Abstract
Introduction
Sleep related eating disorder (SRED) is an uncommon NREM parasomnia, predominantly seen in females in their 20s and 30s and is commonly associated with sleep walking, daytime eating disorders (anorexia and bulimia) and use of certain sedative-hypnotics. Here, we describe a case of unique therapeutic dilemma in a middle-aged female, in whom SRED affected the use of continuous positive airway pressure device (CPAP) for her obstructive sleep apnea (OSA) which lead to worsening sleep quality and daytime functionality.
Report of case(s)
42-year-old female with history of migraines and OSA, came to the clinic with 6-month history of SRED which started after the demise of her husband and was associated with significant weight gain and injuries. During typical episode, she would take CPAP mask off, walk down the stairs and eat in the kitchen area and then fall asleep in the living area. She denied predilection for particular food, food allergies, consumption of inedible materials or use of offending drugs. Upon further inquiry, she reported recent unsuccessful attempts at smoking cessation, frequent nighttime smoking, significant body image issues and discontinuation of topiramate use for her migraines recently. Telemedicine visit limited the physical examination but included increase in BMI from 32 to 35 kg/m2. Compliance report, sleep diary and surveillance videos were consistent with the history with compliance report showing 17% of nights with optimal usage and 59% of nights with any usage. Beside locking the food, safety measures and napping, we recommended her to use clonazepam 1.5 mg. Unfortunately, she continued to have episodes. She was then started on Topiramate 50 mg which was gradually increased to 100 mg with reduction in her episodes and increase in her compliance to 60%.
Conclusion
In sleep medicine, treatment of OSA usually precede the treatment of comorbid conditions. However, SRED with comorbid OSA, requires a reverse strategy where improvement in compliance and coexisting daytime symptoms requires the treatment of SRED first. Moreover, detailed history to investigate the potential precipitating factors, co-existing medical and sleep conditions can help with choice of therapy e.g. patients with depression and SRED can benefit from Selective Serotonin Reuptake Inhibitors rather than other choices.
Support (if any):
BARBITONE-INDUCED TOLERANCE TO THE EFFECTS OF SEDATIVE-HYPNOTICS AND RELATED COMPOUNDS ON OPERANT BEHAVIOUR IN THE RAT
