CASE STUDY NO. 1

An 11-year-old girl arrives at the sleep clinic with her parents. She has difficulty falling asleep until after midnight and has to be out of bed by 6:30 am to get to school on time. On weekends, she sleeps until about 8:30 am and awakens spontaneously. She has a long history of behavioral problems and hyperactivity, fairly well controlled by medication. She is a very restless sleeper and has complained about leg discomfort at night for 8 years. Her parents describe a clear circadian pattern with increased restlessness in the evening. She also admits that she has difficulty keeping her legs still in class, reporting that she “just has to move.” Similar symptoms have been described in her mother, aunt, and grandmother. She is diagnosed with attention deficit hyperactivity disorder (ADHD) and is prescribed a stimulant medication. Her serum ferritin level is 52 ng/mL (within normal limits).