what is the difference between PLM and REM leg twitches?

[elena88]

are they one and the same?

I was watching my husband sleep, and he was dreaming (REM) and he reminded me of our dogs, as he was twitching here and there
and his legs would be doing that too..

so is that PLM, or is REM twitching a whole another thing? In REM I would see all over body twitches..


is PLM only considered associated with RLS? If you have RLS in REM, how does one differentiate between what is causing the leg movements?


I have RLS without PML, I just get a very hot burning feeling on my arms and legs, and the rest of my body, I thought it was a food allergy for the last thirty years, until my sleep doctor explained to me that was a more unusual form of RLS.

[OutaSync]

I don't know the answer to your question, but I have noticed that since I've been on xpap, I have worn through my sheets where my feet are. They are so thread bare that you can see your hand through the material-only where my feet are. The rest of the sheet still looks new. I know I don't move my feet around when I'm awake, so what is happening while I sleep?


Bev

[slaaplekker]

According to Talk about Sleep - PLMD -"The limb movements typically occur 20 to 30 seconds apart, 5 or more times an hour, on and off throughout the night during periods of non-REM sleep" so they need to be associated with Non-REM sleep. My sleep study have and index of 41 PMLD events per hour. If you have Restless Leg Syndrome you have an 80% chance of also having PLMD. Not everyone who has PLMD needs to be treated but if they movments wake you up like mine do then they need treatment. In PCP and I haven't been able to find a treatment combination that works, I'm going to a Neurologist on Thursday. Hope if find something that works soon since lack of sleep is really taking its toll.

regards
John

[-SWS]

are they one and the same?

I was watching my husband sleep, and he was dreaming (REM) and he reminded me of our dogs, as he was twitching here and there
and his legs would be doing that too..

so is that PLM, or is REM twitching a whole another thing? In REM I would see all over body twitches..

While you might assume he was in REM, he probably wasn't. REM sleep is characterized by atonia (paralyzed muscles). On the other hand, if your husband happens to experience leg movements during REM because he lacks atonia, then my understanding is that REM behavior disorder is a more likely cause than PLMD.

is PLM only considered associated with RLS?

Some people have very few or non-disruptive PLMs without the disorder called PLMD. Those leg movements are associated with and present exclusively during sleep---but never during wakefulness. They are unconscious leg movements during sleep that present with periodic or patterned characteristics.

By contrast RLS is currently considered to be associated with wakefulness but also during "bothered" sleep onset or insomnia type sleep. Unlike PLMD, the RLS leg movements present with a "creepy, crawly" urge to move the legs that the patient is usually aware of---whether during the day or amidst troubled sleep onset attempts. I have read that patients who suffer from RLS almost always present PLMs as well, whereas the reverse case is not true.

http://emedicine.medscape.com/article/291931-overview

[kteague]

SWS, question for you... What is the defining point where it is PLMD and not just PLM activity? I mean, if it fits the patterned description, is it not still PLMD just without arousals? Or do there have to be arousals seen in a study to technically qualify as PLMD?

I have been going thru a particularly bad spell again with my legs, and it's affecting my daytime functioning. I'm hobbling around like I'm ancient, hollering ow-ow-ow-ow-ow every time I get up or sit down and my legs, knees, hips and back are in constant pain, and wake me up all night till I have to get on out of bed. My alertness and memory are regressing. It's apparent to me something is going on while I'm asleep. Seems Requip is about to go the way of Sinemet and Mirapex.

[SleepingUgly]

I'm hobbling around like I'm ancient, hollering ow-ow-ow-ow-ow every time I get up or sit down and my legs, knees, hips and back are in constant pain, and wake me up all night till I have to get on out of bed. My alertness and memory are regressing. It's apparent to me something is going on while I'm asleep. Seems Requip is about to go the way of Sinemet and Mirapex.

What is the relation of pain to RLS or PLMS? I am having lots of pain lately--feet (last 3.5 years), knees, hips, back...

I thought for the D in PLMD, there has to be arousals or daytime consequence such as sleepiness, but I could be remembering this wrong.

[-SWS]

Kathy, I think diagnostic criteria can vary from one organization to another. But see PDF page 41 of 208 for PLMD diagnostic criteria in the ICSD as one often-cited example:
http://www.esst.org/adds/ICSD.pdf

SU, you remembered that very well... I had to look it up!

[-SWS]

I'll also link to the other thread showing that PLMs can, indeed, be associated with wakefulness after all:
viewtopic/t55880/Foot-jerks-when-fallin ... ml#p523615

Good information IMHO...

[kteague]

Ok SWS, I thought you were pranking me. Tried to go to pg 41 of your link and it kept skipping from pg 40 to 42. I thought you were waiting for me to say I read it then you'd say "Gotcha! There's no pg 41." Then I realized if I scrolled over that down the right side of the screen was ALL the odd numbered pages. Duh! I did see PLMD mentioned, but that section was mostly about narcolepsy. Did I still miss something? That was interesting reading. Had to make myself not read the whole thing.

[-SWS]

Sorry about that, Kathy. I think I gave confusing page instructions by referring to "PDF page 41 of 208". I probably should have said "ICSD page 67" instead. Here's an excerpt for reference from page 67 of that ICSD document:

Diagnostic Criteria: Periodic Limb Movement Disorder (780.52-4)

A. The patient has a complaint of insomnia or excessive sleepiness. The patient will occasionally be asymptomatic, and the movements are noticed by an observer.

B. Repetitive highly stereotyped limb muscle movements are present; in the leg, these movements are characterized by extension of the big toe in combination with partial flexion of the ankle, knee, and sometimes hip.

C. Polysomnographic monitoring demonstrates:
1. Repetitive episodes of muscle contraction (0.5 to 5 seconds in duration) separated by an interval of typically 20 to 40 seconds.
2. Arousal or awakenings may be associated with the movements.

D. The patient has no evidence of a medical or mental disorder that can account for the primary complaint.

E. Other sleep disorders (e.g., obstructive sleep apnea syndrome) may be present but do not account for the movements.

Note: If periodic limb movement disorder is due to a medication effect or due to drug withdrawal, state and code on Axis A as periodic limb movement disorder: medication-induced type or periodic limb movement disorder: drug withdrawal type, respectively. If associated with an underlying medical disorder, the disorder should be stated and coded on Axis C (e.g., uremia).

Minimal Criteria: A plus B

However, I would suggest reading from the very beginning of the overall PLMD section, which starts on ICSD page 65. I think the PLMD subsections about severity criteria, duration criteria, and even differential diagnosis also help to answer your question about when PLM movements are interpreted as disordered.

[kteague]

Once again, got carried away with the fascinating reading material. Yes, I found the criteria for classification and differential diagnoses. As to my movements during a period of time repeating too rapidly to officially meet the criteria, your mention of that in a thread a few months ago was the first I'd heard of that. On another note, in her last year my mother had chronic kidney failure and developed symptoms of PLMD, though she had never had symptoms prior. She got a kick out of (pun intended) her legs doing what she had watched mine do for years. Due to her communication difficulties from a stroke, she couldn't give me details, but she was very aware of her legs moving.

Thanks again, SWS, for the information.

EDIT: P.S. Just woke up again and my first thought was wondering if it was you, SWS, or NotMuffy that mentioned the timing of the limb movements before? Good grief, I want my brain back!