Does your wife or husband scold you as soon as you wake up in the morning, saying, "You kicked me all night and didn't even let me sleep properly"? Or do you sleep very hard, but wake up in the morning feeling uninspired and tired all day? The reason for these things may be something that happens during sleep that you don't even know about. That's what we're going to talk about today.
Simply put, what is PLMS?
PLMS stands for Periodic Limb Movements of Sleep . In Sinhala, it means "periodic limb movements during sleep." This is a movement disorder. In this condition, your arms and/or legs repeatedly twitch or twitch without your control while you are sleeping. These movements can disrupt your sleep. Some people also call this condition `sleep-related myoclonus syndrome`.
Most of the time, these movements occur in the legs. Imagine, your big toe is extended, while your ankle, knee, and hip are flexed. It's like kicking your foot. In some cases, this can also happen in the hands.
PLMS does not usually occur alone. In about 80%-90% of cases, it occurs with the condition we all know as Restless Legs Syndrome (RLS) . In addition, PLMS is also seen with the following other medical conditions:
- Obstructive Sleep Apnea: This is a condition in which breathing stops during sleep.
- Narcolepsy: Excessive sleepiness during the day.
- REM Sleep Behavior Disorder: Acting out dreams during sleep.
- Uremia: Accumulation of toxins in the blood due to kidney failure.
- Spinal Cord Tumor: A tumor that occurs in the spinal cord.
- ADHD (Attention-Deficit/Hyperactivity Disorder): Attention deficit and hyperactivity.
What is the difference between PLMS and PLMD?
These two names are very similar, so it can be a bit confusing. But there is a small but important difference between the two. Let's understand it clearly.
Simply put, if doctors can't find any other cause for these twitching limbs (like the diseases mentioned above), they call it PLMD (Periodic Limb Movement Disorder) . But if these twitching limbs occur together with another medical condition, it's called PLMS (Periodic Limb Movements of Sleep) .
Of the two, PLMD is a bit rarer, but PLMS is more common.
| Status | Description |
|---|---|
| PLMS (Periodic Limb Movements of Sleep) | Restless Legs Syndrome (RLS) is a sleep disorder that is often associated with other medical conditions (e.g., Restless Legs Syndrome, Sleep Apnea). This is the most common condition. |
| PLMD (Periodic Limb Movement Disorder) | Twitching of the limbs during sleep, but no other identifiable cause . This is a rare condition. |
How common is this condition?
Researchers estimate that between 4% and 11% of adults and 5% and 8% of children suffer from PLMS or PLMD. These limb movements are very common in sleep studies.
What symptoms does someone with PLMS show?
People with PLMS often visit their doctor because of sleep-related problems. The main ones are:
- Excessive fatigue and sleepiness during the day.
- Insomnia.
A person with PLMS or PLMD has their arms or legs twitch or jerk for 20 to 40 seconds at a time during sleep. Surprisingly, many people with this condition are unaware that these movements are happening . But their bed partner may say, "You're kicking at night."
Some people wake up frequently from sleep because of these movements and have difficulty falling asleep.
What causes PLMS?
In fact, researchers still don't know the exact cause of PLMS. They think it's caused by a problem or abnormality in our spinal cord. That is, there may be a problem with the signals coming from the brain or spinal cord that cause our involuntary movements during sleep.
Additionally, some medications have been found to worsen PLMS. Some of these include:
- Some medications for depression (Antidepressants): Examples include `mirtazapine`, `venlafaxine`, `sertraline`, `fluoxetine` and `amitriptyline`.
- Some medications for allergies (Antihistamines).
- Some medications for mental illness (Antipsychotics/neuroleptics).
Risk factors that increase the risk of this condition
Any of the following conditions or habits can increase your risk of developing PLMS. Let's take a look at what they are.
| Risk factor | How it affects |
|---|---|
| Anemia | Low iron levels in the blood affect a chemical in the brain called dopamine, which is important for controlling movement. |
| Being over 65 years of age | The likelihood of such conditions increases with age due to changes in the nervous system. |
| Diabetes-related neuropathy | Nerve damage caused by diabetes can cause these kinds of uncontrolled movements. |
| Family history | If someone in your family has Restless Legs Syndrome, PLMS, or PLMD, you are at higher risk of developing it too. |
| Obesity | Research has shown that being overweight is also linked to this condition. |
| Lack of physical activity | A sedentary lifestyle without exercise is also a risk factor. |
| Smoking | Smoking increases the risk because it negatively affects the nervous system and blood circulation. |
How is PLMS diagnosed?
If you have these symptoms, when you see a doctor, he or she will ask about your medical history. Then, there is a test that is mainly done to confirm this condition. It is called a Polysomnogram (PSG) . Some people also call it a 'Sleep Study' .
This involves staying overnight in a hospital or sleep study center, and having your body monitored while you sleep. They attach a few small sensors to your body. These sensors,
- Your brain activity (brain waves)
- Heart rate
- Breathing pattern
- Blood oxygen level
- And most importantly, it records the movements of the arms and legs .
With this test, an adult is diagnosed with PLMS if the limb movements occur more than 15 times per hour . For a child, the movements occur more than 5 times per hour.
This sleep study can also help determine if you have other sleep problems, such as sleep apnea. Your doctor may also order blood tests to check for other causes.
What are the treatments for PLMS?
There is no specific treatment for PLMS. However, doctors usually prescribe the same medications that are used for Restless Legs Syndrome (RLS). Because there is a strong link between RLS and PLMS, those medications may also be effective for PLMS. Some of these medications include:
- `Pramipexole`
- `Ropinirole`
- `Rotigotine`
- `Gabapentin`
- `Pregabalin`
In addition, researchers are studying several other drugs, including Clonazepam, Melatonin, Valproate, and Selegiline.
Importantly, if you are already taking medication for depression or another condition, it is possible that the medication may be making your PLMS worse. If this is suspected, your doctor may prescribe another medication instead.
But remember one thing: Never, for any reason, stop taking your medication or change the dosage suddenly without talking to your doctor. This can cause serious side effects.
Could this situation have long-term effects?
PLMS can significantly affect the quality of your sleep, and it can also disrupt the sleep of your partner.
There is not much research yet on the long-term effects of PLMS. However, some studies have shown that people with sleep movement disorders like PLMS are more likely to have high blood pressure . High blood pressure increases the risk of future diseases such as stroke and heart attack. Therefore, it is very important to talk to your doctor about how to manage this risk.
Is there a way to prevent PLMS?
Since the exact cause is unknown, there is no specific way to prevent it. However, managing the risk factors we discussed above can reduce the chance of this condition occurring. For example,
- If you smoke, stop.
- Being physically active (exercising).
- Controlling body weight.
- Getting proper treatment for conditions like anemia.
When should I see a doctor?
If you have been diagnosed with PLMS, see your doctor again if:
- If you develop new symptoms or if your current symptoms get worse.
- If the treatment you are taking causes unpleasant side effects.
Is PLMS a precursor to Parkinson's disease?
This is a common fear for many people. Although people with Parkinson's disease may experience limb movements during sleep, no research has proven that PLMS or PLMD are an early sign of Parkinson's disease. So don't be unnecessarily afraid of it.
Finally, if you have any sleep problems, or if you feel exhausted even after sleeping well, it is important to talk to a doctor. Good sleep is essential for our overall health. PLMS may not be the cause of your problem, but it is best to get tested and find out for sure. Don't hesitate to ask your doctor any questions or concerns you may have.
Take-Home Message
- PLMS is a condition in which you experience involuntary jerking of your limbs during sleep. This can cause excessive sleepiness and fatigue during the day.
- Most of the time, the person with this condition doesn't know it. It's the person who sleeps with it who tells them about it.
- This can be associated with other conditions (such as Restless Legs Syndrome, Sleep Apnea). If it occurs without any apparent cause, it is called PLMD.
- To accurately diagnose this condition, a test called a Sleep Study (Polysomnogram) needs to be performed.
- There are medications for treatment, and it is also important to control risk factors.
- If you have any problems with sleep, definitely see a doctor for advice.
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