GREENSBORO CHEST DISEASE & ALLERGY ASSOCIATES, P.A.

E.W. Stevens, M.D., F.C.C.P., F.A.C.A.

C.D. Young, M.D., F.C.C.P., F.A.C.P.

1018 North Elm Street
Greensboro, N.C. 27401
Phone (336) 275-7238
Fax (336) 275-4875

July 14, 1998

Mr. John B. Hatfield, Jr.

Attorney at Law
219 W. Washington St.

Greensboro, N. C. 27401
 

Re: Ronnie Lee Kimble
 

Dear Mr. Hatfield:
 

On July 12, 1998 1 had the opportunity to discuss Ronnie Kimble's history of sleep complaints with you and then to interview Mr. Kimble as requested. I have subsequently reviewed the medical records you have provided with particular attention to sleep studies that he had in June 1995 and January 1997 with the related evaluations by specialists in Neurology, Otolaryngology and Sleep Disorders Medicine (Dr. DeBeck).
 

Mr. Kimble has given a consistent description across several years and through different Interviewers, of a perception of excessive daytime sleepiness not obviously associated with impaired nocturnal sleep.
 

He has described episodes of being asleep on his feet, for instance while marching, and similar near automatic behavior.
 

Nocturnal polysomnograms(sleep studies) on the 2 dates showed fairly similar results. He does snore but does not demonstrate significant objective evidence of obstructive apnea, narcolepsy or
severe pathologic daytime sleepiness. The Multiple Sleep Latency Test for measuring objective daytime sleepiness done with the 1997 study showed mild daytime sleepiness by our local laboratory
criteria with a mean latency of 10.4 latency of 10.4 minutes and no sleep-onset REM. His earlier study in 1995 showed a mean latency of 12.4 minutes with I REM episode. These results Indicate somewhat more daytime sleepiness than I would consider routine in a healthy young man who had been getting adequate nocturnal sleep.
 

It is possible that he either needs more sleep than the average person, or Alternatively, he might have a very mild incomplete form of narcolepsy which is a disorder of excessive daytime sleepiness.

TO; MR. HATFIELD

July 14, 1998
RE; R. KIMBLE
PAGE 2

I think I would put him in the category of Idiopathic Hypersomnia. I don't believe he needs further studies now unless he develops other evidence of neurologic problems.
 

I am sending you some pages from a coding book which describe this disorder.
 

This disorder and associated sense that he may be somewhat different from other people, may cause some degree of depression but I get no Impression from Mr. Kimble that it would significantly affect his ability to make decisions or to control significant actions. I do not get the impression that he has difficulty distinguishing reality from dreams.
 

He does describe occasionally vivid dreams and is able to relate them the next day. To the extent that dreaming may represent some mental processing of daytime issues, we are not surprised if dreams recalled the next day seem to have threads of relevance to issues of daytime life but I can offer no formal opinion that the content of dreams actually means anything very specific.
 

I hope these thoughts are of help to you.
 

Respectfully,
 

/signature/
Clinton D. Young, M. D.
 

CDY;cm

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Idiopathic Hypersomnia