PMC6005892_01
(A) Polysomnography (PSG) results show slightly elevated Apnea-Hypopnea Index (AHI; 5.1 times/hour) and severe night awakening (25.6 times/hour). Minimum SpO2 (95%) was not severely decreased. Stage 1 Non REM sleep was slightly increased and REM sleep slightly decreased. Stage 3 sleep and sleep efficacy were normal. (B) A multiple sleep latency test (MSLT) shows excessive daytime sleepiness. He slept within 2 min four times out of five. Narcolepsy was excluded because no sleep onset REM (SoREM) was observed. (C) Sleep structure shows he woke a lot at the beginning of his sleep and woke an astonishing number of times. He took chlorpromazine 12.5 mg three times at 22:10, 0:15, and 2:45. No snoring of no periodic limb movement was observed.
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F1
As shown in Figure 1, he woke frequently during his sleep (25.6 times per hour on average as shown in Figure 1A) and he lived with excessive daytime sleepiness (he fell asleep within 2 min; on four out of five trials during the MSLT, as shown in Figure 1B).
Sleep log:   represents sleep,   represents drowsiness, and   represents taking a sleeping pill. Sleep time, including drowsiness, steadily increased from 5 to 7 h. No sleep phase advance/delay was observed.
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F2
Figure 2 shows the patient's sleep log.
Case treatment and clinical course. The patient's total sleep time increased from 5 to 7 h per day and his insomnia and psychotic symptoms decreased steadily. He could stop using chlorpromazine as a sedative. Psychiatric symptoms were evaluated by BPRS and sleep disturbance was evaluated by PSQI. BPRS dropped from 48 to 24. PSQI dropped from 13 to 8. CBT-i, Cognitive Behavioral Therapy for insomnia; BPRS, The Brief Psychiatric Rating Scale; PSQI, Pittsburgh Sleep Quality Index.
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F3
The whole course of sleep and psychological tendencies are shown in Figure 3.