Hypernychthemeral sleep-wake cycle: some hidden regularities.

A patient with a sleep-wake cycle greater than 24 h recorded his sleep-onset and wake times for 4 years. During this time the patient found himself unable to maintain a 24-h sleep-wake schedule. The lengths of his sleep-wake periods (subjective days) and his sleep periods were highly variable. Nonetheless, there were certain unexpected regularities in his sleep-wake data, corresponding to fixed clock hours. Across the 4-year period, there were certain clock hours during which sleep onset and waking were likely to occur and certain clock hours that may be considered forbidden zones for sleep, during which the patient rarely either began or ended a sleep period. It is possible that the unexpected regularities resulted from partial entrainment to external cues or from some residual influence of an endogenous ultradian-regulating mechanism.