Residual Sleepiness Despite Effective CPAP Therapy: A Case Report

Binh Pham^1,

¹Sleep Medicine Department, Southwest Healthcare Medical Education Consortium, Temecula Valley Hospital, Temecula, CA, USA

Cite this paper:
Binh Pham. Residual Sleepiness Despite Effective CPAP Therapy: A Case Report. American Journal of Medical Case Reports. 2026; 14(7):66-69. doi: 10.12691/ajmcr-14-7-1

Abstract

Residual excessive daytime sleepiness may persist despite effective treatment of obstructive sleep apnea with continuous positive airway pressure. We report a woman first evaluated at age 73 with moderate obstructive sleep apnea who continued to experience persistent daytime sleepiness and frequent naps despite excellent treatment adherence. Serial device downloads demonstrated average nightly use of nearly nine hours and residual apnea-hypopnea index values of 0.9 and 0.5 events/hour. Modafinil was discontinued because of neuropsychiatric adverse effects, with suicidal ideation documented during treatment, and solriamfetol 75 mg was discontinued because of gastrointestinal upset and worsening gastroesophageal reflux. An individualized off-label trial of bupropion 75 mg was subsequently attempted but was discontinued after severe migraine, gastrointestinal upset, anorexia, racing thoughts, marked activation, and significant insomnia occurred on two treatment attempts. Evaluation for a central disorder of hypersomnolence was discussed but not completed. This case highlights the challenges of managing residual sleepiness despite objectively effective positive airway pressure therapy when multiple pharmacologic options are limited by poor tolerability.

Keywords:
obstructive sleep apnea residual excessive daytime sleepiness continuous positive airway pressure solriamfetol modafinil bupropion medication intolerance

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