Case Report: Sleep Disorders and Women
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Iryna Sapieha, M.D. Sleep Specialist |
A 59-year-old woman presented to our office complaining of exhaustion, and feeling tired and sleepy during the day. Her main concern was the frequent episodes of awakening at night. She also expressed concern about awaking early in the morning with anxiety and panic attacks despite taking alprazolam to control them.
The patient has a history of snoring and observed pauses in breathing. She reported having major difficulties dealing with her daily activities, including problems with memory, concentration and making decisions. Her past medical history includes depression, fibromyalgia, migraines, obesity, hyperlipidemia and diverticulosis. Her BMI is 37 and her neck circumference is 16.5 inches. An oral examination revealed crowded upper airways, an enlarged base of the tongue and elongated uvula (grade 3 Mallampati score).
The patient’s history and symptoms suggested sleep-disordered breathing (snoring, observed pauses in breathing, nonrestorative and fragmented sleep, with obesity a comorbidity).
I scheduled the patient for a diagnostic sleep study, which indicated mild obstructive sleep apnea with an apnea-hypopnea index (AHI) of 7.3/hour overall and a significantly higher AHI of 18.1/hour during REM sleep. Higher AHI during REM sleep is common in women. The patient’s obstructive sleep apnea (OSA) was complicated by severe oxygen desaturation (down to 75 percent) on room air. Mild snoring was present throughout
the study.
As a result of the sleep study findings, and considering the patient’s symptoms during the day and at night and the possible relationship to sleep apnea, we decided to initiate continuous positive airway pressure (CPAP) therapy.
The patient had a very positive response to CPAP, 8 cm of water pressure. During the follow-up visit she reported significant improvement in the quality of her sleep. The panic attacks had disappeared completely and she was able to sleep through the night. Daytime symptoms, as well as her overall performance, improved tremendously. Now that she was sleeping better and not tired all of the time, she also decided to join a health
club and work on her weight issues.
