Periodic Limb Movement Disorder (PLMD)
Do you or your child/teen exhibit some of the following behaviors:
Kick or move around often in bed?
Seem to be hyperactive or inattentive?
Resist or have difficulty falling asleep?
Wake up frequently in the night?
Have an irritable or sometimes difficult temperament?
If you or your child/teen have some of these problems, you need to immediately do an on-line screening for Periodic Limb Movement Disorder and Restless Legs Syndrome because these sleep disorders can prevent people from getting enough deep, restful sleep, which can cause daytime behavior, concentration, and/or learning problems.
Click the screening button below to find out if you or your child/teen have a high probability of PLMD or RLS and what you can do to correct it:
Most adults and parents have little knowledge or awareness of one of the major sleep disorders that can cause many daytime behavior problems and nighttime sleep behavior problems: Periodic Limb Movement Disorder (PLMD). PLMD causes bedtime resistance, difficulty falling asleep, or the child /teen refuses to go to sleep. Once the person with PLMD is asleep, then s/he exhibits lots of restless sleep, including frequent leg kicking or leg jerking movements, rolling around excessively, and occasionally moving arm or other body parts that interrupts one’s deep sleep. This interruption of deep sleep often results in feelings of irritability, oppositional behaviors, and in the case of a child/teen, frequent yelling, tantrumming, or excessive frustration and angry outbursts in the daytime. Most of these children and many adults with PLMD display many symptoms of Attention Deficit / Hyperactivity Disorder (ADHD) or may have a diagnosis of ADHD and are being treated for this disorder or other disorders like Oppositional Defiant Disorder, Conduct Disorder, or other mental health disorders.
The good news is that if the Periodic Limb Movement Disorder can be corrected, and it is pretty easy to correct it, these other daytime or nighttime behavior problems usually decrease or disappear. If you or your child / adolescent exhibit any of these above-mentioned day- or nighttime behavior problems, please read the information below and find out how to screen and get treatment for PLMD:
Periodic Limb Movement Disorder (PLMD) is characterized by the periodic (every 20-40 seconds) and sustained (0.5-4.0 seconds in duration) contractions of one or both front leg muscles often causing unperceived arousals or awakenings from light or deep sleep. These contractions result in repetitive jerks for about 2 seconds of the toes, feet, legs, arms, and/or thighs, which often occur in stages 1 and 2 of NREM sleep and disrupt the quality of sleep. There appears to be a strong correlation between Periodic Limb Movement Disorder and ADHD based on initial research by sleep specialists. Sleep specialists and other experts in the field have not been able to determine if the Periodic Limb Movement Disorder causes some forms of ADHD, or whether they both exist simultaneously.
Many children and adults with Periodic Limb Movement Disorder display considerable amounts of oppositional behaviors and a very touchy, moody temperament due to not feeling rested when they awaken in the morning. This difficult temperament is caused by their frequent periodic limb movements in the night that prevent them from getting into their deepest levels of sleep enough hours of the night; therefore, they do not feel rested the next morning. PLMD often occurs together with Restless Legs Syndrome (RLS). Many children and adults with PLMD also resist going to sleep or have difficulty falling asleep at night. Many people who kick around often in their sleep and also snore have Obstructive Sleep Apnea Syndrome (OSAS) causing the kicking movements to open up their airways to breathe easier. So if you or your child kick and snore frequently, read about Obstructive Sleep Apnea.
PLMD is correctable or can usually be improved significantly with medication taken before bedtime that diminishes or stops the limb movements. Some sleep specialists are prescribing Neurontin, Mirapex, Clonadine, or L-Dopa before bedtime. Neurontin, Mirapex, and L-Dopa reduce or stop the periodic limb movements so that the individual gets a restful night's sleep. The Clonadine helps one fall asleep quicker so that s/he gets a longer night's sleep. However, Clonadine does not stop the leg movements during sleep, and these leg movements may prevent the person from getting enough deep sleep. Both Neurotin and Clonadine have been used successfully with children for several years, whereas L-Dopa and Mirapex use with children are newer and less is known about long-term effects on children (only adult studies have been conducted on these medications).
Many sleep specialists have reported that Neurotin appears to be the safest medication with children, although it has been known to cause some moodiness, crying, and depressive tendencies in a few children. These side effects subside with discontinuation of the Neurotin.
A brand new and more benign form of treatment is 12 weeks of iron supplement therapy in cases where the person may have a Serum Ferritin deficiency causing the Periodic Limb Movement Disorder. The serum ferritin comes from iron and helps one's body process and use the iron efficiently. If the person's body and brain are not getting enough iron processed by the serum ferritin, this can negatively effect the functioning of the frontal lobe of the brain and the central nervous system. A physician can order a simple blood sample taken to check the serum ferritin level and determine if a deficiency exists. Parents/adults must request a check of the serum ferritin level, not the iron level, because one can have a low serum ferritin level, but a normal iron level. This would be the simplest and quickest form of treatment if this is the cause of the nighttime restlessness and periodic limb movements. Based on new research in the field of sleep medicine, iron supplements prescribed by the physician for low serum ferritin seems to be effective with approximately 25% of children who have Periodic Limb Movement Disorder and ADHD. However, if a liquid iron suppliment is used, parents must make sure that the child rinses out his mouth well after taking it or it can discolor the teeth.
With treatment, the person gets a deeper, more restful night’s sleep, resulting in improvements in daytime concentration, behaviors, and work production. Furthermore, the ADHD-like characteristics often decrease, or in some cases, disappear completely. However, if the person has severe ADHD characteristics, sleep specialists are reporting that although the ADHD symptoms decrease with Neurontin, Mirapex, L-Dopa, or Clonadine, they usually do not disappear completely. Recent research by sleep specialists indicate that at least 25% of the children who have a diagnosis of ADHD may truly have Periodic Limb Movement Disorder or a combination of Periodic Limb Movement Disorder and Restless Legs Syndrome (RLS).
One sleep specialist reported that approximately 64% of children in a study with ADHD had Periodic Limb Movement Disorder and/or Restless Legs Syndrome (Picchietti et al, 1999). Other researchers report approximately 25%. Although this estimate seems extremely high, it would be prudent to consult a sleep specialist with training in this area if a student has a diagnosis of ADD or ADHD, is oppositional, and scores high on the Periodic Limb Movement Disorder scale of the Sleep Disorders Inventory for Students.
If you or your child / adolescent displays any of these symptoms of Periodic Limb Movement Disorder, click the screening button at top of page to find out if you or your child/teen have a high probability of PLMD or RLS and what you can do to correct it.
Embla offers an impressive array of sleep diagnostic systems.
Faith Medical carries a full line of diagnostic products such as snore mics and limb movement sensors.
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