Physical exercise may ease nocturnal leg movement

[ozij]

Reuters Health

Tuesday, January 13, 2009


NEW YORK (Reuters Health) - Exercise may improve sleep patterns in people with insomnia or sleep disruptions related to periodic leg movements, according to study findings reported by Brazilian researchers.

Dr. Marco Tulio de Mello and colleagues at Federal University of Sao Paulo-UNIFESP assessed the effects of acute intensive exercise on sleep patterns in 22 volunteers with periodic leg movements, which are often associated with restless legs syndrome. Eleven subjects continued with 72 physical training sessions for roughly the next 6 months.

Reductions in periodic leg movements were observed after both intensive and regular physical exercise. Intensive exercise increased sleep efficiency (actual time asleep) and rapid eye movement (REM) sleep, and reduced wake time after sleep onset. Chronic physical exercise increased sleep efficiency and REM sleep and reduced sleep latency (time to takes to fall asleep). The release of beta-endorphins, opioid compounds that provide a feeling of well-being, after acute intensive exercise corresponded with reduced periodic leg movements levels.

The improvements were particularly pronounced in the patients with milder periodic leg movements, the authors in their report, published in the January issue of Medicine & Science in Sports & Medicine.

In a statement from the American College of Sports Medicine, the journal publisher, lead author Dr. Andrea Maculano Esteves comments, "The ability of have restful and uninterrupted sleep is often taken for granted, but not usually by people with periodic leg movements or restless leg syndrome."

"Exercise restores that ability, and quickly, too, as we see in the improvements in the acute exercise sessions. An added benefit here is that exercise is an alternative to a pharmacologic treatment, in terms of both outcome and cost."

Med Sci Sports Exerc 2009;41:237-242.

http://www.acsm-msse.org/pt/re/msse/abs ... 28!8091!-1

Kathy (Kteague) I know yours is a bad case - but maybe it will still help?
O.

[jnk]

Thank you for posting that, ozij.

I have developed some PLMs now that I'm on PAP therapy, according to my wife. They always seemed to occur after days that I had taken Benadryl, so I had attributed them to that. Now that I think about it, though, the days that I've taken Benadryl have coincided with days I've felt bad enough to skip exercise. Hmmm. Very interesting!

[SaltLakeJan]

I was interested in your post because I have RLS, and have taken 3 mg Mirapex for years. It has worked & enhances my sleep, but I read a short blurb in a woman's magazine about exercise and Periodic Leg Movement. Is there a difference between PLM & RLS? I haven't exercised since before Christmas, & decided to go to the Gym, work on treadmill and follow that with specific leg stretches. Also to cut Mirapex down to 1 1/2 mg. It is too early to know if it is going to help me. I have 19 PLM's on my sleep study. I read that as 19 per hour. Considering how I feel when I am trying to go to sleep, it seems like 190 per hour. Is 19 per hour, mild, moderate, or what? I am exercising 3 times a week, and have completed my first week. I will post again after I complete a month. j

[SaltLakeJan]

I made a mistake when commenting on Ojiz's post regarding nocturnal leg movements. I was taking 300 mg. of Mirapex for my RSL Syndrome. With the medications I take for Fibromyalgia and Diabetes, I am anxious to eliminate any prescription I can, both for cost and possible side effects. I hope exercise will make it possible for me to stay on the reduced 150mg and be able to go to sleep. J.

[kteague]

About the Benadryl - I was told by one doctor that it can make RLS worse.

RLS movements are random and are a response to a sensation. PLMD movements are rythmic and are involuntary. A person can have either or both. I have both.

Mirapex was effective for me for a while. Increasing the dose brought on lots of side effects, like compulsive behaviors and exaggerated limb movements that intruded into semi-sleep time. Dropping the dose back down relieved those symptoms, but the reduced dose was not effective for very long. The thing I found out the hard way was that the instructions to not go off them abruptly is serious business. I made that mistake a few years ago, and to this day have a neurological glitch because of it. I tried going back on the Mirapex then weaning off in stages while ramping up with Requip, but it didn't fix the glitch. It took several months for the Requip to begin having a degree of success with my RLS and PLMD.

During the transition of the meds I was going to water exercise about 3 times a weeks. I guess that wouldn't qualify as intensive exercise, but it's all I can do with my bad back and knees. I hope to resume soon. This information on exercise is a motivator for sure. I don't expect my limb movement issues to go away entirely, but any degree of relief that could result in a lower med dose would be well worth the effort.

Kathy

[SaltLakeJan]

Compulsive behaviors also began slipping their way into my life. They made up a triad of symptoms & cost that motivated me to reduce the dose. I looked up Mirapex on the Internet, I missed the part about not going off abruptly. I'll have to see if I can contact my dr Monday. I really don't want any more complications in my life, and I am glad you included that information in your post. I'm also wondering what my diagnosis is, or should be. All 3 of my sleep studies list PLM's. My internist called it RLS, perhaps because RLS is so common in Fibromyalgia patients. J

[kteague]

SalLakeJan,

Even within the medical community it seems there's an inconsistency in referencing limb movments. I've talked to a few techs about it and got different answers. I think one can have PLMs during a study but not necessarily have Periodic Limb Movement Disorder. One tech said to him periodic limb movements in a study meant they happened multiple times (with periodically meaning occasionally). An article I read said that in PLMD the word periodic means the timing pattern occurs at regular intervals, or at rythmic periods of time. If you were to videotape yourself you could see if they are very patterned.

Sometimes cpap use helps when PLMs are seen in a study. If a person actually has PLMD, there's a chance it will worsen after starting cpap. When that happens, cpap can be unfairly blamed for feeling worse, as the severity of the PLMD was likely not exhibited during the time in the sleep lab. Kinda have to wait and see how things pan out, but optimizing ones cpap treatment is the best way to get a real picture of their PLMD.

While a high dose of Mirapex caused my PLMD movments to be out of the expected picture, generally PLMD is said to occur only when asleep, while RLS is mostly when awake but can also be when asleep.

I usually don't say a lot about my "neurological glitch" because it sounds like I must have lost my mind, but my neurologist said the symptoms are because I stopped the med abruptly. I think it's a form of synesthesia, where the senses get crossed up. When I see anyone (even on TV) at impact - like falling, wrecking a car, getting hit - I feel pain. More specifically, at their precise moment of impact, I feel like I've been kicked in the crotch. It has altered what I watch on TV and movies, but worse, affects me watching the grandkids at play. I'm constantly on guard so I can close my eyes or turn my head. It's odd because I can know they fell and hear them fall, but as long as I visually miss the moment of impact I'm fine. I pay a lot more attention these days to the instructions for any meds I'm given.

By the way, has your ferritin level been checked? That's usually the first step after a diagnosis of RLS. Let us know how things go for you with the exercise and reducing your med dose.

Kathy

[SaltLakeJan]

to kteague: Reading the details of your Neurological Glitch from the abrupt stop of Mirapex made me apprehensive about my abrupt reduction. I'm sorry you have such major problems in addition to sleep apnea. My Dr. said I should have reduced in increments, instead of reducing it by half. So far, I am alright. I do a low intensity treadmill for 20 minutes, which increases my pulse, but you couldn't call it aerobic, that helps. I feel that the leg stretches are the biggest help.. But, from what I read PLM's and or RSL is going to be a constant for life. In checking RSL pages in the internet, caffeine & alcohol can increase the symptoms. I have semi quit my favorite noontime pick-up---Pepsi.

The U. of Michigan, Adult Health Advisor 2005.4 paragraph "How can I take care of myself" includes some suggestions I hadn't heard before: Wear long socks to bed. Hot bath before bedtime. Use hot water bottle or cold compresses on painful area before going to sleep.

Restless Legs Syndrome Foundation pid=543, paragraph 17 quoted a small study in 2006, that a combination of moderate aerobic exercise and low-body resistance training 3 days a week reduced symptom severity by about 50%. It took about 6 week to see maximum benefit. Strenuous exercise may worsen RSL symptoms.

I found some relief a few nights ago, asa I went to bed, that familiar sensation hit my lower leg,and movement began. I decided to try to interrupt the process before it high high gear. I rubbed Ben Gay into my entire leg area, massaging it in for 10 minutes. Then wrapped a towel around my lower leg and tied a heating pad, at low temperature, over the towel. Left it on 'bout an hour. For that night, the combination stopped RSL in its tracks.

Since I cut the toes out of my long warm sox for a hose cover - I can't try that suggestion. But I am open to any & all ideas.
I did discover I am anemic, that's a common co-conspirator in PLM & RLS. Your experience has made me very hesistant about reducing the Mirapex below 150 mag at the present time. I'll post again, in about a month.

Good luck with all you symptoms. Jan

[Mrs. Tatis]

I made a mistake when commenting on Ojiz's post regarding nocturnal leg movements. I was taking 300 mg. of Mirapex for my RSL Syndrome. With the medications I take for Fibromyalgia and Diabetes, I am anxious to eliminate any prescription I can, both for cost and possible side effects. I hope exercise will make it possible for me to stay on the reduced 150mg and be able to go to sleep. J.

I thought I would mention that you need to ween yourself off of Mirapex or Requip. There are bad side effects including death if you just stop taking it. Probably nothing would happen, but there is a risk. The doctor can lower your dose to ween you off. Natural ways of resolving leg movements or RLS are- Iron, Magnesium, Calcuim and Potassium.