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How important is periodic leg movement index and does it get better with time?
#1
I have been on APAP 2 months now and my fatigue/ tiredness is improving, but slowly.

My recent titration study had AHI at 0.8 but periodic leg movement index of 50, causing 3.6 arousals per hour. Sleep efficiency was 78% but only ~10% each for REM and deep sleep. Total arousal index was 8.4.

Does the PLMI sound significant? Does it improve with ongoing CPAP? None of this came up during the consultation, so I'm guessing it doesn't matter much?
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#2
Hi Carbon. I have a forum member for about a month and a CPAP user for only a little longer. so I imagine some more experienced people will come along to answer your questions.

Your post caught my eye because I had periodic limb movements for several years and took clonazepam for them (I know, a benzo, but I tried a couple of anti-Parkinson's drugs and they didn't help).

Yes, the limb movements ARE very important. They disturb your sleep greatly. Some sleep doctors will prescribe either clonazepam or an anti-Parkinson's medication for them. I have seen posts here on this board where people have been prescribed medication for their limb movements after it showed up in their sleep study, so you might want to ask your doctor about that.

When I was having limb movement problems, they seemed to get better or worse depending on two particular factors that I noticed. One was anemia. The other was use of antidepressants. The SSRI or any type of antidepressant that "affects serotonin" strongly would make my limb movements get worse.

I have also seen low vitamin D levels suggested as a cause of limb movements, but I don't know how valid that is.

I am still pretty new to seeing a sleep doctor, but even though the doctor I see has good qualifications, his patient interaction is different from what I'm used to. There's an element of just ignoring anything that's not in a very narrow box.

If your doctor is like that, you may have to be assertive in asking whether the limb movement needs to be treated with medication.

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#3
If the movement is linked to apnea events, then yes, use of the CPAP machine should decrease them. It certainly did mine. I do still have them but they are no where as violent nor as frequent.

PLMD is characterized by sudden, violent, non-voluntary twitching of the legs or arms during sleep. It is considered a sleep disorder.

Restless Leg Syndrome (RLS) is the urge to move ones legs by walking or moving them. It is voluntary movement (meaning we control it) and can happen at any time during the day. However, it loves to happen right as we lay down to sleep and continue for a short while into sleep.

A person can have one and not the other. Or they can have both. I have both.

There are medications to treat RLS but I would hesitate (myself) to take medication for PLMD unless it was severely disturbing my sleep more. I treat my RLS mostly through diet (I increase my potassium intake). If I am told I was twitching a lot in my sleep (I once kicked my 85lb Rottweiler up and over the foot board of the bed), I study the data for my CPAP machine and decrease my caffeine and stress levels.
PaulaO2
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#4
Thanks for the replies green wings and Paula02. I am not aware of the leg movements myself, but I guess they could be slowing my recovery with CPAP. I don't know if they are related to apnoea, but probably not as the AHI was so low for the study - 0.8 vs PLMI 50 with 3.6 arousals/ hour.

I have a review in three months - if I'm still tired then, I guess it'll be something to consider.
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#5
Carbon, if you aren't aware of the limb movement, I can see why your doctor didn't prescribe medication right away.

When I started taking medication for mine, it involved both lower and upper body movement and was so severe that I could not fall asleep and stay asleep.

LOL, Paula, at booting the Rottweiller. I was camping about ten years ago, was lying on my side, had a big movement spasm and kneed my boyfriend in the groin. He was surprisingly nice about it, although he did turn his back on me for the rest of the night.

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#6
I just looked at my titration study and found a PLM index of 61.9, with a 9.7/hour index of arousals. Not to mention spontaneous arousals, but that's another matter.

My doctor never mentioned the PLMs to me, or suggested medication. I knew nothing about them until looking at the study just now.

I've also seen the research linking this to vitamin D deficiency. Since I've been taking large D doses, my blood level is now up to about 47, which isn't deficient, but Dr. Gominak (see on YouTube) says it takes levels between 60-80 to ameliorate these sleep disturbances, so I'm not there yet.
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#7
I guess see how you go tmoody. Periodic leg movement is usually only symptomatic in association with (awake) Restless Leg Syndrome.
I don't have awake/ restless leg syndrome but pure periodic leg movement (ie only when asleep). It is apparently fairly common but is apparently almost always asymptomatic.

I was started on Sifrol a week ago after 3 months excellent CPAP and only ~50-60% improvement in fatigue. I was able to show my sleep physician that I was still having PLM for 3-5 hours a night on a night-vision camera on my legs. These for me are very regular consistent movements every 40 seconds of which I or my wife have no awareness, even though at worst they can involve hip, knee and ankle. I had also done the usual conservative treatment measures (stretches, magnesium load, Vit D load, no exercise <3hours before bed) to no benefit.

The Sifrol appears to have completely stopped this PLM as long as I take it >90 min before bed. In the week, my fatigue seems to be further improving to back to maybe 80-90% of where I was a year ago, so fingers crossed. My theory was that my PLM was causing microarousals, and indeed my sleep study did show a microarousal index of about 4 not related to respiratory events.

I still have some frequent but more erratic leg movements in the last half of sleep which I can be aware of at times, but given its erratic rather than regular/ metronomic PLM, I am presuming this is normal light sleep movements. I probably need to get a more comfortable mattress.
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#8
Carbon,

Wow, it sounds like you really put some effort into eliminating the PLM by non-drug methods and also into documenting that you were having it. Cool. Smile

I'm very glad to hear that the Sifrol medication is working for you. Severe PLM disturbs sleep hugely. I will be interested to hear if your perceived improvement in fatigue continues.

I have been using CPAP therapy for around three months now, but my fatigue levels are usually still pretty bad. I have only had 3 mornings where I felt really rested (but wow, that felt terrific!)

I used to have limb movements anytime I lay down and relaxed. I don't anymore, and I have been assuming that they went away, but your post has made me realize that I don't know that for sure. I might only be having them while asleep now.

I had only a couple of movement events recorded in my sleep study in December, but there was no REM or deep sleep recorded either, so I'm not sure that means I'm not having them anymore.

I am still taking clonazepam but have been on a slow taper-down of the dose for around a year now. I took it for 10+ years, so I am very physically dependent on it and am having to taper the dose very slowly to avoid horrible withdrawal symptoms. (I have been appalled but not really all that surprised at how awful I feel if I don't keep the dose reductions very tiny.)

Thanks for your post. Very helpful and informative.






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#9
My wife, who is a light enough sleeper that she usually notices if there's anything unusual about my breathing, such as the sound of a mask leak, says she has never noticed me having any leg movements during sleep, ever. And yet my sleep study showed a fairly large number. Possibly they're small twitches and not noticeable, but in that case it's puzzling how some of them would lead to arousals.
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#10
tmoody,

I'm surprised, too, that your wife hasn't noticed if you're having a lot of limb movement during sleep. You could probably ask your sleep doctor about how large the movments during your study were.
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