Challenging Circadian Rhythm Disorder Cases.

The complex interplay of the sleep and circadian systems, which are substantially differentially regulated, provides for plasticity that is expressed in health and disease. The classic circadian rhythm disorders are readily recognizable, but atypical forms can be identified by actigraphy and melatonin profilometry. Although the dim-light melatonin onset test maps the start of the biological night, 24-hour mapping can define the limits of the biological night, whereas other forms of strategic testing can identify conditions such as iatrogenic hypermelatoninemia. Routine testing in clinical practice can expand the range of identifiable circadian rhythm disorders.