Filler Christmas 2012: Research

A shaggy dog story

BMJ 2012; 345 doi: (Published 13 December 2012) Cite this as: BMJ 2012;345:e7751
  1. Olivier Le Bon, head of department of psychiatry1,
  2. Paul Linkowski, head of department of psychiatry2
  1. 1Université Libre de Bruxelles, Hôpital Tivoli, Laboratoire de recherches psychiatriques ULB, La Louvière, Belgium
  2. 2Université Libre de Bruxelles, Hôpital Erasme, Laboratoire de recherches psychiatriques ULB, Bruxelles, Belgium
  1. olebon{at}

Our 35 year old patient has severe excessive daytime sleepiness, resulting from a combination of narcolepsy, sleep apnoea, and hypopnea syndrome. She also had bipolar disorder and a body mass index of 34. Sleep attacks occurred three to six times a day. When she was depressed, she slept up to 16 hours a day.

Until recently, this severe sleepiness considerably hampered her social life and limited her use of public transport, as she usually fell asleep within a few minutes of sitting down. She’d then wake up at the end of the line and have to fight sleepiness on the way back. Sometimes she’d forget where she started from.

Over the years, treatments included modafinil, methylphenidate, lithium, lamotrigine, carbamazepine, and several combinations of antidepressants, antipsychotics, and benzodiazepines. Neurostimulating agents had only limited effects on her sleepiness and were misused during hypomanic and manic phases. Continuous positive air pressure was poorly supported. No ENT treatment was deemed useful, and the patient was reluctant to use maxillary advancement devices. Her main psychiatric symptoms are now partially under control, although affective symptoms continue to wax and wane irregularly.

The patient was put in contact with a charity that provides trained dogs for people with visual or hearing impairment. A dog was first trained to wake the patient in the morning at the sound of an alarm clock, even if this sometimes required 30 minutes of gentle biting. The dog then learnt to wake the patient at the sound of a mobile phone ringing. Eventually, he learnt to wake her up, if necessary, at every metro, tram, or bus station. There were no reports of cataplectic attacks associated with dog biting.

This animal companion has allowed our patient to move around the city efficiently and carry on a social life. The intervention could benefit other patients with similarly extreme and treatment resistant daytime sleepiness.


Cite this as: BMJ 2012;345:e7751


  • Patient consent obtained.