Room 2 – 6.17.2015
EMR #1421 – DOB 12.25.1981
JASMINE “JAZZ” ABRAHAM
PATIENT at lab tonight for a nocturnal polysomnographic assessment (NPSG) following complaints of excessive daytime sleepiness. Ordering physician will review data before ordering nap tests to rule out sleep disordered breathing as primary diagnosis.
PATIENT arrives noticeably sleepy. During 10/20 procedure, conversation lulls are induced by frequent microsleeps, but PATIENT is easily aroused.
PATIENT denies reflux, pain, hyperemesis, but complains of hay fever.
PATIENT’s self report indicates a high daytime somnolence score (Epworth 17). She struggles to resist sleep while at work. She denies fainting spells, hallucinations, sleep paralysis, cataplexy.
PATIENT’s sleep hygiene unremarkable. Sleep diary indicates a regular pattern of 8- to 9-hour nights of sleep with consistent appropriate bed times. She reports a recent history of pollen allergy likely due to workplace environment. Morning symptoms include xerostomia, headache, mild pharyngeal discomfort.
Lights Out @22:00; sleep onset @22:02
- @22:02 to 00:32 — Normal sleep staging, unremarkable apneic activity, but respiratory distress index estimated at 45 per hour, likely related to issues with sinus congestion.
- @03:00 — Video records highlight occult patterns of transient muscle activity despite PATIENT tightly swaddled and in lengthy REM stage. Leg and arm movements observed. Possible REM behavior disorder.
- @03:22 — TECH in room to adjust pulse oximeter. A strong floral fragrance persists that was not present prior to start of study. When prompted, PATIENT denies using scented products at any time during study; see AV at epochs 498-502 to corroborate dialog.
- @03:28 — TECH in room to adjust pulse oximeter. Observation: unusual growths along PATIENT’s fingertips—5-petaled, star shaped, waxy white flowers in full bloom, 3cm diameter. PATIENT denies visual, tactile, olfactory awareness of growths. TECH confirms the source of the fragrance and considers collecting samples, but PATIENT experiencing confusional arousal. See AV at epochs 524-576 (close-up and panoramic captures) of unusual high-speed floral bloom along PATIENT’s fingertips occurring while PATIENT experiences symptoms comparable to hay fever. Pattern occurs over several stages of otherwise unremarkable N2, N3 and REM sleep.
- @04:12 — PATIENT self-treats with saline nasal spray.
- @04:14 — TECH observes rapid deceleration of floral bloom following PATIENT’s usage of saline nasal spray.
Lights On @05:30
Following biocalibrations and after PATIENT is unhooked, TECH reexamines PATIENT’s fingers, finds zero evidence of floral growth or fragrance.
PATIENT does not recall dream content when prompted. PATIENT’s post-study questionnaire answers indicate morning symptoms consistent with allergies and upper airway resistance and distress.
TECH recommendation: a thorough review of videotape and tech notes and a possible second NPSG. Please assign to a new tech for objective follow-up.
Tamara Kaye Sellman’s most recent work has appeared, or is forthcoming, in Blanket Sea, Cirque, The Coil, Gargoyle, Lift Every Voice (anthology), and The Nervous Breakdown, among other places. Her writing has been nominated twice for the Pushcart Prize. She now works as a sleep health educator, health-care writer, and MS advocate/columnist, but previously edited and published Margin: Exploring Modern Magical Realism (http://www.magical-realism.com) (2000-2010).
Image banner: *- mika -* via Flickr Creative Commons
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