This chapter presents the clinical history, examination, and the results of the procedures performed on a patient who was a 14-year-old young woman who, according to her parents, has had problems sleeping for several years. The results of the studies showed that the patient had a total of 144 sleep-related respiratory events, with an apnea-hypopnea index (AHI) of 22.47 per hour. There were 140 central apneas and four hypopneas, with 126 events occurring in NREM sleep. The diagnosis was Chiari 1 malformation with associated central sleep apnea. The patient also had a syrinx from C3 through the thoracic cord. Treatment of Chiari 1 malformation involves suboccipital decompression (posterior fossa craniectomy), with or without upper cervical laminectomy. In this case too, the patient underwent suboccipital decompression, and remained in the hospital for 4 days, with some immediate post-operative sleep-related apneas but subsequent significant improvement of sleep.