1029 Thinking outside the “Sleep Logs”

Abstract

Introduction There are numerous clinical indications for the use of actigraphy including the evaluation of insomnia, circadian rhythm sleep-wake disorders, insufficient sleep, and as adjunct to other objective measures of sleep to estimate total sleep time. This case presents a unique use for actigraphy in the longitudinal management of a patient with a disorder of hypersomnolence. Report of case A 36-year-old woman with idiopathic hypersomnia on methylphenidate 20 mg twice a day, presented to a sleep clinic for transfer of care. Records from another reputable sleep practice revealed diagnostic testing confirming the diagnosis of IH after a polysomnogram ruled out obstructive sleep apnea and Multiple Sleep Latency Test revealed mean sleep latency of <8 minutes with no REM sleep onset. After few visits, she started demanding increasingly escalating doses of stimulant medications. She expressed that her excessive sleep was a major barrier in maintaining employment. In order to further assess the clinical situation, two weeks of sleep logs were requested with coinciding actigraphy data collection. The actigraphy data demonstrated extended periods of a complete lack of recorded activity, which was confirmed by enhancing the gain on the sampled data. Actigraphy data from prior testing with this patient had shown an expected pattern of activity with well-defined nocturnal sleep of roughly 8 hours. At follow up, she strongly denied removing the device during data collection, despite of reviewing the data with the physician. Patient was politely reminded of how her intentional manipulation had caused a breach in the therapeutic relationship. Further provision of stimulants was denied from the clinic. Conclusion The actigraphy data collected revealed a pattern supportive of device removal concerning for intentional deception in order to obtain higher doses of stimulant medications. Thus, it was quite useful in guiding the longitudinal management of the patient and prevented from unwarranted dose escalation of potentially dangerous stimulants with abuse potential. This case suggests that the indications for use of actigraphy should be broadened as it can prove to be of high utility in long term management of patients. Support N/A