Severe Leg Jerking During Sleep

[Jim Humphries, B.S., D.V.M.]

My wife Jumps and Jerks during sleep.  Rather severe leg jerks occur about every 30 seconds during an episode.  Shakes the bed and wakes me up!  Occurs right after falling asleep, during middle of night, even when early morning waking drifting in and out of sleep.  I KNOW she is not getting restorative sleep.  She typically naps in the afternoons and sometimes for hours.  I'm concerned about the long term effects of sleep deprivation.  

She had a sleep study done earlier this year but she was not sure she exhibited these jerks in that study.  They did say she has "leg movement" - but not sure they saw the JERKS!  They did say she does not have apnea.  She had a "brain wave pattern consistent with a Chronic Pain Patient", but she does not have chronic pain.  

Could this be a form of RLS?  Should we do another sleep study?  Would an Ambien mask such a symptom for the study (she did not sleep much during the study).

Any other thoughts?  

Thank you Dr. Parks.  You are so helpful in this important area of medicine.  

[Steven Y Park, MD]

This is called periodic limb movement disorder (PLMD). It would be interesting to determine from the sleep study to see what percent of the limb movements resulted in arousals. Treatment is conservative for most people (certain vitamin deficiencies) to looking for various metabolic disorders, to using medications. Although she doesn't have obvious obstructive sleep apnea, it's likely that she still has sleep-breathing issues that prevent her from achieving deep sleep. They probably also saw what's called alpha-intrusion, where fast brain waves are seen intruding into slow deep sleep waves. Sometimes disrupted breathing can wake up brain waves from deep to light sleep, without leading to formal "arousal" on a sleep study. Ultimately, you should discuss your wife's condition with your sleep doctor, who can look at the big picture and make formal recommendations. Her jerks are probably severe versions of her routine limb movements. Good luck.

[Jim Humphries, B.S., D.V.M.]

You are correct, the sleep study shows Alpha Intrusion throughout the study, however she does not have any chronic pain issues.  Also her Ferritn levels have been checked good.  

She showed 161 leg movements an index of 25 per hour and no OSA.

She does NOT want to take the RLS medication due to side effects.  

Are there any other options for her?  Would an Ambien 2-3 times a week help her get some restorative sleep?

[Steven Y Park, MD]

It does sound like she has RLS. Interestingly a paper in this month's Sleep Medicine Journal published a paper that showed that even in patients with low to normal levels (15-75 ng/ml), treating with iron resulted in significant improvements. I've referenced the abstract link below. Their goal was to raise the levels to above 75.

The other way of treating this is to address her possible upper airway resistance syndrome.

http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6W6N-4VMX84H-2&_user=10&_origUdi=B6W6N-4VC150D-3&_fmt=high&_coverDate=10%2F31%2F2009&_rdoc=1&_orig=article&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=b07131e11de4234e71753b2c42a369c2

[Jim Humphries, B.S., D.V.M.]

Thank you Dr. Parks.  I'll research that.  

Her Sleep Study did specifically note NO airway obstruction.  

jim