Periodic Limb Movements & Restless Leg Syndrome

Periodic limb movements (PLM’s) and Restless leg syndrome (RLS) are two related, relatively common conditions.  People may be described as having “ancy feet” or “jumpy legs."  PLM’s are described as rhythmic, repetitive kicking or jerking of your legs, ankles or feet (or even arms, wrists or hands) during sleep.  RLS, on the other hand, is an uncomfortable or strange sensation in your extremities, sometimes described as a creeping, crawling, heavy or painful sensation.  People typically have a difficult time describing these symptoms.  The key feature to recognize in RLS is that the “strange sensations” occur while resting or attempting to fall asleep, yet improve by walking, moving or rubbing the affected extremity.  Both PLM’s and RLS can result in significant insomnia as well as daytime sleepiness and fatigue.     

For PLM’s, the repetitive movement can disrupt your sleep by causing frequent awakenings and a poor sleep quality.  The symptoms of RLS, on the otherhand, will typically result in difficulty falling asleep, or difficulty sitting still while resting.  Realize PLM’s and RLS do not always occur together.  In fact, PLM’s are relatively common while RLS is a much less common disease and almost always occurs in association with PLM’s.  Both of these disorders increase in frequency as we age.  RLS affects up to 5% of the population while PLM’s may affect anywhere from 5%-40% depending on the age group being evaluated.

Although it is very important to try to identify the cause of your PLM’s or RLS, most often the cause is not found.  These conditions are often inherited, but other causes include anemias, kidney disease, diabetes, poor circulation, thyroid disease, neurologic or muscular disorders, breathing disorders such as emphysema, pregnancy, some medications (especially antidepressants) and caffeine.

Treatment of RLS and PLM’s typically involves both relaxation techniques and medications.  Here are some relaxation techniques and therapies:

1.  Learn to wind down a few hours before sleep.  Stress and worry prevent you from becoming relaxed before you fall asleep.  Concentrate on relaxing, pleasant thoughts or of peaceful imagery.  Bedtime rituals such as reading an enjoyable book, taking a warm bath or listening to soft music can be helpful.

2.  Avoid worrying about daily problems.  Attempt to review all of your activities and stresses for that day well before you go to bed.  If possible, talk about some of your stresses and problems with another person as a means to work through these problems and relax before you go to bed.

3.  Do not plan your next day when attempting to fall asleep.  Set aside time during the day to deal with worrisome thoughts.

4.  Consider relaxation therapy, biofeedback or hypnosis.  Therapies aimed at teaching people to relax can be very effective in reducing your stresses.

5.  Avoid exercise before bedtime.  The best time to exercise is in the morning or early afternoon.  If you choose to exercise in the evening, avoid strenuous exercise for at least 6 hours before bedtime.

6.  Avoid or limit caffeine.   Beverages containing caffeine (coffee, tea, hot chocolate, cola beverages) should be limited to no more than 3 cups per day and not taken 6 hours before bedtime.  These products may prevent you from falling asleep and from staying asleep.

7.  Avoid alcohol before bedtime.  Although it may initially help you fall asleep, alcohol typically causes early awakenings and difficulty going back to sleep.

8.  Avoid smoking for at least three hours before sleep.  The nicotine in cigarettes is a stimulant that may result in difficulty falling asleep and staying asleep.  Although the best recommendation is to quit smoking altogether, you should at least not smoke near bedtime.

While PLM’s and RLS are not life threatening illnesses, they can be very detrimental to your health if you are having problems sleeping.  Given that PLM’s and RLS can cause insomnia, if the above measures are not effective in helping your sleep problem, consider an evaluation by a physician experienced in sleep medicine.  These problems can often be identified by visiting a physician, but you may require a sleep study to identify the characteristic leg jerks in association with disruptive sleep.  Your physician may also request some blood tests.  However, you must realize treatments for these problems are very effective.