Case K.10

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Posted by kuchipudi on March 07, 1998 at 11:55:50:

30 yr old WM, CAMARA MEN FOR LOCAL TV HAS DIFFICULTY OF GETTING UP SINCE HIS CHILDHOOD. He was extensively evaluated at a local university without NPSG and concluded that he has personality disorder. He came to our local ENT specialist and gave the h/o snoring restlessness,snoring,eds, go to bed around midnight when he feels sleepy and wake up at 11am. He takes about 30-60mts to go to sleep. he won't look at the clock, wakes up few times but go to sleep immediatelyHis girlfriend says he is allover the bed, did not notice any leg gerks( No h/o arthritis or symptoms of body pains but has mild psoriasis which never bothered him). His EPW SCORE 11.HE DENIES ANY SYMPTOMS OF DEPRESSION/ PANIC ATTACKS, CHOCKING, PALPITATION.hE FIRMELY STATED THAT HE IS VERY HAPPY AND DID NOT HAVE ANY PSYCHOLOGICAL PROBLEM. he also stated that eventhough his friends told him that he is o.k with his work, he knows about himself feel tired and not able to do his work very well.
Clinical exam is unremarkable except for rash on his knee.
NPSG and MSLT WAS DONE;
Significant alfa intrusion, sleep effeciency 88%
sws is 24%, REM 24% with a latency of 60mts
Mean sleep latency 17mts with no REM
Minimal snoring, No plms

He was treated with Elavil which helped him initially but after few wks. it is not helping. he saw his F.P. who gave him xanax. whic he feels is useless. He was evaluated by psychiatrist but is unhappy with thier evaluation and left before he finishes the interview.

His ENT doctor told him that if elavil don't work he wants to try differant medication. ENT DR. left town Now he is reffered to you for further managent. please discuss your managemnt

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