The Case of the “Sleepy Stiff”

Jessica Vensel-Rundo and Carlos Rodriguez

in A Case a Week: Sleep Disorders from the Cleveland Clinic

Published on behalf of Oxford University Press

Published in print September 2010 | ISBN: 9780195377729
Published online April 2013 | e-ISBN: 9780199322985 | DOI:
The Case of the “Sleepy Stiff”

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Case 49 introduces a 56-year-old man with Parkinson's disease who presented to the sleep center with recurrent awakenings from sleep for the past 7 years, unrefreshing sleep, and excessive daytime sleepiness (EDS). He was diagnosed with mild obstructive sleep apnea (OSA) 2 years prior after an initial PSG, which revealed an apneahypopnea index (AHI) of 12, supine AHI of 16, and REM AHI of 14. CPAP therapy was begun and the patient had a second PSG, during which a CPAP setting of 7 cm H2O abolished the respiratory events. Neither study reported periodic limb movements (PLMS) or other unusual behaviors. Despite reported compliance with CPAP (using it 6 hours per night 7 days per week), his nonrestorative sleep, EDS, and frequent awakenings persisted. Treatment with zolpidem and, later, temazepam did not improve the situation. One year prior to his presentation the clinic, his neurologist prescribed modafinil 200 mg daily, which provided no relief from his extreme EDS. Furthermore, his daytime sluggishness had contributed to a 10-pound weight gain since his last PSG.was diagnosed with idiopathic Parkinson's disease 5 years prior and had a history of gastroesophageal reflux disease (GERD), hypercholesterolemia, and hypothyroidism. He also took carbidopa/levodopa 25/100 mg 4 times daily, levothyroxine 125 mcg daily and pravastatin 20 mg daily.

Chapter.  2393 words.  Illustrated.

Subjects: Neurology ; Sleep Medicine

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