This is tricky, PLMS or REM Sleep

[Spurdog1]

This could fall on the PLM or REM sleep (sleep) board.

Recent consultation with the Neurologist suggests that I could be mis-diagnosed with PLMS by my GP, Isn't it good i sought a second opinion. The neurologist reckons it may be REM sleep. I now have an appointment "some miles ahead" at a sleep clinic, Radcliffe.

I truly am grateful for their time, however this suggests one, or t'other.

So, what is the difference between these prognosis? I have heard of a one third chance of a link to Parkinson's, does this only apply to the one diagnosis? Wicked humour here, I'm now trembling with the outcome of this question. No, honestly I am not bothered (anxious) by it, but forewarned is forearmed.

Any thoughts from our experts?

[Madlegs1]

What are your symptoms?

What medications - for anything- are you on?

[Spurdog1 in reply to Madlegs1]

I'm on pram, but i can't see how that defines PLM or REM? Leg movement at night with appropriate mad dream. But whilst on medication i haven't (shhh!) had a dream for a year.

[Madlegs1 in reply to Spurdog1]

I presume you mean Pramipexol?You don't mention the dose?

Pramipexol should eliminate any symptoms of RLS. If it doesn't, then it is unlikely to be rls that you have.

Unless, of course, when you started Pramipexol, it eliminated symptoms, but after a while they returned and you increased the dose.

In that case you might be experiencing augmentation.

[Spurdog1 in reply to Madlegs1]

Yes madlegs, Pramipexole 0.088MG-according to the box (twice at night). I am referring to PLMS, you have referred RLS, which is a "daytime event". Or am i mis-reading (so confusing merging these all into one pool.

[SueJohnson in reply to Spurdog1]

RLS is a nighttime problem.

[Madlegs1]

Leg movement syndrome. ( Unconscious kicking of legs at night while asleep) is different to Restless legs syndrome (absolute need to move legs ,usually in evening when going to sleep).As far as I know, Pramipexol is not indicated for PLMS, but used to be standard med for RLS-( not now.)

Rls only becomes a day time issue when augmentation occurs.

I still don't know what your symptoms are, either now, or when all this started.

[Madlegs1 in reply to Madlegs1]

I must correct my previous reply. Prami is used for PLMD. However, Pramipexol should not be used as a first line med for either PLMD or RLS, because of the danger of augmentation.

This information has been around for at least 10 years, but has not been taken up by many med practices.

[SueJohnson in reply to Madlegs1]

Pramipexole is used to treat PLMS although benzodiazepines are usually used.

[Amrob in reply to SueJohnson]

The same medications are prescribed for RLS and PLMD.

[SueJohnson in reply to Amrob]

Correct

[Spurdog1 in reply to Madlegs1]

I understood PLMS is only in sleep mode, not daytime.

[Amrob in reply to Spurdog1]

One can have periodic limb movements of sleep and also periodic limb movement of wake, however it is far less common in the wake state.

[SueJohnson]

PLMS is very common in patients with REM behavior disorder and Parkinson's disease. But just because you have those conditions does not mean you have Parkinsons nor that you will get it. PLMS is very common.Rapid eye movement (REM) sleep behavior disorder is a sleep disorder in which you physically act out vivid, often unpleasant dreams with vocal sounds and sudden, often violent arm and leg movements during REM sleep — sometimes called dream-enacting behavior. Does this sound like what you have?

[Spurdog1]

Hi Sue. This is perhaps why the consultant is swinging to REM sleep, as there is a mad dream that I respond to. But it is only in legs. Last time my leg was a fishing rod, and it was kicking out of my bed (fortunately it was the side away from my wife. When the fish strike you lift the "rod". Hmmm

[Amrob]

I presume you're doing a sleep study at the sleep clinic? This will give you the most accurate diagnosis however in the meantime you could do an overnight video recording to see what your movements look like. Periodic limb movement are unmistakeable. "Periodic" refers to the fact that the movements are repetitive and rhythmic, and occur about every 20-40 seconds. They don't occur in every sleep phase.Most people have some degree of limb movement when asleep. From the descriptions already provided, movements arising from REM disorder appear to be distinct from Periodic Limb Movements of Sleep.

I have PLMD (PLMS and PLMW) as does my young son and another family member. I've also done 4x sleep studies so very familiar with the condition and what it looks like.

[Spurdog1 in reply to Amrob]

Very interesting Amrob. So if I read this correctly "REM has a vocal attachment". This according to Sue, which I believe I never had. I believe i haven't had augmentation, manly because I came within Pramipexole tolerances very quickly, and so averted.

[Cowbsky]

_hi, Spur,_ yes, it appears PLMS may mix up complexily with REM sleep disorder;

_ take a look at this study, on PLMS mimicking RSD; good outcomes using Pramapexol: academic.oup.com/sleep/arti...

_ by the way, I have disturbed REM stages (nightmares all nights and commonly interrupted in the middle or before ending), which I have been following closely for some 3 years, all night (using dataset from a Bilevel CPAP and the softer OSCAR, free from internet). I tried Pramipexol once (never more in no hypothesis) and Pregabalin (also, unbereable side effects). I rather prefer using 0.4 mg of Clonazepam to alliviate all things a little, with a rather life quality, in spite of my UARS and RLS (not sure on PLMS, yet it appears on polissonography?);

all the best and good luck

[Spurdog1]

Thank you Cowbsky. Good read, and good news. My primary appointment has been moved forward from August, to next week...(yes, I typed correctly)

[Cowbsky in reply to Spurdog1]

_ that's great!

good luck