Name Dan, Ryan, Eric Lin Class 2
Sleep Case Study
Patient: Alice
Age: 22
Gender/Pronouns: She/Her
Diagnosis: Narcolepsy
Presenting Problem: Alice was sent to hospital by her colleagues for her excessive daytime
sleepiness and sleep attacks. Starting at the age of 19, sudden sleep attacks happen to Alice, and her
knees suddenly buckle and her jaws sag. The abrupt cataplexy happens every day when Alice laughs,
gets angry, or feels excited. In the night, she experiences nightmares and, in the daytime, she
experiences atonia. The fatigue and sudden sleep attacks significantly affect her job as a saleswoman.
Her failure in jobs makes her feel unhappy.
Background She began to sleep in the daytime at the age of 13. When she was a high school
student, she failed to stay awake during class and exams. Her classmates described her as often
sleeping in class and the teacher thought he was disrespected and refused to wake her up. Nobody
cared about her grades in high school. When she graduated from high school, she became a
saleswoman and was penalized for sleeping when driving.
Medical History: She did not have any trauma or psychiatric medical history. However, her father
reported that he suffered from fatigue and sudden muscle weakness when laughing. Although many
doctors claimed there was nothing unusual about him, a psychiatrist prescribed him 37.5 mg of
venlafaxine and 0.75 mg of alprazolam for depression, and the treatment was ineffective even
though it lasted for several months.
Assessment:
• Physical Exam: The multiple sleep latency test was conducted on the daughter and the
father. On multiple sleep latency tests of the daughter, the mean sleep latency was 1.9
minutes and sleep-onset REM periods occurred four times. On the father’s multiple sleep
latency test, the mean sleep latency was 5 minutes and the sleep-onset REM periods
occurred 4 times. Moreover, Nocturnal polysomnography was conducted on Alice. The
result was that her sleep efficiency was 91% (429min/472min). There were no respiratory
disturbances, abnormal REM movements, or behaviors during sleep.
• Lab Tests: The HLA-DQB1*0602 (DQ6.2) allele was tested for both father and daughter.
The results were positive, indicating genetic influence takes part in causing their narcolepsy.
Treatment Plan:
Alice is prescribed 200 mg of modafinil once a day in the morning to deal with the sleep disorder,
and she has to take this medicine every day. She needs to go to see the doctor every month and the
doctor will evaluate the condition and evaluate the effectiveness of the medicine. She will not stop
Name Dan, Ryan, Eric Lin Class 2
taking the medicine until her doctor tells her to stop. Moreover, she was required to take 75 mg of
venlafaxine per day, and she had to take this for at least half a year.
