0815 Treatment Success in a Resistant Case of Insomnia with an Irregular Circadian Rhythm Disorder

Abstract Introduction A 19-year-old non-verbal male with history of CHARGE syndrome, severe autism, intellectual disability, coloboma blindness OD and severely imparied vision OS, deafness, self-injurious aggressive behavior, Tetralogy Fallot status post repair, pulmonary valve replacement, hypertension, hypothyroidism, megacolon, gastrostomy tube dependence, eosinophilic esophagitis chronic kidney disease an irregular sleep cycle who has failed multiple medications for insomnia shown treatment success suvorexant. Report Cases: This patient’s schedule ranges from 1.5 to 5 hour segments at various times day or night including naps school occasional longer periods up 10 hours wakefulness 22 been treated the following medications: trazodone, clonidine, hydroxyzine, diphenhydramine, quetiapine, gabapentin, mirtazapine, eszopiclone, melatonin ramelteon. His behavioral problems have olanzapine. He continued be difficult direct. parents reported exhaustion. Then, suvorexant 5mg was added bedtime while were continued: gabapentin total daily dose 1500mg (300mg in morning 3pm; 900mg bedtime, 300mg one later if still awake), ramelteon 8mg, mirtazapine 7.5mg olanzapine 10mg bid prn behavior. also takes bisacodyl, polyethylene glycol, simethicone, hyoscyamine, cholecalciferol, aspirin, levothyroxine, hypoallergenic nutritional formula, starch albuterol prn. With addition 5mg, he had able get 9.5 consolidated improvement his behavior until contracted Covid-19 regressed. The increased which again improved Conclusion Various either not worked all suboptimally this medically complex patient Circadian rhythm disorder. Adding orexin receptor antagonist as a novel mechanism regimen promise. At time, stable month after regression on that coincided infection. We are proceeding cautious optimism. Support (If Any)