diabetes.

Although light is the brain’s most powerful environmental cue to trigger circadian rhythms and synchronize a person’s sleep patterns, this is not an option for individuals who are blind. Fortunately, there are other “nonphotic” (non-light-related) measures that can positively affect the circadian pacemaker.

According to Dr. Jing Zhang, individuals with visual impairments may rely more on routine and structure to navigate their daily lives. With technological advances, utilizing assistive technologies such as alarm clocks with vibration or sound options might be beneficial as well.

In addition to the above tips for avoiding fatigue, consider implementing these behavioral changes to improve your chances of getting good sleep:

• Follow a strict sleep/wake schedule. Try to make sure you go to bed at the same time each night and wake up at the same time every morning. Once your body expects to power down at a certain time, it should be easier for you to fall asleep on schedule.
• Create a relaxing bedtime ritual. Falling asleep at night is easier if you are relaxed. Create a bedtime ritual that allows you to relax— like taking a warm bath or reading — and try to repeat the ritual night after night.
• Exercise regularly. Movement is important for overall health and sleep patterns, particularly for people who are blind or visually impaired. Try to get at least 30 minutes of exercise daily, such as walking, swimming, dancing, or any physical activity you enjoy.
• Light exposure plays a crucial role in regulating the circadian rhythm, even for those who are visually impaired, so it is important to get enough light exposure during the day and avoid artificial light during night. Research shows that those who are visually impaired and blind can still benefit from light therapy.
• Find the right mattress for you. The bed you sleep has a big impact on your ability to sleep well at night. Finding the best mattress for you means considering factors such as sleep position, body weight and shape, and comfort preference.

NOTE: Physical stimulation too close to bedtime can inhibit sleep. Try to exercise in the morning or afternoon, avoiding it in late evenings or right before bed.

• Don’t eat or drink right before bed. Eating right before bedtime can also disturb your sleep, as your metabolism ramps up to process the food. Try to eat dinner several hours before bedtime, and avoid snacks that contain carbohydrates or protein. If you absolutely need to eat later than usual, opt for small portions of nutrient-dense foods such as vegetables, nuts, avocados, or apples.
• Avoid napping if possible. Though it’s tempting (and sometimes unavoidable), taking naps during the day can make it more challenging to fall asleep at night, especially for blind or visually impaired individuals whose sleep-wake cycle may already be out of sync.

NOTE: If you find you do need a nap, try to limit it to 20 minutes, and follow these general guidelines: if your bedtime is 10 p.m., your nap should begin no later than 2 p.m. If you go to bed around midnight, your nap should begin no later than 3 p.m.

How can I help people understand what I’m going through?

First, acknowledge this truth: you’re not alone— even though it may feel that way. Thousands of other people are experiencing many of these same challenges.

Then acknowledge the next truth: the people who are NOT going through these same things are not likely to initially comprehend what you’re dealing with on a daily basis. Because of this, living with Non-24 can make you feel misunderstood, neglected, and alone. But fortunately, communication and education can help you break down this isolation and misconception.

This is where you acknowledge the third truth: You need to be proactive and bring the issue up with your friends, family, fellow students, professors, co-workers, and employers. Communicating is especially important if anyone has judged you for being inattentive or lazy, or for falling asleep at inappropriate times; it’s important you tell them what’s going on. Describe your symptoms and explain the science behind the condition. Once they know more, they will often realize their error in judging you and be more likely to collaborate with you on finding solutions.

How can I maintain my social life?

There are several strategies you can use to bolster your social networks:

• Educate your community. Direct your loved ones to learn more about your condition through online resources like Non-24 Sleep-Wake Rhythm Disorder in the Totally Blind.
• Temper family and friends’ expectations. Let them know that you may not always be able to attend special events, or you may need to wait until the last minute to accept or extend invitations for get-togethers.
• Make friends with people who work different hours. Cultivating a friend group that includes shift workers on both day and night shifts will give you a better chance of finding someone available to get together at a time when you are alert.
• Maintain contact via email. Email is a great way to keep in touch with people close to you during the times you’re awake but they might be sleeping— or when you’re sleeping and they’re awake. Conversations can be carried on according to your own timing.
• Conserve energy for special events. If you’re anticipating a special event that you want to attend, try to sleep as much as possible during the hours your body wants to sleep for several days preceding the event. This will help you rest up for the “big” event.
• Join an online support group. There are a few options available, such as the Non-24-Hour Sleep-Wake Disorder group on Facebook, and the Circadian Sleep Disorders Network. Find one that fits you best.

How can I maintain my work life?

Keeping up with class or work duties can be a nightmare when you’re constantly fighting to stay awake and alert, and that struggle can be exacerbated if colleagues, professors, or employers misunderstand your inability to complete required tasks. Advocating for yourself might sound like more than you can handle in such a compromised state, but the sooner you let your co-workers in on what’s happening with you, the more effectively you can collaborate on solutions.

Open a dialogue with your boss and co-workers— or, if you’re not comfortable with that, talk to a representative from human resources. Prepare short answers to common questions about the condition.

Today’s workplace culture is making great strides in accessibility and nontraditional alternatives to the standard office environments, so you might see if you can take advantage of this trend. If you’re already employed, ask your employer for:

• Greater flexibility in your work hours
• The opportunity to work from home as needed periodically
• The opportunity to work part-time rather than full-time, if feasible

If it becomes impossible to keep up your work in a traditional office or workplace environment, you might begin searching for alternative approaches to the standard employment setup, such as a job with flexible hours that you could do from home. Just a few examples include:

• Virtual assistant
• Medical transcriptionist
• Translator
• Web developer/designer
• Customer support
• Freelance writer or editor

NOTE: Non-24 is considered a disability under the Americans with Disabilities Act, so your employer is required to provide you reasonable accommodations, up to and including a part-time or modified work schedule.

If you have been diagnosed with and treated for Non-24, talk to your employer about some options. You may also want to consult with an attorney who specializes in disability.

For more information about living with blindness and Non-24 sleep-wake disorder, talking to the people in your life about the effects, and connecting with networks and resources, visit:

• Non-24 Hour Sleep-Wake Rhythm Disorder in the Totally Blind: Diagnosis and Management
• Non-24 Hour Sleep-Wake Disorder in Sighted Patients
• Podcasts collected at Non-24.com about living with Non-24 sleep-wake disorder
• Non-24-Hour Sleep-Wake Disorder group on Facebook
• Circadian Sleep Disorders Network

Non-24 Treatment and Care

There is currently no permanent cure identified for the Non-24 sleep-wake disorder. For sighted people suffering from Non-24, phototherapy and the prescription of melatonin are two current treatments. Since people who are totally blind cannot respond to phototherapy, the daily administration of melatonin has been used as an effective therapeutic strategy.

However, in 2014, the U.S. Food and Drug Administration approved the medication tasimelteon (brand name Hetlioz) for the treatment of Non-24 sleep-wake disorder in individuals who are totally blind without light perception. It is the only FDA-approved medication on the market for the purpose.

This is how it works

In sighted people, light enters the eyes to signal the hypothalamus about the time of day. That information triggers the pineal gland, synchronizing its melatonin secretion with the 24-hour cycle of daylight and darkness, turning on at nightfall and continuing for about 12 hours. But in totally blind people, the absence of light cannot trigger the natural secretion of melatonin, necessitating the need to replace melatonin in the human system synthetically for regulation back to a 24-hour cycle.

This what you need to know

Melatonin as a supplement has long been a standard and effective treatment option for Non-24. Tasimelteon/Hetlioz stimulates the same cellular receptor as melatonin, according to the FDA, but no head-to-head trials have compared the efficacy of the two, said Charmane Eastman, a scientist at the biological rhythms research lab at Rush University Medical Center in Chicago.

A 2014 Reuters Health story reported that tasimelteon/Hetlioz may cost up to $60,000 a year or more, so some patients with Non-24 may want to consider nonprescription melatonin supplements as an alternative, which typically cost up to $50 a year. Patients who choose melatonin to treat Non-24 should be sure to take it at the same time each day, three to five hours before bedtime, and stick to that schedule consistently.

Two studies, both published in medical journal The Lancet, found the most common side effects of tasimelteon/Hetlioz to be headaches, nightmares or abnormal dreams, elevated levels of liver enzymes, and upper respiratory and urinary tract infections.

For more information about treatment and care for Non-24 sleep-wake disorder, visit:

• National Institute of Health: Visual impairment and circadian rhythm disorders
• National Organization for Rare Disorders: Non-24-Hour Sleep-Wake Disorder
• Reuters Health News: Hetlioz pill may ease sleep disorder for some blind people
• The Lancet: Tasimelteon for non-24-hour sleep–wake disorder in totally blind people

Information, Support, and Resources for People with Non-24

Many websites and other entities offer resources and information that can help blind people who suffer from Non-24 and other sleep-related disorders.

Cleveland Clinic

The Cleveland Clinic’s Sleep Disorders Center publishes a glossary of sleep-related terms, a guide to sleep disorders, and informational overviews of common sleep disorders and circadian rhythm disorders.

American Academy of Ophthalmology

In a clinical update titled Obstructive Sleep Apnea and the Eye: The Ophthalmologist’s Role, the academy noted links between the circulatory impact of sleep apnea and several ocular diseases, including papilledema, glaucoma, floppy eyelid syndrome, and retinal disorders.

National Organization for Rare Disorders

This organization’s rare diseases website collects scientific data on the nature, affected populations, symptoms, and causes of the Non-24 sleep-wake disorder, as well as treatment options and related disorders.

VisionAware

The VisionAware website, an interactive forum and comprehensive, authoritative source for those seeking information on blindness and vision impairment, published a personal account written by a blind person who learned they had the Non-24 sleep-wake disorder.

National Institute of Health Studies

A study titled Association between Visual Impairment and Low Vision and Sleep Duration and Quality among Older Adults in South Africa, printed in The International Journal of Environmental Research and Public Health and published by the National Institute of Health, substantiated the findings of previous studies done in Korea, Japan, and the United States, all of which found links between visual impairment and disruptions in sleep, most notably short sleep duration and poor sleep quality.

Also, the medical journal Dialogues in Clinical Neuroscience, published by the National Institute of Health, printed an article titled Visual Impairment and Circadian Rhythm Disorders detailing a promising clinical trial that was aimed at finding a treatment for circadian rhythm disorders in people who are totally blind.

Online support groups

There are a few options available, such as the Non-24-Hour Sleep-Wake Disorder group on Facebook, and the Circadian Sleep Disorders Network. Find one that fits you best.

Pharmaceutical treatment options

Pharmaceutical treatment should always be a last resort— if behavioral and environmental interventions don’t work— and only implemented under a doctor’s supervision.

• Read up on the supplement melatonin as a treatment for Non-24 sleep-wake disorder.
• Read up on the prescription drug tasimelteon (brand name Hetlioz) as a treatment for Non-24 sleep-wake disorder.