Posted by Strohl on March 04, 2003 at 18:36:12:40 year old post-menopausal woman veteran with a chief complaint of tiredness and fatigue all the time. This started 4-5 years ago. The ESS is 12/24. At night, she can never sleep more than a couple hours at a time. She does not think she snores or makes noises, but is quite restless all night. She has uncomfortable feelings in her legs and will get up and walk around occasionally. She doesn't have a sense that morings are better. She carries a diagnosis of fibromyalgia and is on SSRI drugs which do not help; she stopped them prior to the study. She has been given Ambien without success. She works as a hand and foot manicurist and likes her job. She has a mentally challenges son. On physical examination she is obese and can breathe easily though her nose and speaks the same in the upright and supine posture. There are no masses. The pharynx is unremarkable. Chest and heart examination are normal. No Clubbing cyanosis or edema. The PSG shows a total sleep time of 5.8 hours with 70% efficiency. The arousal index is 66/hour. Stage 1 30% Stage 2 40% SWS 24% REM 6%. There is alpha-delta sleep. The PLM index is 20/hour with PLM arousal index or 11/hour. There is an AHI of 4.5 overall, with more in REM (6 vs 2/hr)and in the supine posture (6 vs. 3/hour). She was shown CPAP and went back and tried her husband's CPAP; did not like it.
Questions: What is for and against RLS? ....OSA?
What would you tell her?
What would you do first and why?
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