Behavioral treatment of excessive daytime sleepiness in an elderly woman with multiple medical problems

The case is described of a 61-year-old woman who complained of excessive day-time sleepiness, periodic cataplexy, and nocturnal urinary frequency, in the context of several other medical problems. Behavioral treatment consisted of training in progressive muscle relaxation and fluid restriction to facilitate sleep maintenance, and the use of a rubber band which was snapped against the wrist to facilitate daytime arousal. Following this self-management program, improvements were noted in the following dependent measures: sleep attacks at home; sleep attacks while driving; cataplectic episodes; nocturnal awakenings, and nocturnal urine output. These improvements were maintained at 6- and 12-month follow-up. The integration of medical and behavioral strategies was highlighted.