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Pulmonary, Critical Care, and Sleep Pearls |

A 44-Year-Old Woman With Excessive Sleepiness

María Paula Tovar-Torres, MD; Cynthia Bodkin, MD; Ninotchka L. Sigua, MD
Author and Funding Information

From the Department of Medicine (Dr Tovar-Torres), Eastern Virginia Medical School, Norfolk, VA; Department of Neurology (Dr Bodkin), Indiana University School of Medicine, Indianapolis, IN; and the Department of Medicine (Dr Sigua), Division of Pulmonary, Allergy, Critical Care, Occupational and Sleep Medicine, Indiana University School of Medicine, Indianapolis, IN.

CORRESPONDENCE TO: Ninotchka L. Sigua, MD, 714 N Senate Ave, Ste 120, Indianapolis, IN 46202; e-mail: nsigua@iu.edu


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;146(6):e204-e207. doi:10.1378/chest.14-0221
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A 44-year-old woman was referred by her primary care physician for a polysomnogram for further workup of excessive daytime sleepiness. She reported a 6-month history of uncontrollably falling asleep. She frequently dozed off while watching television, sitting inactive in public places, and talking to people. She had dozed off while driving, but had not had any driving accidents. Her Epworth Sleepiness Scale score was 21 of 24. She admitted to snoring, but no apneas were witnessed by her bed partner. She denied symptoms of morning headaches, gasping for air, leg jerking during sleep, cataplexy, sleep paralysis, hypnagogic hallucinations, gastroesophageal reflux during sleep, or insomnia. She usually went to bed at 10:00 pm and woke up at 9:00 am. She reported three to four nocturnal awakenings per night. She denied taking naps. Medical history included chronic pain from cervical spinal stenosis, hypothyroidism, hyperlipidemia, depression, restless legs, migraines, and gastroesophageal reflux disease. She had no known cardiac illnesses. Medications included levothyroxine, 50 μg daily; duloxetine, 60 mg daily; cyclobenzaprine, 10 mg tid; omeprazole, 20 mg daily; trazodone, 50 mg daily; gabapentin, 600 mg daily; tolterodine, 2 mg bid; cetirizine, 10 mg daily; extended-release oral morphine sulfate, 15 mg bid; and immediate-release oral morphine sulfate, 15 mg qid as needed for pain.

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