Insomnia due to a dislocation storm in hypermobile Ehlers-Danlos syndrome with small fibre neuropathy and recurrent syncope.

Abstract

Objective: To report on a patient with hypermobile Ehlers-Danlos syndrome (EDS) with SFN in whom frequent dislocations during sleep led to sleep deprivation.

Case report: The patient is a 19-year-old female with hypermobile EDS manifested by frequent dislocations of large joints and small fiber neuropathy (SFN) presenting as recurrent syncope. The dislocations occurred spontaneously or triggered by voluntary or involuntary movements with such frequency, even during the night, that sleep was disturbed. The maximum sleep duration was between 4 and 5 hours. Bedding, analgesics, muscle relaxants and physiotherapy only marginally improved the pain and discomfort caused by the dislocations.

Conclusions: This case demonstrates that hypermobile EDS can manifest phenotypically with insomnia due to pain and discomfort from frequent dislocations during the night. Patients with hypermobile EDS should undergo polysomnography to determine the cause of the sleep disturbance and initiate the most appropriate treatment for insomnia in a timely manner.