Sleep-related movement disorders include bruxism and limb movements (restless legs syndrome and periodic limb movement). Sleep-related involuntary movements are detected using a polysomnography and a video recording of the test is used to distinguish between bruxism and other mouth or jaw movements (snoring, somniloquy, teeth chattering, jaw muscle contractions or tics, etc).

There are two kinds of limb movement disorders:

1. Restless legs syndrome (RLS) is characterized by a strong urge to move your legs, but can also happen in your arms. Tingling or prickling (not pain or cramps) can also occur when you are inactive. Symptoms tend to grow worse in the evening (seated in front of the TV) or as you fall asleep. These feelings are sometimes intense enough to cause insomnia (making it hard to fall asleep). During the day, RLS causes fatigue, sleepiness and sometimes, attention or memory problems. This syndrome affects about 10% of adults. In children, daytime symptoms are sometimes mistaken for ADHD (attention-deficit hyperactivity disorder). RLS can be hereditary and is more common in women (especially in pregnant women with an iron deficiency) than in men. RLS is a neurological disorder whose cause is not yet known.

2. Periodic limb movements (PLM) is related to RLS but happens while you are awake or asleep. These involuntary, unconscious and repetitive movements usually occur in the legs, and sometimes the arms. PLM could be extending your big toe or flexing your foot, or sometimes even bending your knee or hip. Movements last anywhere between half a second to five seconds and can recur more than 30 times in one hour of sleep. PLM usually happens in the first part of the night. A diagnosis of PLM requires at least five episodes per hour of sleep. PLM can cause insomnia and a slowing of daytime functioning. PLM is rare in people under 30 years old but prevalence increases with age. It affects both men and women.

Most people with RLS also have PLM. However, people with PLM do not always have RLS.

How are limb movement disorders treated?

A polysomnography is used to detect periodic limb movements, indicating the frequency and duration of the episodes so the physician can determine the severity of the disorder and identify related events (sleep apneas, insomnia, etc.). The diagnosis of restless legs syndrome (RLS) is based on a medical evaluation and certain clinical data; these are not essential but they can help if there is uncertainty about a diagnosis (e.g. family history of RLS or a positive therapeutic response to the medication).

Drugs are part of the treatment for periodic limb movements. For RLS, dopamine (first line of treatment) and iron have been shown to be effective treatment. Alternative treatments include opioids and benzodiazepines. Sleep hygiene measures should be instituted.

Signs of limb movement disorders

Unrestful sleep
Insomnia
Fatigue during the day
Excessive daytime sleepiness (sometimes expressed as hyperactivity in children)
Cognitive disorders (attention and memory)
Mood disorders (depression and anxiety)

Bruxism:

Bruxism is characterized by the grinding of teeth or clenching of the jaw while sleeping, usually associated with arousals. This condition may lead to sleep disruption. Bruxism can cause jaw or tooth pain, headaches or fatigue during the day. Bruxism can be primary or secondary related to sleep or medical disorders (sleep apneas, sleep-related epilepsy, cerebral infarct).

Bruxism prevalence in children 3-6 years of age is 18%. The rate drops to 14% in children 7-10 years of age, and continues to decrease to 8% in adults and 3% in people over 60 years old. Several factors would seem to explain this disorder; poor occlusion, diseases of the central nervous system, stress, anxiety, etc. An oral appliance (bite plane) prescribed by the dentist may help prevent enamel wear and other associated symptoms.

How is bruxism treated?

1. Diagnosing bruxism may require digitally recording the person sleeping in addition to a polysomnography.
2. There is no specific cure for bruxism.
3. The primary goal is to prevent damage to the mouth and face and reduce sensory complaints.
4. Available treatments include behavioural therapy (sleep hygiene, relaxation to reduce stress), orodental therapy (soft mouth guard, bite splint, dental occlusion) and pharmacotherapy (sedatives, cardioactives, serotonin or dopamine); however, the effectiveness of these strategies is yet to be confirmed.

NOTE: Dental splints reduce tooth damage and the sound of teeth grinding but are not recommended for sleep apnea patients. The mandibular advancement device, allowing full coverage of the maxillary and mandibular teeth, seems to be more tolerated in sleep apnea patients. Palliative management of bruxism varies according to age. Behavioural therapy could be a better choice for young children; similarly, a soft mouth guard is recommended for teens. Medication is recommended for more severe cases in adults.

Polysomnography recordings, including an EMG of the jaw muscles with video monitoring, are recommended since patients can present with concomitant sleep disorders (sleep apnea, sleep epilepsy, etc.)

Consult your physician or dentist for more information and to find the right treatment for your condition.

Signs of bruxism

Unrestful sleep
Fatigue in the morning
Jaw pain
Headaches

Refrences:

American Academy of Sleep Medicine. International Classification of Sleep Disorders: Diagnostic and Coding Manual. 2nd ed. Rochester, 2005.

Lavigne, G., et al. “Sleep Bruxism.” Principles and Practice of Sleep Medicine. 4th ed. Edited by MH Kryger, T. Roth and WC Dement. 2005.

Montplaisir, J. et al. “Resltess Legs Syndrome and Periodic Limb Movements During Sleep.” Principles and Practice of Sleep Medicine. 4th ed. Edited by MH Kryger, T. Roth and WC Dement. 2005.

Montplaisir, J. et al. “Resltess Legs Syndrome and Periodic Limb Movements During Sleep.” Principles and Practice of Sleep Medicine. 4th ed. Edited by MH Kryger, T. Roth and WC Dement. 2005.

About Us

Services Offered

Sleep Essentials

Tools

Library

Glossary

Links