[41F] Experiencing excessive sleepiness and neurological symptoms

Patient Description

A 41-year-old female reports excessive sleepiness that persists regardless of activity, worsening over the past few months. The patient finds temporary relief with Armodafinil. She also experiences speech difficulties, where her intended words come out differently or mumbled. Additionally, she reports electric shock-like sensations in her legs, causing them to buckle and resulting in falls. These symptoms have been present for about a month. A sleep apnea test was conducted, which returned negative results. The patient is currently on multiple medications, including Metoprolol, Protonix, Cimetidine, Ibuprofen, Pregabalin, Spironolactone, Tamsulosin, Buspirone, Cetirizine, Flexeril, and Vitamin D. She has allergies to penicillin, morphine, and sulfa drugs. There is no family history of sleep disorders or neurological conditions. The patient does not consume alcohol or use recreational drugs, but does consume caffeine. No recent travel to different time zones or high altitudes was reported.

Arora's Assessment

What might be happening

Based on the symptoms you've described, here are some possible explanations:

Narcolepsy: This is a chronic sleep disorder characterized by overwhelming daytime drowsiness and sudden attacks of sleep. It can also cause sudden loss of muscle tone (cataplexy), which might explain the buckling of your legs. Speech difficulties and muscle twitching can also be associated with narcolepsy.
- Typical treatment involves medications like stimulants to help you stay awake during the day, and lifestyle changes to manage symptoms.
Sleep-Related Breathing Disorders: Although your sleep apnea test was negative, other sleep-related breathing disorders could still be contributing to your symptoms. Changes in breathing when falling asleep might indicate a need for further evaluation.
- Treatment often involves addressing the underlying cause and may include the use of devices to assist with breathing during sleep.
Restless Legs Syndrome (RLS) or Periodic Limb Movement Disorder (PLMD): These conditions can cause uncomfortable sensations and involuntary movements, which might explain the electric shock-like sensations and muscle twitching.
- Treatment typically includes lifestyle changes, iron supplements if needed, and medications to reduce symptoms.
Medication Side Effects: Some of the medications you are taking, such as Pregabalin and Flexeril, can cause drowsiness and muscle-related side effects. It's important to review these with your healthcare provider.

What you can do

Consult a Healthcare Provider: It's important to discuss your symptoms with a healthcare provider who can perform a thorough evaluation and possibly refer you to a sleep specialist or neurologist for further testing.
Maintain a Sleep Journal: Use MDandMe to track your sleep patterns, episodes of sleepiness, and any triggers or activities that precede these episodes. This information can be valuable for your healthcare provider.
Review Medications: Discuss your current medications with your healthcare provider to determine if any could be contributing to your symptoms.
Lifestyle Adjustments: Try to maintain a regular sleep schedule, avoid caffeine close to bedtime, and create a restful sleep environment.

What you should look out for

Increased Frequency or Severity: If your symptoms become more frequent or severe, seek medical attention promptly.
Safety Concerns: If your sleepiness or leg buckling poses a risk to your safety, such as while driving or operating machinery, take precautions and discuss this with your healthcare provider.
New Symptoms: If you develop new symptoms, such as changes in vision, severe headaches, or significant changes in mood or behavior, seek medical attention.

Remember, while I can provide information and suggestions, it's important to consult with a healthcare professional for a formal diagnosis and treatment plan.

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1 mo ago

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