Some degree of movement in the arms and legs is common when we sleep. For most people, these movements have no significant effect on their sleep quality.
These movements are considered a disorder, Periodic Limb Movement Disorder (PLMD) when they disrupt a person’s sleep and daily life. Statistics show that PLMD affects 4%-11% of the population.
We put together this guide to help you better understand PLMD and explore treatment options if you or a loved one suffers from the condition.
What is Periodic Limb Movement Disorder?
PLMD is a sleep disorder that causes a person’s legs (and sometimes arms) to move repetitively and uncontrollably while they sleep. People with PLMD experience brief muscle twitches, jerking movements, or flexing of the feet upward.
These episodes can disrupt the person’s sleep even if they don’t wake up. This disruption often leads to insomnia and/or daytime sleepiness.
- PLMD is the only movement disorder that occurs solely while sleeping
- It can occur at any stage of life
- It’s called “periodic” because of the movements’ repetitive and rhythmic patterns.
- Episodes can last a few minutes to an hour and usually occur every 20-40 seconds.
What are the symptoms of PLMD?
Many people with PLMD are unaware of their leg movements unless someone who sleeps in the same bed makes them aware of them. This can make it very hard for you to know if you have periodic limb movements.
Symptoms of PLMD are:
- Unusual, repetitive movements, especially in your lower legs, while you sleep
- Never feeling well-rested, even after a full night of sleep
- Poor sleep
- Extreme daytime fatigue and sleepiness
The American Academy of Sleep Medicine suggests that PLMD can be a factor in the development of depression, poor memory, and a short attention span.
What causes PLMD?
Scientists don’t know much about the cause of primary PLMD. It has been linked to anomalies with nerve regulation traveling from the brain to the limbs, but more research is needed to fully understand the disorder.
For secondary PLMD, the condition might be caused by:
- Iron deficiency
- Spinal cord injury
- Spinal cord tumor
- Restless leg syndrome (RLS)
- REM sleep behavior disorder
- Sleep apnea
- Willam’s syndrome
- A side effect of medications like anti-nausea drugs and anxiety and depression medicines
- Withdrawal from certain sedative medications
How is PLMD diagnosed?
Because people typically don’t link excessive movement in the arms and legs to the cause of their poor sleep, many live with PLMD undiagnosed for some time.
People usually seek treatment after their partner experiences disrupted sleep from their movement symptoms or when daytime sleepiness and fatigue interfere with daily functioning and their overall well being.
If you suspect you or your sleep partner may have PLMD, you should talk to your doctor. At your appointment, your health care provider will most likely do a physical exam, ask for your medical history, and possibly consult your partner to learn about your sleep history. They may also order blood work and other tests to look for signs of an underlying cause for your sleep problems, such as anemia and metabolic disorder.
Your doctor will likely have you do a sleep study called polysomnography. While you sleep, this test records your brain waves, heart rate, and breathing. It also monitors how your arms and legs move and can help identify any other sleep disorders that you may have.
What treatment options are available for PLMD?
Secondary PLMD may go away if you treat the underlying issue.
While there is no cure for primary PLMD, treatment options can relieve symptoms and improve sleep quality.
Depending on the severity of symptoms, your doctor may recommend a mix of lifestyle changes and medication.
Cases of mild to moderate PLMD may be treated with lifestyle changes to improve sleep. Some of these recommendations may include:
- Adding more iron into your diet
- Decreasing or eliminating caffeine and alcohol
- Using stress management techniques (i.e., deep breathing exercises, meditation, or yoga)
- Creating better sleep habits, including consistent bed and wake times and forming a bedtime routine.
When PLMD is severe, doctors may prescribe drugs to reduce movements or help the person sleep through it. These medications include, but are not limited to:
- Benzodiazepines- Sedatives that suppress muscle contractions. Clonazepam is the most widely prescribed benzodiazepine for PLMD as it has been shown to decrease the number of periodic limb movements.
- Anticonvulsant agents – Reduce contractions in some people. Neurontin (Gabapentin) is commonly used for treating PLMD.
- Dopaminergic agents– Increases the brain chemical dopamine, which helps control muscle movements. Carbidopa-levodopa (Sinemet), also used for Parkinson’s disease, is a dopamine agent in PLMD patients.
- GABA agonists – Hinder the release of certain brain chemicals that stimulate muscle contractions. GABA agonists can also help relax muscles and promote sleep. Baclofen (Lioresal) is the most common GABA prescribed for PLMD.
With the proper diagnosis and treatment plan, the symptoms of PLMD can be managed and you can improve your sleep health. If you’re having trouble sleeping, you should consult your doctor for testing and treatment options.
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