Severe sleep apnea resistant to all treatments

A 62-year old female was referred to the Sleep Clinic with severe daytime somnolence despite sleeping 11-13 hours/day, falling asleep during conversations and at meals with an Epworth Sleepiness Scale score of 24/24. She was diagnosed with obstructive sleep apnea (OSA) of unknown severity >10 years ago and underwent three titration polysomnograms (PSGs). She was using bi-level PAP in the spontaneous mode (BPAP) at 24/20 cm of water pressure (CWP) with supplemental oxygen bled in at 3 Liters/min and endorsed several pressure-related side effects.

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