Limb Movements During Wakefulness After Sleep Onset and Their Correlation with Restless Leg Syndrome

Understanding RLS and PLMS

The American Academy of Sleep Medicine characterizes RLS as a sleep-related movement disorder with an urge to move the legs (and sometimes arms) when immobile, often associated with uncomfortable sensations, symptoms that worsen during periods of rest or inactivity, relief of symptoms with movement, and symptoms that worsen or only occur in the evening or night 1, 2, 3
The American Academy of Sleep Medicine describes PLMS as brief, recurrent movements of the lower extremities, occurring approximately every 15-30 seconds, with high night-to-night variability in both adults and children, and association with electroencephalogram arousal and elevations in heart rate and blood pressure 1

The American Academy of Sleep Medicine recommends that RLS diagnosis is based on clinical criteria, not on the presence of PLMS, and a careful clinical history is imperative as there is no objective test to aid in making an RLS diagnosis 1
The American Academy of Sleep Medicine states that the diagnostic criteria for PLMD include frequent PLMS (>15 events/h in adults, >5 events/h in children), coexisting clinically significant sleep disturbance not better explained by another disorder, and absence of other sleep disorders associated with high rates of PLMS (including RLS) 1

The American Academy of Sleep Medicine recommends first-line treatments for RLS, including gabapentin enacarbil, gabapentin, or pregabalin (strong recommendations), iron supplementation for patients with appropriate iron status, and dopaminergic agents (with caution due to augmentation risk) 4, 5
The American Academy of Sleep Medicine suggests that treatment for PLMD may include similar medications as RLS but with greater reliance on levodopa compounds and sedative-hypnotics, and avoidance of medications that may worsen symptoms, such as valproic acid and triazolam 6, 7

The American Geriatrics Society notes that medications such as tricyclic antidepressants, SSRIs, lithium, and dopamine antagonists can exacerbate RLS symptoms 3