CASE PRESENTATION: A 48 year old Hispanic lady was diagnosed with amyloidosis at the age of 33 following symptoms of bilateral lower extremity pain, swelling in submandibular gland and tongue, dysarthria, dysphagia to solids, peripheral edema and initial 30 pound weight loss. Patient was noted to have audible breathing at night, abnormal overnight oximetry and daytime sleepiness. Patient had documented amyloid involvement of the heart, peripheral nerve and tongue. On physical exam, patient’s weight was 69 kg. He was noted to have a large tongue and a Friedman class 4 oropharynx. EKG revealed first degree AV block and echocardiogram showed increased ventricular septum thickness with small pericardial effusion. Chest X-ray revealed a small pleural effusion. Overnight oximetry was suggestive of severe sleep disordered breathing. PSG showed an apnea hypopnea index of 121 per hour of sleep which was non-positional with an oxyhemoglobin nadir saturation of 74%. The events were predominantly obstructive with a few mixed events. Patient was subsequently tried on CPAP with control of sleep disordered breathing at 17 cm of water pressure and was issued a prescription.