A 54-year-old woman with widespread pain, fatigue, and insomnia presents to the healthcare provider’s clinic with complaints of excessive daytime drowsiness. The patient is a busy executive for a non-profit organization who neither smokes nor drinks. She has a family history of obstructive sleep apnea.
The patient developed this pain after endometriosis surgery ten years back. She initially ranked her pain on a visual analogue scale as 9 of 10 but now says it is about 4 of 10. She also had irritable bowel syndrome, migraine headaches, irritable bladder, fatigue, restless leg syndrome (RLS), temporomandibular joint (TMJ) pain, nonrestorative sleep, and myofascial pain. Her past medical history is negative for cervical spinal trauma or psychosexual trauma.
She has been told that she stops breathing at night. Her RLS is managed well with pramipexole 1.5 mg taken at bedtime, and she wears a bite guard for her TMJ. The figure illustrates the results of the sleep hypnogram, which indicates severe OSA.
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