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Case Reports
. 2020 Dec;40(4):383-387.
doi: 10.1002/npr2.12142. Epub 2020 Sep 29.

Non-24-hour sleep-wake disorder successfully treated with the combination of ramelteon and suvorexant in a case of autism spectrum disorder

Masaaki Iwata  1 , Koichi Kaneko  1
Affiliations
Case Reports

Non-24-hour sleep-wake disorder successfully treated with the combination of ramelteon and suvorexant in a case of autism spectrum disorder

Masaaki Iwata et al. Neuropsychopharmacol Rep. 2020 Dec.

Abstract

Introduction: Non-24-hour sleep-wake disorder (N24SWD) is often observed in the visually impaired and those who isolate indoors. Melatonin receptor agonists may be used for treatment, but there is currently no evidence that they are effective in patients without visual impairment.

Case: We report a case of a 23-year-old woman who withdrew from her social life owing to autism spectrum disorder and experienced an unusual sleep rhythm. She presented with N24SWD. The N24SWD cycle averaged 25.6 days but was extended to 42 days using ramelteon. However, this was not enough. We prescribed the addition of suvorexant and the sleep cycle returned to normal.

Conclusion: N24SWD is a disease that seriously impairs social life and productivity. We propose a possible treatment strategy for N24SWD using ramelteon and suvorexant.

Keywords: autism; melatonin; non-24 hour sleep-wake disorder; ramelteon; suvorexant.

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Conflict of interest statement

M. I. received honoraria as a speaker from MSD KK KK declares no conflict of interest.

Figures

Figure 1
Figure 1
In September, we initiated behavioral education but, owing to a lack of improvement, we prescribed ramelteon 8 mg from the end of September. Although the N24SWD cycle was extended from 25.6 to 42 d, the patient did not completely recover. Thus, we added 15 mg of suvorexant, and the sleep rhythm was restored
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