Home / Sleep-Related Movement Disorders / Periodic Limb Movements Disorder

Periodic Limb Movements Disorder

What it is, what it feels like, its possible causes, and how it’s addressed

Written by

Logan Foley

author

Medically Reviewed by

Dr. Anis Rehman

author
Fact Checked

Periodic limb movement disorder (PLMD) is a rare sleep disorder characterized by periodic, repetitive movements of the legs and feet during sleep. In some cases, the disorder also affects the arms. If you have PLMD or sleep with someone who has PLMD, you may recognize these movements as brief muscle twitches, jerking movements, or an upward flexing of the feet. PLMD can disrupt sleep and co-occur with other sleep disorders, including restless legs syndrome and narcolepsy.

What Is PLMD?

Periodic limb movement disorder, referred to as PLMD, is a sleep disorder that affects approximately 4% to 11% of the population. People with PLMD experience repetitive jerking, cramping, or twitching of their lower limbs during sleep. These are known as periodic limb movements (PLMS) and happen every 5 to 90 seconds for up to an hour. The movements disrupt the person’s sleep — even if they don’t wake up — and cause daytime sleepiness and fatigue as a result.

Because the movements occur during sleep, the affected individual may not realize they have a sleep disorder. They’ll notice symptoms like waking up during the night for no apparent reason or feeling excessively tired during the day. As a result, they may believe they have insomnia. It is more common for a sleep partner to notice the movements and mention them to the affected individual.

PLMD can occur at any age, although it is quite rare among children. Comorbid sleep apnea or a neuropsychiatric disorder increase a child’s risk, as can having a parent with RLS. The risk for PLMD increases significantly with age, and as many as 45% of older adults exhibit symptoms. PLMD affects men and women equally.

What Causes PLMD?

PLMD can be a primary or secondary disorder, meaning that it either appears on its own (primary) or is caused by another medical condition (secondary). In the case of primary PLMD, scientists still do not know what causes the condition. Two potential causes are dopamine deficiency or miscommunication between nerves along the spinal cord.

In cases of secondary PLMD, the condition may be attributed to:

  • Diabetes
  • Iron deficiency
  • Caffeine use
  • Spinal cord injury or tumor
  • Uremia
  • Anemia
  • Other sleep disorders such as restless leg syndrome (RLS), narcolepsy, REM sleep behavior disorder, or sleep apnea
  • Neurodevelopmental disorders like attention deficit hyperactivity disorder (ADHD) or Willam’s syndrome
  • Side effect of certain medications, including tricyclic antidepressants, neuroleptics, anti-nausea drugs, and lithium
  • Withdrawal from sedative medications, including barbiturates and benzodiazepines

While PLMD can co-occur with other sleep disorders, it most frequently occurs with RLS. Between 80 to 90 percent of people with RLS also have PLMD.

PLMD is often confused with RLS because both conditions involve symptoms affecting the legs, but they’re not the same, and they are diagnosed and treated differently. The symptoms of RLS occur while the person is still awake, while PLMS occurs during sleep. The physical sensations are also different. With RLS, the person experiences uncomfortable tingling or crawling sensations in the legs, accompanied by an uncontrollable urge to move them in order to feel relief. With PLMD, the legs repeatedly jerk or twitch, often unbeknownst to the sufferer.

    What Are the Symptoms of PLMD?

    The main symptoms of periodic limb movement disorder include poor sleep, daytime sleepiness, frequent awakenings, and rhythmic movements involving one or both legs during sleep. To be characterized as PLMS, the movements must:

    • Involve one or both limbs, with a tightening, bending, or flexing of the knee, ankle, or big toe
    • Occur in light non-REM sleep, typically during the first half of the night
    • Last two seconds at a time, and repeat every 5 to 90 seconds at least 15 times per hour

    The leg movements of PLMD can vary in nature from night to night, ranging from mild to severe. They may also occasionally involve the hips and upper arms. What makes the movements distinct is their repetitive nature and the occurrence during sleep.

    How Is PLMD Diagnosed?

    People may live with PLMD undiagnosed for some time. They may not even notice an impact on their sleep quality. It’s actually more common for their sleep partner to experience disrupted sleep due to the movements. People typically seek treatment after their sleep partner notices the symptoms or once the other symptoms — such as daytime sleepiness or fatigue — begin to interfere with their daily functioning and wellbeing.

    If you think you or your sleep partner may have PLMD, talk to your doctor. At your appointment, they will ask questions to better understand your sleep issues and determine if they may be caused by an underlying issue like an iron deficiency or diabetes. They may review your personal and family medical history, any medications you take, and your current sleep and lifestyle habits. Your doctor may collect a urine or blood sample, or order additional tests, to rule out another condition.

    If your sleep partner describes your leg movements and your doctor suspects PLMD or a sleep disorder, they may refer you to a sleep specialist. A sleep specialist may order an overnight sleep study, known as a polysomnogram. While you sleep, your breathing will be monitored (to rule out sleep apnea), as will your leg movements and other vitals. If the leg movements occur at least 15 times per hour you may receive a diagnosis of PLMD.

    What Are the Treatments for PLMD?

    Cases of secondary PLMD may go away if you address the underlying issue. There is no cure for primary PLMD, but treatment can significantly relieve symptoms and help improve sleep. Treatment for periodic limb movement disorder may include a mix of lifestyle changes and medication, depending on the severity of symptoms.

    Lifestyle Changes

    Cases of mild to moderate PLMD may be treated with lifestyle changes to improve sleep, such as incorporating more iron into your diet. Your doctor may recommend reducing or eliminating your caffeine or alcohol intake. They may also recommend stress management techniques likes deep breathing exercises, meditation, or yoga. Better sleep habits, such as sticking to regular bed and wake times and following a bedtime routine, can also help.

    Medication

    In cases of severe PLMD, doctors may prescribe medication to either reduce the PLMS or help the person sleep through it. These include many of the same medications prescribed for RLS, including benzodiazepines, melatonin, dopaminergic agents, gabapentin, and GABA agonists. Clonazepam, in particular, has been proven to reduce the total number of leg movements a person experiences per hour.

    With proper treatment, the symptoms of periodic limb movement disorder are manageable. If you’re having trouble sleeping, consult your doctor.

    • Was this article helpful?
    • YesNo

    About Our Editorial Team

    author
    Logan Foley

    Certified Sleep Coach

    Logan has extensive experience testing sleep products and producing sleep content. She is also a Certified Sleep Science Coach.

    author
    Dr. Anis Rehman

    Endocrinologist

    MD

    Dr. Rehman, M.D., is a board-certified physician in Internal Medicine as well as Endocrinology, Diabetes, and Metabolism.

    About Our Editorial Team

    author
    Logan Foley

    Certified Sleep Coach

    Logan has extensive experience testing sleep products and producing sleep content. She is also a Certified Sleep Science Coach.

    author
    Dr. Anis Rehman

    Endocrinologist

    MD

    Dr. Rehman, M.D., is a board-certified physician in Internal Medicine as well as Endocrinology, Diabetes, and Metabolism.

    • References

      +15 Sources
      1. 1. American Academy of Sleep Medicine. (2014). The International Classification of Sleep Disorders – Third Edition (ICSD-3). Darien, IL. https://aasm.org/
      2. 2. Joseph V, Nagalli S. Periodic Limb Movement Disorder. [Updated 2020 Jul 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560727/
      3. 3. Ferri, R., Gschliesser, V., Frauscher, B., Poewe, W., & Högl, B. (2009). Periodic leg movements during sleep and periodic limb movement disorder in patients presenting with unexplained insomnia. Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology, 120(2), 257–263.https://doi.org/10.1016/j.clinph.2008.11.006
      4. 4. Hornyak, M., Feige, B., Riemann, D., & Voderholzer, U. (2006). Periodic leg movements in sleep and periodic limb movement disorder: prevalence, clinical significance and treatment. Sleep medicine reviews, 10(3), 169–177. https://doi.org/10.1016/j.smrv.2005.12.003
      5. 5. Picchietti, D. L., Rajendran, R. R., Wilson, M. P., & Picchietti, M. A. (2009). Pediatric restless legs syndrome and periodic limb movement disorder: parent-child pairs. Sleep medicine, 10(8), 925–931.https://doi.org/10.1016/j.sleep.2008.10.006
      6. 6. Bliwise D. L. (2006). Periodic Leg Movements in Sleep and Restless Legs Syndrome: Considerations in Geriatrics. Sleep medicine clinics, 1(2), 263–271. https://doi.org/10.1016/j.jsmc.2006.04.005
      7. 7. Eisensehr, I., Ehrenberg, B. L., & Noachtar, S. (2003). Different sleep characteristics in restless legs syndrome and periodic limb movement disorder. Sleep medicine, 4(2), 147–152.https://doi.org/10.1016/s1389-9457(03)00004-2
      8. 8. Lesage, S., & Hening, W. A. (2004). The restless legs syndrome and periodic limb movement disorder: a review of management. Seminars in neurology, 24(3), 249–259. https://doi.org/10.1055/s-2004-835066
      9. 9. Ferri, R., Fulda, S., Manconi, M., Högl, B., Ehrmann, L., Ferini-Strambi, L., & Zucconi, M. (2013). Night-to-night variability of periodic leg movements during sleep in restless legs syndrome and periodic limb movement disorder: comparison between the periodicity index and the PLMS index. Sleep medicine, 14(3), 293–296.https://doi.org/10.1016/j.sleep.2012.08.014
      10. 10. Hornyak, M., Riemann, D., & Voderholzer, U. (2004). Do periodic leg movements influence patients' perception of sleep quality?. Sleep medicine, 5(6), 597–600. https://doi.org/10.1016/j.sleep.2004.07.008
      11. 11. Gurbani, N., Dye, T. J., Dougherty, K., Jain, S., Horn, P. S., & Simakajornboon, N. (2019). Improvement of Parasomnias After Treatment of Restless Leg Syndrome/ Periodic Limb Movement Disorder in Children. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 15(5), 743–748.https://doi.org/10.5664/jcsm.7766
      12. 12. Littner, M. R., Kushida, C., Anderson, W. M., Bailey, D., Berry, R. B., Hirshkowitz, M., Kapen, S., Kramer, M., Lee-Chiong, T., Li, K. K., Loube, D. L., Morgenthaler, T., Wise, M., & Standards of Practice Committee of the American Academy of Sleep Medicine (2004). Practice parameters for the dopaminergic treatment of restless legs syndrome and periodic limb movement disorder. Sleep, 27(3), 557–559.https://doi.org/10.1093/sleep/27.3.557
      13. 13. Kume A. (2014). Gabapentin enacarbil for the treatment of moderate to severe primary restless legs syndrome (Willis-Ekbom disease): 600 or 1,200 mg dose?. Neuropsychiatric disease and treatment, 10, 249–262.https://doi.org/10.2147/NDT.S30160
      14. 14. Jiménez-Jiménez, F. J., Esguevillas, G., Alonso-Navarro, H., Zurdo, M., Turpín-Fenoll, L., Millán-Pascual, J., Adeva-Bartolomé, T., Cubo, E., Navacerrada, F., Amo, G., Rojo-Sebastián, A., Rubio, L., Díez-Fairén, M., Pastor, P., Calleja, M., Plaza-Nieto, J. F., Pilo-de-la-Fuente, B., Arroyo-Solera, M., García-Albea, E., Agúndez, J., … García-Martín, E. (2018). Gamma-aminobutyric acid (GABA) receptors genes polymorphisms and risk for restless legs syndrome. The pharmacogenomics journal, 18(4), 565–577. https://doi.org/10.1038/s41397-018-0023-7
      15. 15. Edinger, J. D., Fins, A. I., Sullivan, R. J., Marsh, G. R., Dailey, D. S., & Young, M. (1996). Comparison of cognitive-behavioral therapy and clonazepam for treating periodic limb movement disorder. Sleep, 19(5), 442–444.https://pubmed.ncbi.nlm.nih.gov/8843536/

    Learn more about Periodic Limb Movements Disorder