Periodic Limb Movements in Sleep Study

My sleep study says frequent Periodic Limb Movements were noted on the baseline portion of the study. The PLM index was 68.2 with a PLM arousal index of 3.8. It then says during the titration portion of the study the PLM index was 10.2 with a PLM arousal index of 2.

When I discussed the report (without seeing it) with my primary doc, she didnt mention anything about PLM. I thought I was having leg cramps every nite and that that was what I was experiencing. There were no suggestions in the report for controlling the PLM.

I have some questions:

1. could the PLM contribute to why I had no REM sleep all night?
2. is that amount of PLM really significant or not?
3. will the PLM likely be helped by CPAP?

PLMs can be as disruptive, and more disruptive, than OSA, if they don't resolve over time.

The "significance" of PLMs in a particular patient may be related to their effect on daytime symptoms of that particular patient.

The improved sleep and health that occur from CPAP alone can sometimes appear to help resolve PLM troubles over time for some.

PLMs can be highly variable night-to-night, so comparison between the diagnostic night and the titration night may not always be meaningful.

There is still some controversy in these matters, which are not well understood medically, in my opinon.

Further reading: http://www.ncbi.nlm.nih.gov/pmc/article ... 452455.pdf

I had 77 PLM's during my study. I had zero after they strapped the alien to my face. Alien = cpap mask.

1. Yes, possible.
2. The effect of the movements is probably of more concern than the count, as in how are they affecting sleep architecture. Some people have many small movements and never wake up. Others can have a terrible time with a less number than are more pronounced movements. I experienced a residual effect of muscle and joint pain from the lower back on down.
3. Your sleep report should differentiate respiratory related movements. Those will likely be helped by CPAP. This is different from PLMD movements which will likely continue after CPAP treatment. Nothing is set in stone.

I agree with JNK that knowledge in this arena is still developing.

Thanks all for your responses. I guess I will just have to wait and see. So far (two weeks) I am alot less sleepy with CPAP. From what I have read this afternoon it sounds like SSRI's can contribute to PLM. I am on two of them. Will follow up with doc about that.

I never had them prior to my sleep test and not after. It turned out to be low B-12, which also makes you have lack of energy. Three months of shots fixed that.

In may last two sleep studies, plmd was recorded. In the first, not many but arousals were happening as a result. In the most recent, i had a lot of leg movements but no arousals were recorded due to leg movements. I've tried medication for plmd but it made the movments significantly worse (Sinemet). So back to square 1 with EDS and now stimulants to keep me going through the day.

lullaby wrote:In may last two sleep studies, plmd was recorded. In the first, not many but arousals were happening as a result. In the most recent, i had a lot of leg movements but no arousals were recorded due to leg movements. I've tried medication for plmd but it made the movments significantly worse (Sinemet). So back to square 1 with EDS and now stimulants to keep me going through the day.

What is EDS?

oak wrote:What is EDS?

Excessive daytime sleepiness

lullaby wrote:In may last two sleep studies, plmd was recorded. In the first, not many but arousals were happening as a result. In the most recent, i had a lot of leg movements but no arousals were recorded due to leg movements. I've tried medication for plmd but it made the movments significantly worse (Sinemet). So back to square 1 with EDS and now stimulants to keep me going through the day.

lullaby, did you go through any testing like iron studies? Maybe there is something lacking that could be added and help you. You should not have to resign yourself to a lifetime of poor sleep and stimulants unless all avenues have been addressed. Because of my long miserable history with this stuff, it breaks my heart to hear of people who are stuck there. Maybe there's hope and help for you yet.

Hi kteague,

I think we've chatted before

I've had all the blood tests done and they all came back normal for iron, thyroid etc. I've endured five sleep studies and mslt's in the last two years with each test pretty much contradicting the last. One test had lots of rem sleep, the next had pretty much none. As i mentioned earlier, another test had a little plmd with arousals and another had lots of plmd with no arousals. The mslt's were the same - one showed no eds, another showed a lot - almost to the point of a narcolepsy diagnosis. Another came back showing only average eds. My poor sleep doctor has called me a 'mystery' and just scratches his head. The last resort was to put me on stimulants as he thinks i just have a predisposition to eds or a chemical imbalance in my brain.

The other problem i'm facing now is more physcoligical. I'm starting to withraw from cpap treatment as i couldn't be bothered with all the mask hassle considering i'm still exhausted during the day. I know that cpap treatment is still necessary for the osa but it's just really hard at night when all i can think of is 'what's the point when i'm still going to be tired tomorrow'. I have to say though, the stimulants have helped a lot and do make me more alert and focused during the day. I'm not sure what else to do.