A protocol to entrain the Non 24 circadian rhythm disorder (ICD10 code: G47.24). This management (not curative) protocol is not (yet) peer-reviewed, but is already showing excellent results in 1-of-N experiments.
The goal is to define a therapy that can reliably entrain the circadian rhythm of (sighted) individuals with non-24 circadian rhythm disorder, using a combination of 2 insights:
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New therapies based on the careful manipulation and combination of zeitgebers, such as light therapy, melatonin and food timing, can allow for better results. It is hence necessary to determine what is the minimal set of zeitgebers for effective long-term entrainment and what parameters and conditions affect their effeciency on the circadian rhythm.
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Self-monitoring of the circadian rhythm is necessary to optimally time the therapies on a day-to-day basis and achieve stable therapeutic benefits, as is the case for other chronic diseases such as diabetes where glucose monitoring is necessary. Similarly, circadian rhythm monitoring is a necessity.
The latest working therapy protocol, which is considered mature and reproducible as of 2023, is named VLiDACMel, which stands for:
- Very long Light therapy at wake-up (after minimal core body temperature),
- Dark therapy in the evening,
- Avoid Carbs and Melatonin mixup,
- and, optionally, take exogenous instant-release Melatonin timed before DLMO (measured via core body temperature or approximated via 3 days average of wake-up times).
This protocol, along with data of the author's sleep patterns with a >1y annotated sleep diary, are available in this repository.
To read the VLiDACMel protocol: https://circadiaware.github.io/VLiDACMel-entrainment-therapy-non24/SleepNon24VLiDACMel.html
I am open to collaborations (eg, to design a group study on healthy volunteers and/or patients with sighted non-24).
A (messy) side notebook with lots of references along with an older draft protocol (based on chronotherapy and melatonin - which did not work) is available here: https://circadiaware.github.io/VLiDACMel-entrainment-therapy-non24/other_docs/SleepNon24.html
All notebooks were written in Zim Desktop Wiki and exported with a table of contents using this template. The document may migrate to Zettlr in the future for publication since the latter supports academic-style bibliography and citations.
In order to both better characterize the non-24 circadian rhythm disorder's phenomenology without intervention, and the effect of the VLiDACMel intervention (and maybe of other interventions) in an objective fashion, the author is developing a set of software tools and self-monitoring wearable devices to monitor the circadian rhythm disorder.
This was split into another project Wearadian for better management, see: https://github.com/Circadiaware/wearadian
If you would like to reuse some of this material, please feel free to do so under Creative Commons v4 with attribution (CC BY 4.0) or Creative Commons v4 with attribution share-alike (CC BY SA 4.0) at your discretion.
This protocol was designed and documented by Stephen Karl Larroque.
If you would like to cite this therapeutic protocol, please cite it as below:
VLiDACMel - A therapy for the entrainment of treatment-resistant sighted non24, Stephen Karl Larroque, 2023, doi: 10.5281/zenodo.7512052, url: https://circadiaware.github.io/VLiDACMel-entrainment-therapy-non24/SleepNon24VLiDACMel.html .