Understanding Sleep Disorders: Part 4
The patient successfully undergoes diagnostic in-lab polysomnography and shows 6.5 hours total sleep time with an Apnea-Hypopnea index (AHI) of 16/hr sleep. He undergoes a second study with positive airway pressure titration, and his AHI is reduced to 1.3/hr sleep with a pressure of 8 cm H2O.
He uses the machine and tolerates the mask without incident. His insomnia also improves following a short course of cognitive behavioral therapy for insomnia and melatonin, 3 mg, before bedtime.
Upon follow-up, his Epworth Sleepiness Scale score is 9 out of 24 (an upper limit of normal), Insomnia Severity Index score shows very mild insomnia, and Fatigue Severity Scale is still 37 out of 63 (mildly elevated). Upon further questioning he says his legs are now “jerking” at night, making it difficult to go to sleep and sometimes causing an awakening from sleep. He has not made any medication changes.
Routine laboratory test results show a ferritin level of 75 ng/mL and a 25-hydroxyvitamin vitamin D level of 33 ng/mL and the remainder of chemical panel results are normal. What is the next step?
Email your responses to neurologyeditor@consultant360.com, and be sure to tune into next week’s podcast with Dr Joseph Diamond for the answer!
Read Case Part 3 here: https://www.consultant360.com/podcast/neurology/dr-joseph-diamond-home-vs-lab-polysomnography-sleep-disordered-breathing
Listen to the answer to Case Part 3 here: https://www.consultant360.com/podcast/neurology/dr-joseph-diamond-home-vs-lab-polysomnography-sleep-disordered-breathing
Read Case Part 2 here: https://www.consultant360.com/exclusive/neurology/sleep-medicine/understanding-sleep-disorders-part-2
Listen to the answer to Case Part 2 here: https://www.consultant360.com/podcast/neurology/sleep-medicine/joseph-diamond-md-starting-conversation-about-sleep-disordered
Read Case Part 1 here: https://www.consultant360.com/exclusive/neurology/sleep-medicine/understanding-sleep-disorders-part-1
Listen to the answer to Case Part 1 here: https://www.consultant360.com/podcast/neurology/sleep-medicine/dr-joseph-diamond-diagnosing-multiple-sleep-conditions