Sleep related movement disorders can be a frustrating and perplexing condition. These conditions usually cause problems with sleeplessness and consequent daytime sleepiness and can take a severe toll on a person's psychosocial well being. However when accurately diagnosed and properly treated can lead to a significant and marked improvement in the quality of life. I will briefly describe these conditions below.

 

Restless Legs Syndrome (RLS) occurs in 5-15% of healthy subjects. It can cause severe emotional distress, is characterized by an irresistible urge to move the limbs and the sensations have been described variously as creepy-crawly, burning, cramps or aches. It occurs at rest, most commonly in the evenings and is relieved partially or completely by movement. It can occur independently without any obvious cause but also has been associated with various conditions including iron deficiency, vitamin deficiencies, kidney failure, pregnancy, hereditary and various medications including antidepressants and over the counter and prescription allergy medications. It should be differentiated from periodic leg movements, sleep related leg cramps, painful peripheral neuropathy and akathisia.

 

The treatment depends on the frequency and severity and usually encompasses both non pharmacological and pharmacological (i.e. medication) means. The non pharmacological approaches include measures such as the avoidance of caffeine, alcohol and tobacco. There are various classes of medications available to treat RLS and include dopamine agonists like ropinirole and pramipexole which are preferred, anticonvulsants (gabapentin and carbamazepine), benzodiazepines and opiods. Clonidine which is an antihypertensive medication has sometimes been used as well. If iron deficiency is present, it should be corrected.

 

Periodic Limb Movement Disorder (PLMD) is a related disorder that involves repetitive and stereotyped limb movements while asleep known as periodic leg movements-PLMS. This can lead to sleep fragmentation and poor sleep quality as they usually lead to arousals or awakenings. Interestingly about 80% of people with RLS also have PLMS which has also been described as commonly occurring in REM behavior disorder (RBD) and narcolepsy. Diagnosis requires a polysommnogram. They need to be differentiated from hypnic jerks, obstructive sleep apnea induced leg movements and nocturnal seizures and myoclonic epilepsy. It is associated more or less with the same risk factors as RLS such as iron and vitamin deficiencies, kidney failure and various medications including antidepressants. The treatment is also mainly along the same lines.

 

Sleep Related Leg Cramps (SRLC) occur as frequently as RLS. Also known as ¨charley horse¨, they are painful, usually affect the calf, and can be associated with pregnancy, prior vigorous exercise, electrolyte disturbances and diabetes. It may have a waxing and waning character over many years. Treatment usually involves massage, heat application or quinine sulfate.

 

Sleep Related Bruxism is characterized by grinding or clenching of the teeth during sleep and can cause tooth wear and jaw discomfort. Whereas close to ninety per cent (90%) of people will grind their teeth at some point, it will present as a clinical condition in less than ten percent (10%). It can cause disturbing sounds which can be loud and unpleasant during sleep and is sometimes brought to attention from a visit to the dentist. It is known that some antidepressants and alcohol can exacerbate this condition and severe disease may benefit from the use of a special mouth guard during sleep. Other approaches to treatment include addressing anxiety and in rare cases medications.

 

Rhythmic movement disorder (RMD) refers to a group of behaviors characterized by stereotyped movements (body rolling, head banging) and occurs most commonly in childhood. They typically occur at bedtime and are more common in males. They are usually benign.

 

In conclusion, while the sleep related movement disorders can be challenging to deal with given their manifestations and consequences, they need not be as vexing as previous and can be managed effectively in most cases.