Definition

What is periodic limb movement disorder?

Periodic limb movement disorder (PLMD) is a condition characterized by twitching, flexing, and jerking movements of the legs and arms during sleep. It’s sometimes referred to as periodic leg movement during sleep (PLMS). The movements typically occur every 20 to 40 seconds and may last for minutes or hours throughout the night.

People with PLMD don’t know their limbs are moving. They’re unable to control or stop the movements. They often wake up tired and irritable.

How common is periodic limb movement disorder?

This periodic limb movement disorder is extremely common. It commonly affects more females than males. It can affect patients at any age. It can be managed by reducing your risk factors. Please discuss with your doctor for further information.

Symptoms

What are the symptoms of periodic limb movement disorder?

The common symptoms of periodic limb movement disorder are:

  • Repetitive leg movements in one or both legs and sometimes in the arms, which may involve flexing of the big toe, upward bending of the knee or ankle, or twitching of the hip
  • Restless, unrefreshing sleep
  • Multiple awakenings at night
  • Daytime sleepiness and drowsiness
  • Irritability, behavior problems, and decline in performance at school or work due to lack of quality sleep

PLMD movements typically occur every 20 to 40 seconds in batches of 30 minutes or more during the night. They are more common in the legs but may occur in the arms as well. The limb movements typically occur during non-rapid eye movement (non-REM) sleep.

There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.

When should I see my doctor?

If you have any signs or symptoms listed above or have any questions, please consult with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.

Causes

What causes periodic limb movement disorder?

Persistent sleep disruption and daytime sleepiness are not part of normal aging.

Periodic limb movement disorder can be primary or secondary. Secondary PLMD is caused by an underlying medical problem. Primary PLMD, on the other hand, has no known cause. It has been linked to abnormalities in regulation of nerves traveling from the brain to the limbs, but the exact nature of these abnormalities is not known.

Secondary PLMD has many different causes, including the following. Many of these are also causes of restless legs syndrome.

  • Diabetes mellitus
  • Iron deficiency
  • Spinal cord tumor
  • Spinal cord injury
  • Sleep apnea syndrome – Breathing difficulties that disrupt sleep, causing daytime sleepiness and a number of other problems
  • Narcolepsy – A sleep disorder involving excessive sleepiness and overpowering urge to sleep during waking hours
  • Uremia – Build-up of waste products in the blood because of poor kidney function
  • Anemia – Low level of hemoglobin, the substance that carries oxygen in the blood
  • Medication – Neuroleptics and other antidopaminergic agents such as Haldol, dopaminergic agents such as Sinemet (despite the fact that Sinemet is often a treatment for PLMD), or tricyclic antidepressants such as amitriptyline (Elavil)
  • Withdrawal from sedative medications such as barbiturates or benzodiazepines (such as Valium)

Risk factors

What increases my risk for periodic limb movement disorder?

Please discuss with your doctor for further information.

Diagnosis & treatment

The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.

How is periodic limb movement disorder diagnosed?

Often people first become aware that they may have PLMD when their partner complains of being kicked at night. Or they may find that their blankets are all over the place in the morning.

PLMD is diagnosed with a polysomnography test, also called a sleep study. This study is done overnight in a laboratory while you sleep. This test records:

  • Brain waves
  • Heart rate
  • Oxygen levels in your blood
  • Eye movements
  • Other nerve and muscle functions during sleep
  • Blood pressure

It’s usually done at a sleep disorders unit in a hospital or at a designated sleep center. A sleep technologist places sensors on your scalp, temples, chest, and legs using medical glue or tape. The sensors are then connected to a computer with long wires, and measurements are taken all through the night while you’re asleep.

Your doctor may also get your complete medical history and give you a physical exam to look for other underlying issues that may be disrupting your sleep. Urine and blood samples are often taken to look for signs of iron deficiency anemia and any metabolic disorders. Low iron and metabolic disorders such as diabetes have been linked to PLMD.

How is periodic limb movement disorder treated?

Treatment does not cure the disorder but usually relieves symptoms.

Treatment involves medication that either reduces the movements or helps the person sleep through the movements.

Medications

Therapy does not cure PLMD but relieves symptoms. Note that many of the medications used to treat PLMD are the same as those used to treat restless legs syndrome.

  • Benzodiazepines: These drugs suppress muscle contractions. They are also sedatives and help you sleep through the movements. Clonazepam (Klonopin), in particular, has been shown to reduce the total number of periodic limb movements per hour. It is probably the most widely used drug to treat PLMD.
  • Dopaminergic agents: These drugs increased the levels of an important neurotransmitter (brain chemical) called dopamine, which is important in regulating muscle movements. These medications seem to improve the condition in some people but not in others. Widely used examples are a levodopa/carbidopa combination (Sinemet) and pergolide (Permax).
  • Anticonvulsant agents: These medications reduce muscle contractions in some people. The most widely used anticonvulsant in PLMD is gabapentin (Neurontin).
  • GABA agonists: These agents inhibit release of certain neurotransmitters that stimulate muscle contractions. The result is relaxation of contractions. The most widely used of these agents in PLMD is baclofen (Lioresal).

Next Steps – Follow-up

Your health care provider will ask you to return for one or more follow-up visits after trying his or her recommendations.

It is very important that your bed partner understand the nature of PLMD and that you are not intending to injure him or her with your movements.

Lifestyle changes & home remedies

What are some lifestyle changes or home remedies that can help me manage periodic limb movement disorder?

The following lifestyles and home remedies might help you cope with periodic limb movement disorder:

  • You might not need treatment at all if your PLMD is moderate and doesn’t disturb you or your partner too much. In this case, cutting down on caffeine, alcohol, and smoking can help. Caffeine isn’t just found in coffee. It’s also in sodas, teas, chocolates, energy drinks, and some medications, such as Excedrin.
  • Yoga, meditation, and other relaxation exercises may also help reduce symptoms. As well, massages or a hot bath prior to sleep can help tame symptoms at night.

If you have any questions, please consult with your doctor to better understand the best solution for you.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Sources

Review Date: November 6, 2017 | Last Modified: November 6, 2017

Want to live your best life?
Get the Hello Doktor Daily newsletter for health tips, wellness updates and more.