Sleep Disorders

A. Narcolepsy

35-years old woman presented for years with episodes of un-specific dizzy spells, headaches, almost black out spells when tired. Her husband describes spells of drunkenness followed by headaches and the need for sleep. She was seen by few neurologists, had numerous tests (including MRI of brain, EEG, EKG, Holter, and Echo). Within few years into symptoms, she became very depressed, anxious, and developed memory lapses. Patient has been treated with several antidepressants and anticonvulsants with poor response or intolerable side effects. She had psychotic episode which required hospitalization and finally she lost her job.

When she came to our practice, her neurology exam was normal, her ESS score was 12. Her sleep study showed very mild OSA (with AHI – 10 per hour). She did not tolerate CPAP. Her MSLT study showed mean sleep latency of less than 3 minutes and she had REM onset sleep (dream sleep onset) in 3 naps out of 5. Her DNA blood testing was positive for 2 out of 3 narcoleptic genes tested. She was diagnosed with severe Narcolepsy and Cataplexy (episodes of near-blackout spells). She was started on medications. She feels like a new person and she returned to work where she was recently promoted.

B. Problem sleeping

Do you have difficulty falling asleep or difficulty staying asleep? If so, you may have insomnia. Melatonin 3 mg tablets (2 hours before the desired bed time) may help. Try Melatonin for at least 2-3 months. You can use it with your normal medications for sleep.
Are you sleepy or tired? These are not the same. You may test yourself and find out if you suffer from daytime sleepiness by answering few questions on the website (Epworth sleepiness test). If your score is greater than 10, you are sleepy! You may need to be tested for sleep disorder.
Do you snore and stop breathing while snoring? Do you wake up in the morning and feel tired even with 7-8 hours of sleep? You may have OSA, especially if you have few extra pounds of weight.
Do you know that the most common sleep disorder in the US is insufficient sleep syndrome or sleep deficiency. If you function on only 3-4 hours of sleep you may be sleep-deprived.

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