1222 These Boots Were Made for Walking, but Not Sleeping

Abstract Introduction Somnambulism occurs during slow wave sleep, prompted by an arousal, followed by sitting up or walking, disorientation with no recollection of the event, and falling back asleep. While somnambulism/sleepwalking is a parasomnia that is not typically associated with Ehlers-Danlos syndrome (EDS), it was the presenting sleep disorder in a patient, with multiple etiologies of insomnia. Report of case(s) A 54-year-old female with a history of chronic insomnia, attention-deficit/hyperactivity disorder (ADHD), EDS, and osteoporosis presents with somnambulism. Patient reports sleepwalking since childhood and continuing to sleepwalk into adulthood. Fifteen years prior, she became a paramedic, worked 24-hour shifts, and developed insomnia. Patient started her first insomnia treatment with zolpidem 5 years ago, which increased her sleepwalking frequency from twice a week to daily and included more complex behaviors like preparing food. Patient retired with disability 4 years prior due to recurrent fractures and joint deformities secondary to her osteoporosis and EDS. She took cyclobenzaprine, methocarbamol, oxycodone-acetaminophen, and pregabalin for chronic pain, and dextroamphetamine-amphetamine for ADHD. Patient presented to Sleep Medicine clinic July 2023 where zolpidem was changed to clonazepam. At her follow up December 2023 visit, exam was notable for her wearing a left post operative short boot. Her sleepwalking had ceased, but insomnia worsened. It was taking her 3 hours to fall asleep after her 6PM bedtime, and 1 hour to fall asleep after nocturia-related awakenings 1-2 times per night. Since her surgery three weeks prior, she had been dozing off during the day, likely from her sedative pain medications. We recommended delaying her evening pain medications and bedtime and ordered a sleep study. Conclusion Chronic pain, fatigue, and pain medications used to treat EDS contribute to this population's higher rates of sleep disorders like insomnia. They also have higher rates of obstructive sleep apnea due to nasal-maxillary cartilage changes, that are successfully treated with nasal CPAP. Psychiatric disorders, including anxiety, mood disorders, and ADHD are also more common in this population, and carry their own sleep pathology. While the patient’s primary sleep complaint was somnambulism, it was important to evaluate for and treat underlying sleep disorders for optimal outcomes. Support (if any)