Case study: The Hollywood star

A female patient describes her childhood as being fairly normal and happy until the unexpected death of her father that she had difficulty coping with. Later in life, she became an actress and worked hard in her various roles, but due to the immense pressure of her public-facing career, she maintained a strict diet of only 300 calories a day while taking laxatives. She mentioned she was afraid of being “outed” by the press and tried to keep her eating habits under wraps. At one point she was diagnosed with lupus (but this was found to be incorrect). No other medical conditions were apparent, though it is noted that she does have comorbid depression. When she presented with symptoms, she was a very low weight for her age and height.

The case study above is based on the true story of Portia de Rossi who, in her book Unbearable Lightness: A Story of Loss and Gain, describes her struggle with anorexia and bulimia. Watch more of her story here.

Case Study: Taisha

Taisha is in her first semester of sophomore year at college and went to student counseling for help with increased depression and anxiety. She is a high-achieving student who’s made the Dean’s list every term but has been struggling with concentration and fatigue. She didn’t do as well on her mid-terms as she’d hoped and has complaints that she can’t sleep and she is constantly exhausted. She’s resorted to OTC sleeping pills for sleep and energy drinks to keep her awake during the day. She knows this isn’t a healthy routine, but doesn’t know what else to do; if she doesn’t take something to sleep, she barely gets two or three hours of rest each night.

Treatment

CBT would be a good first-line treatment for Taisha. Though medication may help in the short-term, a focus on cognitive processes and problem behaviors, as well as include stress management techniques could help improve the patient’s symptoms. CBT has been demonstrated to be very effective in treating insomnia.

Case Study: Carson

Carson is a 50-year-old man who went to the doctor due to his wife’s frustration with his snoring. He had a consistent history of loud and frequent snoring after he turned 40. After his 40th birthday, he changed jobs and therefore had to change his routine. Over a period of five years, he gained 40 pounds, reduced his exercise, and had increased stress. When Carson slept, his wife was frightened by the snoring noise, but also noticed the occasional pauses in his breathing during sleep, and at times he awakened to his snoring. During the day, he also reported frequent morning headaches and acid reflux. He had seasonal allergies, which resulted in occasional nasal congestion, yet he always woke up with a dry mouth and sore throat. Also, in his sleep, he had frequent bouts of movement and he tossed and turned. Carson constantly felt sleepy during the day, especially while reading and driving.^[1]

Treatment

In this case, the best course of treatment, following a sleep study, would likely be to try a continuous positive airway pressure (CPAP) device, which involves the use of a mask that fits over the sleeper’s nose and mouth, which mask is connected to a pump that forces air into the person’s airways, helping them remain open. Other possible treatments (especially for those who are unable or unwilling to use a CPAP machine) include surgery of the nose, tongue, jaw, trachea, or uvula. These types of surgeries help expand airways and stop blockages so the patient can breathe better at night, and thus, sleep better.