12  EXCESSIVE MOVEMENT DURING SLEEP                  [Rev 10-25-2017]

This is one of the special conditions considered in Step B

Generally, we all change position from time to time during sleep, to get comfortable, accommodate to changes in room temperature, etc. Movement is excessive when it disrupts our sleep repeatedly.

Sometimes excessive movement is a consequence of other issues – chronic pain, infection, etc. Treatment involves recognizing the source and dealing with that.

Some people are generally agitated and restless, which can lead to disordered blankets and disruption of a partner’s sleep.

Detailed diagnostic criteria can be found in International Classification of Sleep Disorders, pp.281-299.

 

12a. Extreme Types

Three commonly mentioned forms of excessive movement are Periodic Limb Movement Disorder, Restless Leg Syndrome, and nocturnal leg cramps.

According to Reite, Weissberg and Ruddy (p.60), Restless Leg Syndrome (RLS) is not actually a sleep disorder, although many patients refer to it as such. Rather, it typically occurs when a person is awake but not moving- sitting or lying down. It may be worse at the point of lying down to sleep. It is relieved by walking or other movement. However, it can delay sleep to the point of substantial sleep loss.

Periodic Limb Movement Disorder (PLMD)is a diagnosable form of excessive movement that disrupts sleep. Symptoms include

  • The person’s leg may jerk, possibly for extended periods of time
  • He/she may kick or otherwise disturb a bed partner
  • Frequent awakenings are possible but the person also may not be aware of the
  • Bedclothes are disturbed
  • General fatigue and restlessness during the day.

Nocturnal Leg Cramps are painful contractions in the muscles of the leg or foot that occur without warning and can wake a person from sleep. Often they can be relieved by putting pressure on the painful limb by standing. Some discussion can be found in Silber (205-206) and in Hirshkowitz and Smith, (242-243). If they occur frequently, a medical consultation may be needed.

12b. Assessment

The best information comes from the patient or patient’s bedpartner. Further information can be gathered by use of an actigraph, worn through the night (Germain and Moul, 93)

Treatment

Common treatment suggestions are directed toward eliminating factors that may be making the symptoms worse, rather than attempting to eliminate them entirely. These include

  • Avoiding alcohol, tobacco and caffeine.
  • Checking medications that could be contributing to the symptoms, including SSRIs, SNRIs andantipsychotic medications (Rumble and Benca, p.135)
  • Dietary supplements
  • Physical therapy
  • Exercise
  • Relaxation before bed