Sleep Problems

Periodic Limb Movement Disorder

PERIODIC LIMB MOVEMENT DISORDER (PLMD): JERKING LEGS THAT DISRUPT SLEEP

OVERVIEW: Periodic limb movement disorder (PLMD) is a condition in which the legs jerk or cramp repeatedly during sleep. It often occurs in connection with restless legs syndrome, or RLS. The two conditions are not the same thing, however. RLS refers to a condition in which a strange sensation in the limb makes it want to move, while in PLMD, the limb jerks on its own. Most people with RLS have PLMD, but people with PLMD do not necessarily have RLS. The older someone is, the more likely they will be afflicted with periodic limb movement disorder.

CAUSES: PLMD is divided into two categories. Primary PLMD is a condition by itself, while secondary PLMD is a result of another condition. No one really knows what causes primary PLMD, although it is theorized that it is a disorder of the messages sent along the nervous system. Secondary PLMD is often caused by another illness. Some diseases that can cause PLMD are diabetes, anemia, sleep apnea, narcolepsy, and an injury or tumor on the spinal cord. In addition, PLMD can be a side effect of certain medications.

SYMPTOMS: People with periodic limb movement disorder often are able to sleep through the episodes of jerking. The movement, however, does diminish the quality of sleep. This means that the symptoms that usually bring a person to the doctor are the symptoms that result from sleep deprivation and not getting enough rest. Daytime sleepiness is likely. The jerking movements usually involve flexing all the joints of the leg, feet, and toes. They are rhythmic movements that occur more slowly than jerking that happens during an epileptic seizure. The movements happen about two or three times per minute. They can be mild movements or wild thrashing about.

DIAGNOSIS: The diagnosis of periodic limb movement disorder is usually made after the patient comes to the doctor looking for help for daytime sleepiness and trouble sleeping. Poor daytime performance, irritability, and poor coordination are other signs of sleep deprivation, or at least that the sleep a person is getting is not restorative. Blood and urine tests can determine if diabetes or another illness is causing the jerking of the limbs, which in turn is reducing the quality of sleep. They can also determine if it is a drug side effect that is making the limbs move during sleep. Sometimes a doctor recommends a night in a sleep lab in order to monitor the activity in the calf muscles.

TREATMENT OPTIONS: A doctor treating a case of PLMD will recommend a sound routine of healthy sleep habits first. Medications are sometimes prescribed. Some of the most effective medications are those that are prescribed for Parkinson's Disease. Sleeping pills can help by keeping the patient asleep when the leg jerks, but they don't reduce the number of jerks. Pain relievers sometimes reduce the frequency of movements, but don't generally help the patient sleep. For some people, taking extra vitamin E has helped calm down those night jerks.

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