PMC5167487_01
Double-plotted sleep-awake cycle of a patient.. Note: The times of sleep are shown as black bars and are double-plotted for clarity.
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The patient had kept a sleep diary over the past 5.5 years, starting from 2008 (Figure 1).
Circadian rhythms (tau-value: red), depressive symptoms (MADRS: green), and drug history (lines).. Notes: Tau-values were determined from actogram and periodogram data every 4 weeks. Remission of depressive symptoms is defined as a score <=8 on the Montgomery-Asberg Depression Rating Scale (MADRS).
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Her mean MADRS score over the same period was 17.0+-12.3 points (n=47, Figure 2), and was unstable during episodes of non-24-hour sleep-wake syndrome. Non-pharmacologic measures, including several treatments of phototherapy (20,000 lux) and efforts to improve sleep hygiene by avoiding daytime sleeping, also failed (Figure 2).
Valproic acid concentration (blue bars) and circadian rhythms throughout (red points) the course of treatment.. Abbreviation: VPA, valproic acid.
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The patient's sleep diary during this period showed that the 24-hour sleep-wake cycle synchronized to 24.03+-0.05 hours (n=19 periods, Figure 3) at a valproic acid concentration of 5.0+-2.7 microg/mL.