A 67-Year-Old Woman With Unexplained Nocturnal Hypoxemia

Case Presentation: A 67-year-old woman presents for a second opinion for insomnia. She reports falling asleep with ease but difficulty maintaining sleep, with several nighttime awakenings. She has previously undergone cognitive behavioral therapy for insomnia without any improvement in her symptoms. She denies snoring and witnessed apneas but reports occasional daytime sleepiness, with an Epworth Sleepiness Score of 11 out of 24, indicating significant sleepiness. The remainder of her sleep history is unremarkable. Additionally, she has a medical history of anxiety, depression, and chronic pain, which is managed with aripiprazole, bupropion, clonazepam (as needed), and gabapentin. Her surgical history is pertinent for a tonsillectomy at age 5.