1. Criteria

There is a persistent or recurrent pattern of sleep disruption due primarily to alteration of the circadian system or misalignment between the endogenous circadian rhythm and the sleep-wake schedule required by the person's environment.

The sleep disruption leads to excessive sleepiness, insomnia, or both.

The sleep disturbance causes clinically significant distress or impairment.

2. Context

Circadian rhythm sleep-wake disorder is a mismatch between the person's internal clock and the sleep schedule that their life requires. Patients often say they can sleep, just not at the time they need to, and that distinction is often what separates circadian problems from primary insomnia.
Clock mismatch: The central issue is timing. The sleep pattern may work biologically, but it is misaligned with social or occupational demands.
Subtype matters: Delayed sleep-wake phase, advanced phase, irregular sleep-wake rhythm, non-24-hour type, and shift-work type can look quite different in practice.
History first: A careful sleep schedule history and sleep diary are often more helpful than a generic sleep complaint alone.
Clinical focus: Most useful first tool for seeing the actual pattern across days and weeks.

3. Validated scales

Sleep diary

Most useful first tool for seeing the actual pattern across days and weeks.

Actigraphy

Helpful when trying to document sleep timing and circadian pattern objectively.

Epworth Sleepiness Scale

Useful if daytime sleepiness is prominent.

4. FDA approved treatments

FDA-approved medication relevant to circadian disorders

Tasimelteon has FDA labeling for non-24-hour sleep-wake disorder in blind adults. Other circadian interventions are often behavioral, light-based, or used off-label.

Common treatment side effects

Check drugs.com/sfx for common side effects. Direct side-effect links for the medications in this section are below when available.

Tasimelteon side effects

Common off-label medications

Interventional psychiatry modalities

Light therapy and schedule-based interventions are more central here than interventional psychiatry procedures.
TMS, ketamine, and ECT are not standard treatments for circadian rhythm sleep-wake disorders.
Care often depends on subtype-specific chronotherapy and behavioral planning.

Related Guides

5. Top management articles

Management review for Circadian Rhythm Sleep-Wake Disorder PubMed search
Circadian Rhythm Sleep-Wake Disorder treatment guideline PubMed search
Circadian Rhythm Sleep-Wake Disorder pharmacotherapy or psychotherapy review PubMed search

When to seek professional help

Seek urgent help if there are thoughts of suicide, self-harm, or feeling unable to stay safe.³
Seek urgent help if there are thoughts of harming someone else, escalating violent urges, or loss of behavioral control.³
Take hopelessness seriously, especially if the person feels trapped, cannot imagine staying safe, or is withdrawing from support.⁴
Use emergency services if there is immediate danger, severe agitation, psychosis, intoxication, or inability to care for basic needs. In the United States, call or text 988 for crisis support and call 911 for immediate danger. Use emergency services in your region if you are outside the U.S.³

Simple Psych

Circadian Rhythm Sleep-Wake Disorder