Sleep Medicine
Brigham and Women’s Hospital
Harvard Medical School
Boston, MA USA
A 31-year-old man presented for follow-up in the Sleep Medicine clinic. He has a past medical history of a seizure disorder and supraventricular tachycardia (SVT) and was referred after complaining of excessive daytime sleepiness. Current medications include citalopram and diltiazem. Four months prior, he was diagnosed with severe obstructive sleep apnea characterized by an apnea-hypopnea index (AHI) of 34 and an oxygen saturation nadir of 86%. The patient was initiated on continuous positive airway pressure (CPAP) therapy; however, he reported ongoing mask discomfort and difficulty with exhalation while wearing CPAP. Despite partial improvement in sleep fragmentation and daytime sleepiness, the patient reported sleeping for only 4 hours per night. The patient's sleep schedule was irregular, with bedtime ranging between 9:30 pm and 12 am, waking up at 5 am, and taking a daily nap for 4-5 hours in the morning during which he continued to use CPAP. Additionally, he described experiencing episodes of waking up from dreams, often screaming or throwing punches. A score of 15 on the Epworth Sleepiness Scale (ESS) indicated significant daytime sleepiness.
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