6 year old with PLMD- seeking MD feedback

[seeking32604]

Recently my 6yo daughter had a sleep study and was diagnosed with PLMD with an avg of 20 movements an hour.  She is displaying a lot of daytime sleepiness and byt the end of the school year was having some difficulties in class and at home.  I have previously considered having her evaluated for some behavior issues but, in light of this diagnosis, I want to make sure she is well rested before I go down that road at all.  I think children who are not well rested get mislabeled as having behavior issues when all they need is better/more sleep.  All that being said, I was wondering if I should seek a ped. neuro second opinion.  The sleep doc suggested medicating with Mirapex but I want to avoid medication or at least exhaust all other options/possible causes first.  Thanks, in advance, for any input.

[Paderla Anitha, DNB]

Hello and hope you are doing well.

If a diagnosis of PLMD has been made, then medications may be needed to control her symptoms.

Also anxiety or stress is known to aggravate symptoms and promote lack of sleep. Have an open discussion with your child and help her with any issues that might be troubling her. Many times parents tend to get stressed that the child is not sleeping well and communicate this anxiety to the child which forms a vicious cycle, so relax and let bedtime be a pleasant experience then a  task which needs to be completed, tell her good relaxing stories or let her read good books prior to sleeping.  Do not give her caffeine rich drinks before bedtime. Ensure to see she plays adequately during the day, as good exercise promotes good sleep. Always make the bedroom environment very cool, dark and cozy like a cave, cause bats are super snoozers and they sleep in caves.

Hope this helped and do keep us posted.

[seeking32604]

Thank you for that info.  I hadn't thought about the epsom salt baths.  I do those periodically  myself .  She love to soak in the bath every night so that will be an easy addition.  I will try that and the melatonin also.  I know she desparately needs the sleep and I am hoping to figure out the best method over our summer break before heading back to school.  As the year went on, it was obvious she was struggling more and more.  We did check her ferratin levels which were 45.  I'm going to switch her to a multi that has iron also but, from what my her doc told me, that really isn't exceptionally low.   Thanks, again, for the great info.  

[DokterJ]

You have done a very good job identifying the problem.  I can understand your reluctance to use medication until you have tried alternatives.  

Magnesium can be one very helpful treatment for PLMS.  The easiest way to find out if it will help your daughter is to have her take an epsom salt (magnesium salt) bath before bedtime.  If you do this, use at least 4 cups.  You can also use oral magnesium supplements.  If you do, use the forms that are the most absorbable and are the least likely to cause stomach problems.  Avoid magnesium oxide or magnesium citrate.  I usually recommend magnesium glycinate, but you can also use "chelated" magnesium.  Start with the lowest dose possible, but you can increase as high as 400 to 500 if she isn't having problems.

Melatonin can also be very helpful.  Usually start with .333mg dose but you can increase it as high as 3mg if it is effective.

If you haven't already done this, have her iron levels checked.  Low iron is a common cause of RLS and PLMS.  

If none of these work, I do recommend using prescription medications.  As you already know, it is critical for her to get good quality sleep.  It is much better for her to get good quality sleep with medications than to continue getting chronically poor quality sleep.  

The dopaminergic medications such as the one your doctor recommended, are usually the most effective.  If she can't tolerate this (can cause excessive sedation or stomach problems) I would consider trying clonazepam next.  

Good luck.