Have you been diagnosed with RLS or PLMs?

By Clinton Marquardt - Sleep & Fatigue Specialist

March 19, 2015

PLMs, RLS

Here’s a great set of Restless Legs Syndrome (RLS) and Periodic Limb Movement (PLM) Disorder treatment strategies that I developed and used with my clients when I was a Sleep Coach.

Work with a medical doctor who is a Diplomate of the American Board of Sleep Medicine to implement the following strategies.  Add the strategies sequentially one by one, working from #1 onward because they get more “aggressive” near the end.  Test each one for at least two weeks.  If there is significant improvement after adding a strategy, stop there for now.  If not, add the next strategy.

After running through all the strategies, you may find one strategy, or a combination that works best for you, by removing one strategy at a time, testing for at least two weeks, then adding it back in.  Test all the combinations possible and record your tests and progress in a sleep diary.

  1. Have a sleep study performed to document the severity.
  2. If you have been diagnosed with PLMs and not RLS, then request a trial of Continuous Positive Airway Pressure (CPAP).  There is a very strong link between PLMs and respiratory disturbances. In essence, the PLM’s are a component of the arousals caused by the respiratory disturbances. In most cases, CPAP stops the PLMs by stopping the arousals caused by even minor respiratory disturbances.
  3. See a Sleep Coach to set up a proper sleep pattern, make sure they use behavioural techniques such as sleep hygiene, stimulus control and sleep restriction therapy. Adhere strictly to the recommended sleep / wake pattern.
  4. Explore the role of such things as menopause, medication, anxiety, and depression on your sleep and the influence of uremia, diabetes, tricyclic and SSRI antidepressants, lithium, dopamine antagonists, and caffeine on your PLMs or RLS.
  5. Increase leg exercise by standing more during the day, this may mean changing office furniture.  Stretching and isometric exercises in the morning and before bed at night may also help.
  6. The Sleep Coach can help you set up a bed time ritual to make it easier to fall asleep.  Include a long and very hot bath in your bedtime ritual.
  7. Try bright light therapy to combat the daytime sleepiness.
  8. Add in one or two days per week where you allow yourself to sleep in a little later. Alternatively, try a 20 minute or 1.5 hour nap at the same time on two days per week.  Make sure there are a couple of days in between each sleep-in or nap day. On the night following the sleep-in or nap you must stay up a little later than usual and wait until you feel sleepy before going to bed.
  9. Try going to bed later and getting up later.  This may get you better sleep outside the circadian rhythm of the RLS and PLMs.
  10. Explore magnetic therapy, acupuncture and alternatives.
  11. Increase iron intake, especially if your ferritin levels are below 50 mg/dL.  According to the April 1999 Restless Legs Syndrome Foundation Medical Bulletin, oral administration of 325 mg ferrous sulfate (65 mg of elemental iron) taken one to three times a day can bring the ferritin level up to a desired normal level of 60 mg/dL.  The normal range for ferritin level is 18-300mg/dL. Use this medication under the guidance of your medical doctor only as there is a risk of iron-overloading. Do not combine this medication with any others unless your medical doctor recommends it.
  12. Increasing your intake of calcium, magnesium, vitamin B-12, folate, and potassium may also be beneficial.  Increase one of these at a time and only under the guidance of your medical doctor.  Do not combine these medications with any others unless your medical doctor recommends it.
  13. Using a benzodiazepine medication such as clonazepam (Rivotril, Klonopin), nitrazepam (Mogadon), temazepam (Restoril) every now and then will help you get a night of restorative sleep.  You may need to alternate these medications and increase dosages to avoid tolerance.  Use these medications under the guidance of your medical doctor only and do not combine these medications with any others unless your medical doctor recommends it. Never combine these medications with alcohol.
  14. Regular use of a dopaminergic agent such as carbidopa/levodopa (Sinemet or the sustained release version Sinemet CR), pergolide (Permax), pramipexole (Miraprex), bromocriptine mesylate (Parlodel), ropinirole (Requip).  Use these medications under the guidance of your medical doctor only and do not combine these medications with any others unless your medical doctor recommends it. Never combine these medications with alcohol.
  15. Regular use of an anticonvulsant medication such as gabapentine (Neurontin). Use this medication under the guidance of your medical doctor only and do not combine this medication with any others unless your medical doctor recommends it.  Never combine this medication with alcohol.
  16. Irregular use of an opioid medication such as codeine, propoxyphene (Darvon, Darvocet), oxycodone (Percocet, Tylox, Roxiprin) or pentazocine (Talwin), hydrocodone (Vicodin), and methadone (Dolophine).  Use these medications under the guidance of your medical doctor only and do not combine these medications with any others unless your medical doctor recommends it. Never combine these medications with alcohol.

 

Footnote:

For more info on RLS, check the RLS Foundation Web site:  www.RLS.org.

 


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