Monitoring leg movement while on asleep with CPAP

I am currently using cpap and my AHI and leak are within reasonable range. I have done a sleep study last week, and my doctor told me that I have high rate of leg movement and I will need to do full sleep study (with EEG), to see if I need medication for the restless legs... However, the hospital where I am insured is not going to have the machine until few months down the road. Has anyone tried to see if there is a way to monitor leg movement while asleep and using CPAP. I thought about buying night-vision camera and record my entire sleep session and count the number of movements, but I thought to ask if someone had a better idea?



newcpap

There are two syndromes, sometimes seen together, but not always. One is called 'restless legs' and it's more a matter of your legs feeling 'crawly' rather than excessively moving. PLMD is the one where your legs rhythmically 'walk' in bed over and over, so each condition has different fixes, and maybe different origins... neither are understood very well, but K. Teague knows a lot about them so you might want to PM her. PLMD is more easily seen by others, if not felt as much as RLS, and a good sleep study (in lab) would probably pick up at least one if not both of them, but if you can rig a camera or something (someone?) to watch for a time while you're asleep - without heavy bedding - that might help.

Thanks Julie for explaining that.

I'll just address the things I feel (not a professional) one can do before even testing or medicating the movements for those with PLMD. Treatments for RLS and PLMD generally overlap. The only disclaimer here is - do what you gotta do if you are in crisis mode and your need for sleep requires immediate resolution to save your health, job, or sanity. Some may get relief through medication, usually dopamine agonists, but so often we read stories of increased dosing needs, side effects and augmentation, so it makes sense to not go that route unless necessary. First, make sure your levels of nutrients thought to be involved in nerve function and muscle movement are in a healthy range. I would put magnesium, Vitamin D and B vitamins in this list. Hopefully others can add to it. Get iron studies, at least your ferritin level, drawn. What's considered a normal range for someone without limb movement issues may not be enough for those who do have problems. From what I've read and personal experience, docs these days are recommending that their patients with limb movement issues keep their ferritin level closer to 100. While increasing your ferrtin level may or may not help your movements, those with lower ferritin levels who take dopamine agonists are thought to be more prone to augmentation. Augmentation is not something you want. Take my word on that and do whatever is in your power to lower the chances of that happening. That would mean getting your ferritin level up BEFORE starting a dopamine agonist. Also, eliminate possible triggers. No caffeine later in the day. Check any meds or supplements you are taking for this being a possible side effect. Some find warm foot soaks before bedtime helpful. Sleeping with a pillow between the knees and feet can have a buffering effect, and enable you to sleep through some of the movements. Once you've done all you can to help yourself, if movements are still a problem, you may then want to get another sleep study while using your CPAP to see how destructive the remaining legs issues are to your sleep. I've had numerous lab studies, and video taped myself at home. There's a link to my home video in my signature line below. Good luck going forward.

Thanks kteague/Julie,

so, if I record myself sleeping, I should be able to see any leg movement. I thought these movement are very subtle, but after watching the video clip that kteague has put online, the movement seem pretty dramatic. I guess, I am gonna go with night-vision camera and see what happens...



newcpap

If you want to do videos, follow the link in my signature to build an IR video camera and IR source. Many laptops with built in webcams now come with the ability to do time-lapse, so additional software isn't needed. Just an inexpensive auxiliary webcam that can be converted to "night vision" by taking the IR filter out. Lot's of examples on Youtube. Here's one: https://www.youtube.com/watch?v=0247cM-UjTI They fuss about a lot with a visible light filter, but if the room is dark, it's not so critical. I used one piece of exposed film. If you don't want to build the IR source, as I pointed out in my thread, a single low wattage red light works pretty well.

Do get your Dr. to order all the blood tests (D3, B12, Ferritin, etc) that Kathy mentioned above.

I would suggest buying a ResMed S+, which monitors many parameters of your sleep with no connections to your body. While it doesn't directly measure leg movements, it does measure sleep disruptions. So, if your leg movements are disrupting your sleep, this device will measure it. This device showed I was averaging 7-10 disruptions per night (not counting actually waking up for pee breaks). I showed the graphs to my pulmonologist, along with anecdotal info from my wife that I move or jerk a lot during sleep, and he prescribed medication to hopefully reduce the disruptions. It has worked as the disruptions have been reduced to 0-3 per night over the last 4 months, and the quality of my sleep has improved. Fitbits also measure sleep disruptions, and I also have one of those, but I have found it to be unreliable compared to the S+.

Here's something I found a few yrs ago which you may not only find interesting, but possibly talk to your MD about -

viewtopic/t105483/viewtopic.php?f=1&t=5 ... ma#p544899

Not sure why your doc didn't just try a treatment first to determine what the leg movement is about. In my case, it was known I had anemia, so he put me on 325 Mg. ferrous sulfate. So long as I remember to take the pills, my restless leg movement is virtually eliminated. I say virtually, because if my legs get too hot, the need to move legs is there whether I'm taking the pills or not. However, I was AWARE I had this leg movement thing and it doesn't occur once I am asleep. Perhaps that is what determines the difference in cause?

Maybe a cheapo option is to use a motion detector with video. I think those game cameras work for that. Just a suggestion.

newcpap wrote:Thanks kteague/Julie,
so, if I record myself sleeping, I should be able to see any leg movement. I thought these movement are very subtle, but after watching the video clip that kteague has put online, the movement seem pretty dramatic. I guess, I am gonna go with night-vision camera and see what happens...newcpap

The movements in my video are NOT classic PLMD. This was during a period of augmentation - see why I said to try to avoid it? PLMD movements can be as mild as a repeated flexion of the big toe, to involving the foot, to involving the leg and more. As Julie mentioned, a bicycling motion is sometimes described. You can record yourself, and get an idea. There are some pretty specific parameters for classifying leg movements, and you won't have the diagnostic info a sleep study has. But movements from PLMD have a pretty distinctive appearance - rhythmic and stereotypical - so you can get a good idea.