The patient is a slender young woman in her mid-twenties who had experienced excessive sleepiness for eight years, which had worsened to the point of falling asleep at the wheel (with a resulting serious highway crash) and at work. She also had been experiencing dreaming before fully asleep and during brief naps.
Her husband had not noted any snoring but he sleeps soundly.
She was recorded for a single night at another sleep center and underwent a multiple sleep latency test (MSLT). She was told that she had narcolepsy and was treated with a stimulant, methylphenidate, with only partial improvement and with rapid loss of effectiveness.
She came to our Center to obtain a second opinion.
There were several clues suggesting that she did not have simple narcolepsy:
-Her sleep was prolonged, unrefreshing and associated with both heavy night sweats and tooth grinding--which are not at all typical of narcolepsy.
-Her father snores loudly with gasping and is excessively sleepy: consistent with sleep apnea which is strongly hereditary.
-Her physicial examination revealed a long soft palate and retrusive jaw such that her upper airway appeared "crowded".
We performed two overnight sleep studies on consecutive nights, followed by an MSLT.
During her first overnight recording, she demonstrated only mild snoring, but she had 32 episodes of upper airway obstruction per hour of sleep.
Nasal CPAP eliminated her sleep apnea and the MSLT (performed after her second overnight study during which she slept throughout the night with CPAP) was entirely normal.
She began nightly use of CPAP and gradually weaned herself off methylphenidate. She no longer suffers from daytime sleepiness and to her delight, she no longer needs to take any stimulant medications.
COMMENTS: This find that this young woman's story is an all-too common one.
We also see many patients who do have narcolepsy but who were doing poorly on medications simply because they also suffered from sleep related breathing problems that had been missed by other sleep centers--and that had been rendering their sleepiness untreatable.
We believe that there is no substitute for either good quality sleep or thorough and thoughtful evaluations.
If this patient's story reminds you of your own--or that of a loved one--please do not hesitate to contact us at flamenco@netexp.net with any questions that you may have. We are here to help.
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