Sleep Related Movement Disorders


Ever felt something weird while sleeping? Sudden jerks while sleeping, of which you are aware of Sleeping with someone and waking up to find out that you moved your legs, but the person does not remember doing so? Hearing from other people about movements while sleeping, the other person is unaware that such things happened. Do sleep disorders exist, and are they harmful? Does a sleep disorder indicate some serious issue going on within your brain or body? How is sleep affected by neurological or biological changes? Why is there a need to understand the sleep cycle and its related disorders?

Sleep−Related Movement Disorders

Motor movements characterize sleep−related movement disorders (SRDM) during sleep, most of which are involuntary. They happen when one is sleeping and have daytime consequences. They also might be the first clinical manifestation of the disorder in the central nervous system. Though most of these disorders are represented by abnormal motor movements, some of them can be missed or misinterpreted. According to the International Classification of Sleep Disorders 3, the most common SRDM are −

  • Restless Legs Syndrome (RLS)

  • Periodic Limb Movement Disorder

  • Sleep−related Cramps

  • Sleep−related Bruxism

  • Sleep Terrors

Restless Legs Syndrome

Restless Legs Syndrome is an intense urge to move limbs or legs. A painful sensation in the limbs accompanies it, and that pain is partially or relieved by moving, stretching, or walking. It is a neurological disorder and usually has an early start. When the sensations are not relieved by walking or stretching, they worsen with time. It usually begins in the evening or at night. Because of the constant movement, the person may experience daytime sleepiness and be moody and irritable. It can be comorbid with insomnia or other psychiatric symptoms. It is rare in children and more common in uremia, iron deficiency, and pregnancy.

Periodic Limb Movement Disorder (PLMD)

This disorder is characterized by periodic stereotyped movements similar to Babinski's reflex. In this, there is partial flexion of the foot and leg. Each episode lasts 0.5 seconds to 10 seconds and consists of at least four episodes. It is related to increased arousal during the night and has consequences in the daytime, like drowsiness or fatigue. Severe PLMS has recently been linked to abnormal sleep behaviors, mimicking dream enactment behavior and greater cognitive decline in non−demented individuals.

Sleep−related Cramps

In sleep−related cramps, there are intense and painful contractions of muscles, usually in the lower calf. These are involuntary contractions. These are very common and increase with age. Children rarely experience this but with age. The incidence and occurrence of these cramps increase. This can happen due to intense exercise, endocrine diseases, neuromuscular diseases, or medications. The consequences of this can be muscular pain or daytime drowsiness.

Sleep−related Bruxism

This disorder is characterized by teeth−grinding during sleep. Bruxism, or nocturnal tooth grinding, is associated with arousal during sleep. Friction can cause tooth decay or the breaking off of tooth enamel, jaw muscle pain, headaches, and tooth pain. It can happen while sleeping or while waking, and primary bruxism is when the cause is unknown; secondary bruxism is related to psychoactive substances. This is usually seen in children and decreases with age.

Sleep Terrors

It is characterized by sudden onset of fear, loud screaming, and autonomic symptoms arising from deep NREM sleep, usually lasting only a few minutes. People experiencing this cannot be woken up easily and do not have any memory of those episodes. It usually co−occurs with other parasomnias (e.g., sleepwalking), which may lead to significant daytime sleepiness in combination.

Treatment

The treatment of each disorder varies as their nature, and biological causes vary, but they all have some common symptoms. So there can be some common treatments. For example, avoidance of caffeine before bedtime, alcohol and nicotine avoidance, sufficient meals, sleep hygiene, and reduction of nighttime activities. Specifically, for RLS, benzodiazepines, opioids, and dopaminergic medicines can be prescribed to control the symptoms.

Psychotherapy can be used for disorders like parasomnia, bruxism, paralysis, or sleep−related dissociative disorders. Cognitive behavioral techniques can also be used for sleep−related paralysis, bruxism, and dissociative disorders. Benzodiazepines, antiepileptic drugs, antidepressants, dopaminergic agents, and melatonin can be used for parasomnia, RLS, PLMS, nocturnal epilepsy, etc. Stress−reducing techniques could be applied to reduce the occurrence of sleep−related bruxism, seizures, and dissociative disorders.

Rapid eye movement (REM) and Non−Rapid Eye Movement (NON−REM) sleep

There are two different types of sleep. There are two types − rapid eye movement sleep and non−rapid eye movement sleep. REM sleep has rapid eye movement, but the brain does not receive any visuals. The eyes move rapidly in different directions, but the brain does not receive any visuals. In non−REM sleep, there is no movement of the eye. In REM sleep, the brain is most active, and in this stage, one dreams, whereas, in non−REM sleep, a person is in a deep sleep.

Conclusion

Sleep can be classified in two ways − rapid eye movement sleep and non−rapid eye movement sleep. In REM sleep, there is a rapid eye movement in which a person usually dreams, and in non−REM sleep, a person is in deep slumber. During sleep, our body is at a relaxing stage, but due to arousal and lifestyle factors, many disorders can take place. They usually have a biological or neurological basis. Some of the sleep−related movement disorders are sleep paralysis, sleep terrors, sleepwalking, restless leg syndrome, and periodic limb movement disorder. The treatment of every disorder varies, but psychotherapy and stress−reducing techniques can be applied throughout, with specific medications according to the need. Sleep can be classified in two ways − rapid eye movement sleep and non−rapid eye movement sleep. In REM sleep, there is a rapid eye movement in which a person usually dreams, and in non−REM sleep, a person is in deep slumber. During sleep, our body is at a relaxing stage, but due to arousal and lifestyle factors, many disorders can take place. They usually have a biological or neurological basis. Sleep−related movement disorders include sleep paralysis, sleep terrors, sleepwalking, restless leg syndrome, and periodic limb movement disorder. The treatment of every disorder varies, but psychotherapy and stress−reducing techniques can be applied throughout, with specific medications according to the need.

Updated on: 13-Dec-2022

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