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How to find stillness when you have periodic limb movements

Jul 28, 2016
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Tamara Kaye Sellman, RPSGT, CCSH
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plmd

keeping_feet_still_PLMDThere is no cure for the movement disorder of sleep known as Periodic Limb Movement Disorder.

However, the 4 percent of Americans who suffer from this curious neurological condition can manage its symptoms through lifestyle changes and medications.

Not only can they recoup some of their lost energy and enjoy more alertness during the day, but so can their bed partners. 

 

PLMD and the differential diagnosis

Getting a diagnosis of PLMD typically requires the attention of a primary care provider, a sleep specialist, and sometimes, a neurologist. You will likely participate in a sleep study and may also have blood drawn to analyze for deficiencies in blood iron, among other things.

Between these three medical opinions, you should be able to land a differential diagnosis that rules out other sleep disorders, other movement disorders (like Restless Leg Syndrome, or RLS), other medical conditions which might cause similar symptoms, and any drug or supplement interactions which may result in symptoms that mimic PLMD. need_a_diagnosis

Why a differential diagnosis? All of these potential causes for periodic limb movements in sleep (PLMs) require vastly different treatments, and what may help some of these conditions can worsen PLMD. 

Treatment for Periodic Limb Movement Disorder

Once the diagnosis is confirmed, it's up to the patient to decide how severe their condition is. PLMD has no cure, so treatment exists primarily to offer relief of symptoms.

For those with PLMD who do not have life-affecting symptoms like chronic insomnia, daytime sleepiness, or fatigue, and whose limb movements are not disturbing their bed partners, treatment may not even be considered.

But for those with severe PLMD or whose nocturnal movements are depriving their bed partners of sleep, the options for managing symptoms include lifestyle changes and medications. 
 

no_caffeineLifestyle changes to treat PLMD

  • Abolish all sources of caffeine. This stimulant commonly found in coffee, tea, soda, chocolate, and energy drinks and supplements can intensify the symptoms of PLMD. You may need to cut back on caffeine, limit your consumption to before noon, or eliminate it from your diet entirely. 
  • Be wary of mixing alcohol and sleep. There may be a bidirectional relationship between alcohol use and increases in periodic limb movements in sleep. On the other hand, some people choose to self-treat their PLMD with alcohol to relieve symptoms. In others, the movement disorder may actually be secondary to alcohol use prior to bedtime. 

Medications used to treat PLMD

Clonazepam (Klonopin)
This common PLMD treatment is a drug classified as a benzodiazepine. It has sedative properties and dampens muscle contractions, improving overall sleep quality for people with PLMD. 

Anti-Parkinson drugs dopamine

These drugs increase levels of dopamine, a substance the brain uses to regulate muscle activity. The two anti-Parkinson medications most commonly prescribed to treat PLMD are Sinemet (carbidopa-levodopa) and Permax (pergolide mesylate). 

Anticonvulsants
It makes sense that drugs used to control muscle spasms are often prescribed to treat PLMD. Neurontin (also known as gabapentin) is widely prescribed as a treatment for symptom management. 

Muscle relaxants
Certain drugs which inhibit the brain chemistry that stimulates muscle contractions can sometimes reduce the symptoms of PLMD. Most commonly, baclofen (also known as Lioresal) is used for this purpose. 

older_woman_sleepingAs with any sleep health issue, we encourage you to talk with your primary care physician or other healthcare specialist when encountering sleep problems. We take pride in being recognized regionally for working in tandem with all kinds of medical practices to help you get to the bottom of your sleep concerns. 


Sources: 

Alaska Sleep Clinic
American Academy of Sleep Medicine
National Institutes of Health/PubMed

National Sleep Foundation

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