An 18-Year-Old Woman with Prolonged Eyes Closed Unresponsiveness during Multiple Sleep Latency Testing

Journal of Clinical Sleep Medicine, Vol. 13, No. 1, 2017 The patient is an 18-y-old white woman who presents for evaluation of excessive daytime sleepiness, with long sleep time, and an Epworth Sleepiness Scale score of 19/24. Her past medical history is significant for depression, anxiety disorder with panic attacks, and suicidal ideation, and intent, without plan, requiring psychiatric and psychological counseling. She goes to bed at 21:00, falls asleep within minutes, does not awaken during the night, and rises in the morning at 07:30 with multiple alarms, often not feeling refreshed, and sometimes sleeps through multiple alarms missing school. She denies snoring, apnea, lower extremity restlessness, cataplexy, hypnogogic/hypnopompic hallucinations, or typical sleep paralysis, but does report a single episode where she tried to awaken in the morning but was not able to move for over 30 min. Medications include paroxetine, and over-the-counter iron and carnitine supplements, which have not resolved her daytime sleepiness. She denies use of tobacco, alcohol, or illicit drugs; and drinks caffeine beverages only occasionally. Body mass index is 20.4 kg/m2, oral airway is not crowded; and remainder of physical and neurological examination is unremarkable. Seven-day wrist actigraphy performed immediately before diagnostic polysomnography showed variability in sleep SLEEP MEDICINE PEARLS