When a child's sleep pattern doesn't match expectations, parents can feel confused and helpless, especially if the child has school and other social commitments, which can have a greater impact. Today, let's share a successful treatment case: a 9-year-old boy who visited the clinic due to congenital disease and vision problems.

His sleeping habits have been unusual since childhood: sleeping in the afternoon during the day and having good and bad nights of sleep. According to the sleep diary provided by the parents (as shown in the figure below, black indicates the times the child fell asleep), the child's best sleeping period at night was from after 9 PM to past 1 AM, but sometimes he would sleep from 3 AM to after 6 AM. During the day, he might sleep from noon to 6 or 7 PM, or even have several naps throughout the day. 

This situation pointed to a problem with the circadian rhythm. Internationally, treatment suggestions for such problems include behavior therapy, light therapy, and the use of melatonin drugs. However, in Taiwan, the types of melatonin drugs are restricted, usually recommended for patients over 55 years old, which differs from international practices.

After communicating and agreeing with the parents, we spent about two weeks to determine the most appropriate time for medication (red circles indicate medication times). The results were encouraging; the correct timing of medication shifted the child's long periods of sleep to nighttime, and since then, the child's sleep pattern became regular, maintaining for about seven months. 

The human biological clock (circadian rhythm) operates on a roughly 24-hour cycle influenced by light, food, and surrounding environment, maintaining wakefulness during the day and sleep at night, with the timing of night sleep being relatively consistent. However, when there are problems with vision and the central nervous system, or insufficient environmental stimuli (such as long-term exposure to insufficient light), it's challenging to maintain the circadian rhythm at a certain point.

- Advanced Sleep-Wake Rhythm Disorder (ASWRD): the patient still has a long period of sleep but shifts to sleeping and waking up early. Common seen in elderly people.

- Delayed Sleep-Wake Rhythm Disorder (DSWRD): Still a long period of sleep but shifts to sleeping and waking up late. Common seen in teenagers.

- Irregular Sleep-Wake Rhythm Disorder (ISWRD): the patient can sleep, but their longest duration of each sleep is less than 4 hours of continuous sleep. Many short naps throughout the day with no fixed sleeping times are also occurred. 

- Non-24-Hour Sleep-Wake Rhythm Disorder (N24SWRD): the patient may have a long continuous sleep , but the bedtime gradually shifts later, possibly returning to the original sleeping time after a month.

1. Observe the Child's Sleep Patterns: When you notice irregular or problematic sleep times, record them. This is very important for seeking professional help.

2. Seek Professional Advice: If your child has similar sleep issues, it's recommended to seek help from a professional doctor to get an appropriate treatment plan. 

3. Behavioral and Environmental Adjustments: Besides medication, changing pre-sleep behaviors and the sleep environment may also help improve sleep quality. Ensure the sleeping environment is quiet, comfortable, and establish a consistent bedtime routine.

4. Maintain Patience and Persistence: Changing sleep patterns takes time and continuous effort. Keep patient and work together with your child.

For children with special needs who have sleep problems, it can be very troubling for caregivers. Proper diagnosis and medication treatment can be very helpful for both parties.