Periodic Limb Movement Syndrome: a neurological condition characterized by involuntary movements of the legs during sleep and sometimes wakefulness. People with periodic limb movements may become very sleepy during the day because the movements disrupt their sleep throughout the night.

Features  

     This sleep disorder is roughly divided into two categories: Periodic Limb Movements of Sleep (PLMS) and Periodic Limb Movements of Wakefulness (PLMW). PLMS is far more common. PLMS is more common. PLMW occurs most often in those with severe PLMS.
       PLMS movements may vary from slight to strenuous. A common movement is for the big toe to extend. The foot, ankle, knee, or hip may also bend slightly. Movements are not just limited to the lower extremeties. Some people experience this condition in their arms. Symptoms vary from person to person, and from night to night. Episodes usually last anywhere from a few minutes to an hour.


Diagnosis  

When symptoms interfere with sleep or other activities, especially if you are tired during the day, it may be time to consider a sleep evaluation.
       Keeping a sleep log of your sleep habits and rating the quality of your sleep with the Epworth Sleepiness Scale will demonstrate how periodic limb movements interfere with sleep and therefore your life.
       Although it is not always necessary, an overnight sleep study at an accredited sleep lab will assess how your arms and legs move. It will also record brainwaves, heart rate, and additional muscular movements, which may be helpful if another sleep disorder is suspected.


Treatment

Periodic Limb Movement Syndrome may be treated with a combination of medication and behavioral modifications.
Behavioral Modifications: Regular exercise such as walking, riding an exercise bicycle, or swimming may reduce or eliminate PLMS, particularly if Restless Legs Syndrome is part of the problem.  Massaging the legs and soaking in a hot tub prior to bedtime may also help. 
Medications: Several medications are available to treat PLMS. Many of these drugs are also used to treat RLS or a combination of both conditions:
Dopamine Replacement: a group of drugs that reduce muscular movement by replacing a chemical messenger in the brain called dopamine. They include: Pramipexole (Mirapex), Ropinerole (Requip), and very often a combination of Carbidopa and Levidopa (Sinimet).
Opiods: narcotic  medications, which reduce muscular movements by inducing sleep, but which can also be addictive. They include: codeine, the combination of Oxycodone/ Acetaminophen (Percocet, Roxicet), and the combination of Hydrocodone/ Acetaminophen  (Lortab, Vicoden).
Benzodiazepines: muscle relaxants and sleep medications, which may improve sleep but may not eliminate leg sensations. They include: Clonazepam (Klonopin), Eszopiclone (Lunesta), Ramelteon (Rozerem), Temazepam (Restoril), Zaleplon (Sonata) and Zolpidem (Ambien).
GABA Agonists: relaxes PLMS-related muscle contractions by inhibiting chemical messengers called neurotransmitters. For PLMS, Baclofen (Lioresal) is sometimes prescribed.
Anti-epileptics: drugs used in the treatment of epilepsy, which may relax muscles, as well as promote sleep. They include: Gabapentin (Neurontin).

PLMS Mechanics

       Periodic Limb Movement Syndrome may be primary (occurring by itself), or secondary to a medical problem. The etiology or cause of primary periodic limb movements is unknown. It has been linked to a communication problem between the brain and limbs. Specifically, there is an abnormality in the regulation of nerves (neurotransmitters) that travel between the brain and the limbs. The exact nature of these abnormalities is not known.
      It is important to remember that persistent sleep disruption-including disruptions due to PLMS or RLS are not a normal part of aging.


Suggested Downlaods

SleepIssues:Can’t Wake Up
SleepCaptions: Periodic Limb Movement Syndrome