Periodic Limb Movement Disorder

The first symptom most patients with PLMD or their bed partners notice is involuntary limb movements during sleep. Movements often cluster at the beginning of slumber and can include anything from extending the big toe to flexing the knee or hip. Regular intervals of 20 to 40 seconds typically occur between movements.  

To be diagnosed with PLMD, patients must demonstrate involuntary limb movement at least four times in a row during sleep and have symptoms of restless legs syndrome, such as an uncomfortable tingling in leg muscles or nearly uncontrollable urge to move the legs. 

PLMD can occur on its own or result from medical conditions such as: 

• Anemia 
• Diabetes 
• Neurodevelopmental disorders 
• Other sleep disorders, such as narcolepsy or obstructive sleep apnea 
• Spinal cord injury

To diagnose PLMD, our sleep experts will perform a physical and neurological exam. Next, we will schedule an overnight sleep study in our hotel-like sleep laboratory, where you will have a private, comfortable room.  

During the sleep study, we will monitor your movements and record your breathing patterns as you cycle through the stages of sleep. Your results will help our sleep medicine team determine whether you have PLMD or another condition that is causing your symptoms. 

Before beginning treatment for PLMD, we will address any underlying conditions first. In some patients, PLMD symptoms resolve once the underlying cause has been treated. 

Patients with PLMD who sleep through their involuntary movements may not require treatment. However, most people experience repetitive "micro-arousals" throughout the night, preventing them and their bed partner from getting adequate sleep. These patients may benefit from making small daily routine changes or taking medication. 

Some patients get relief from behavior modifications such as: 

• Eliminating caffeine and tobacco 
• Exercising regularly 
• Massaging the affected area 
• Taking pain relievers 
• Taking warm baths 
• Using heat and ice packs

If these methods do not provide sufficient relief, medication may work by helping to: 

• Increase calcium or iron levels 
• Mimic the effects of dopamine in the brain (dopamine agonists) 
• Relax the muscles 

Everyone responds to medication differently. Your doctor may recommend trying various treatments over time to pinpoint the most effective therapy for you.