1131 Restoration of Normal Sleep Pattern in a Patient with Non-24-Hour Sleep-Wake Rhythm Disorder and Mood Disorder after Treatment with Aripiprazole

Abstract Introduction Non-24-Hour Sleep-Wake Rhythm disorder (N24SWD) is characterized by progressive daily shifting (delaying) of the sleep wake cycle, generally by 1–2 hour increments. It is usually seen in blind individuals, but can also present in sighted individuals. Primary treatments center around light therapy and melatonin for sighted individuals. We present the case of a sighted male in whom standard therapy was ineffective, but whose N24SWD was corrected by the antipsychotic aripiprazole. Report of Case A 57 year-old male with history significant for depression presents for evaluation of poor sleep quality and fatigue. For many years, he had a free running sleep wake cycle. His schedule was distressing to him because it greatly reduced his quality of life, and did not allow him to keep a job. He was trialed on melatonin, light therapy, and numerous mood stabilizing medications without success in stabilizing his sleep-wake cycle. He was eventually started on the antipsychotic aripiprazole, and via sleep logs he endorsed that his sleep-wake cycle quickly stabilized. While his current sleep cycle is delayed, he reports that quality of life has improved; since starting aripiprazole he has been able to resume usual daily activities. Conclusion While N24SWD is primarily a disease of blind individuals it is also seen in the sighted population. The pathogenesis in sighted individuals may be due to the lack of exposure to light or other entraining cues. Our case illustrates that N24SWD in sighted individuals may be associated with underlying mood disorders.