I have posted before and felt my s. study wasn't helpful.  I feel like I hardly slept.  Anyway, I received the actual results and they are as follows:

<<Increase in sleep stage 1, normal sleep stage 4, and decrease in stages 2,3, and REM.  No significant sleep-disordered breathing with a normal total apnea-hypopnea index of 0.2 per hour.  There were frequent leg movements with an index of 56.2 per hour. and leg movement arousal index of 22.5.>>

So apnea was ruled out, but is the leg movement index high?  There was no graph attached so I could not see how often the PLM's were causing arousal.  My symptoms are all the same as most people on this site as far as daytime fatique etc.  I do have RLS, and am on Effexor for depression.  I am going to switch to Wellbutrin to see if that makes any changes.

These results seem pretty weak compared to others I have seen posted so I don't know if anyone can give me any insight, but I am desperate to find out why I can't seem to have a good night's rest no matter what I do.
Mary

Quote:

Conclusion
Individuals with RLS and other sleep disorders exhibit a variability of the frequency of PLMS from night to night. Multiple-night recordings of PLMS may be necessary to support a clinical diagnosis, to assess effects of a specific drug on PLMS in an individual case, or to evaluate the efficacy of a substance on PLMS in clinical trials.

The paragraph above is a concluding paragraph defining a study regarding Restless Legs Syndrome. Please visit the site for more and complete information.  Perhaps this will provide further information for discussion with your doctor.

                                            Click Here

Edit to include actual URL address:  http://www.medscape.com/viewarticle/505241


_________________
Success Nourishes Hope

Two links provided in the post above fail to lead to the text of the site.  Consequently, the entire text is pasted below.  Please credit: http://www.medscape.com/viewarticle/505241

Restless Legs Syndrome, June 2005

Anil N. Rama, MD, MPH; Clete A. Kushida, MD, PhD

The Restless Legs Syndrome Journal Scan is the clinician's guide to the latest clinical research findings about restless legs syndrome in Movement Disorders, Sleep, Journal of Sleep Research, Annals of Neurology, Neurology, Archives of Neurology, Archives of Neurosurgery, The Lancet, The New England Journal of Medicine, and other journals that publish articles of interest to neurologists and specialists in sleep and movement disorders. Short summaries of feature articles include links to the article abstracts when available. (Access to full-text articles usually requires registration at the specific journal's Web site.)

--------------------------------------------------------------------------------


From
SLEEP
March 1, 2005  ( Volume 28, Number 3 )

Variability of Periodic Leg Movements in Various Sleep Disorders: Implications for Clinical and Pathophysiologic Studies
Hornyak M, Kopasz M, Feige B, Riemann D, Voderholzer U
SLEEP.  2005; 28 (3) : 331-335
Overview
Restless legs syndrome (RLS) is a common neurologic condition characterized by unpleasant sensations deep inside the legs, occurring at rest, especially at bedtime. The paresthesias are accompanied by an irresistible urge to move the limbs, which results in a temporary relief of the symptoms. In virtually all patients with RLS, periodic limb movements in sleep (PLMS) are observed. These are stereotyped, periodic, jerking movements, typically consisting of flexion of the ankle, knee, and hip. PLMS may be accompanied by an awakening resulting in sleep fragmentation and subsequent excessive daytime sleepiness, although this is controversial. Dopamine agonists are considered the treatment of choice for RLS and periodic limb movement disorder (PLMD).

Objective
In this study, Hornyak and colleagues address the issue of stability of the PLMS measure for RLS when comparing 2 consecutive nights in the sleep laboratory. Their study includes a sample of RLS patients (n = 42) as well as samples of patients with primary and secondary insomnia (n = 55), sleep apnea (n = 13), and narcolepsy (n = 5) patients.

Results
Although the PLMS index and PLMS arousal index did not systematically change from the first to the second night, both indexes showed significant intrasubject variability between nights. The most significant differences appeared in patients with RLS and to a lesser degree in patients with other sleep disturbances. Patients with other sleep disturbances also showed significant variance of PLMS but not to the extent seen in patients with RLS.

Regarding the PLMS index, a difference of more than 10 per hour from one night to the next occurred in 27% of patients. A difference in the PLMS index of greater than 25 per hour between both nights was present in 10 patients with RLS and in 1 patient with secondary insomnia.

Regarding the PLMS arousal index, a difference of more than 5 per hour from one night to the next occurred in 19% of patients. Of the 9 patients showing a difference of more than 10 per hour, 8 presented with RLS.

With a cutoff value of 10 per hour for the PLMS index, 10% of the RLS and 16% of the non-RLS patients would be assigned to different categories ("normal" vs "clinically relevant") if PLMS recordings had been performed on only 1 night. Using a cutoff value of 5 per hour for the PLMS arousal index, 19% of RLS patients and 10% of the non-RLS patients would change from one category to the other.

Conclusion
Individuals with RLS and other sleep disorders exhibit a variability of the frequency of PLMS from night to night. Multiple-night recordings of PLMS may be necessary to support a clinical diagnosis, to assess effects of a specific drug on PLMS in an individual case, or to evaluate the efficacy of a substance on PLMS in clinical trials.

Review: Periodic Limb Movement Disorder

PLMD is a disorder characterized by limb movements while asleep, which may result in a complaint of insomnia and excessive daytime sleepiness. Periodic limb movements affecting the lower extremities can be described as intermittent extensions of the big toe and dorsiflexion of the ankle with occasional flexion of the knee and hip.[1] The movements are often bilateral but may predominate in one leg or alternate between legs.[2] Periodic limb movements may affect the upper extremities and manifest as intermittent flexion at the elbow. PLMS predominate in the first half of the night and show a typical pattern of progressive decline through the course of the night.[3]

RLS is a clinical diagnosis made by the characteristic symptoms of the disorder, but the diagnosis of PLMD is made by polysomnography with electromyographic (EMG) recordings from the tibialis anterior muscles. Movements are counted if they last .5-5 seconds and occur in a series of 4 or more at intervals of 5-90 seconds. The EMG amplitude of the nocturnal limb movements must be 25% or more of the baseline EMG amplitude while awake.[4]

The severity of PLMD is determined by the periodic limb movement index, which equals the number of periodic limb movements per hour of sleep. The periodic limb movement arousal index is the number of periodic limb movements associated with electroencephalographic arousals per hour of sleep. Mild PLMD is defined as 5-25 periodic limb movements per hour of sleep; moderate as 25-50 periodic limb movements per hour of sleep; and severe as more than 50 periodic limb movements per hour of sleep or greater than 25 periodic limb movements associated with arousals per hour of sleep.[5] When symptoms of insomnia and excessive daytime sleepiness exist, the diagnosis of idiopathic PLMD can be made if no other medical, psychiatric, or sleep disorders can be found to account for these symptoms. PLMD may also occur in association with medications or a variety of other conditions, such as narcolepsy and obstructive sleep apnea.[6,7]

Since the designation of PLMD as a distinct sleep disorder, issues have arisen concerning the validity of this nosology. Some have suggested that no significant association exists between periodic limb movements and either objective or symptomatic reports of insomnia or daytime sleepiness.[8-10] Furthermore, periodic limb movements are rarely diagnosed in patients younger than age 30 but are found in 44% of subjects aged 65 and older.[11] The common finding of PLMD in the elderly has cast doubt to the validity of PLMD as a distinct sleep disorder.[12]


_________________
Success Nourishes Hope

Hi Mary!
Well this turned out to be very important information.
The number of PLMs obviously puts you in the severe category (the index, or number of PLMs per hour can be rated as mild if 5-24/hour, moderate if 25-49/hour, and severe if more than 50/hour, as noted above).  But PLMs by themselves are harmless.  Fun to watch, maybe tough on the spouse, but to you, nada...
EXCEPT-  if they cause arousals.  You PLM arousal index (PLMs per hour, or PLMAI) at 22.5 is a bunch.  You start thinking about treating at PLMAI 5.0, if you have symptoms, and at >20 just about everybody's going to have symptoms.
Briefly about drugs, just about all the antidepressants can worsen RLS and PLMs except Trazadone and Wellbutrin.  Cool, huh?  Wellbutrin may even help PLMs, so there could be a big swing there.  There are excellent drugs to treat RLS/PLMs, but other than than that, let me stay away from drugs, it's not my business, the whole drug thing can get very complicated, very fast, and is best left up to a physician.  Good luck, sounds very promising.
Oh, BTW a good PLM/RLS site is http://www.rlshelp.org/ in case you're interested.
sleepydave

Thanks SleepyDave!  I feel like I may be getting somewhere. I hope the Wellbutrin will make a difference.  I'll keep you updated.
Mary

Hi Mary!
Great, and I almost forgot, if you get a hold of the complete study, hang onto it.  Once your PLMs and RLS are sufficiently under control, you could always get a another sleep study to see how you've improved in re: your % of quality sleep, reduction in PLMAI and the like.  PSG can be used very effectively to track progress in the control of PLMs as well as OSA.  Indirectly, for RLS too, for that matter, if your sleep onset is significantly delayed now by the RLS.  All right, if it takes you a hour to fall asleep now, and that turns into 5 minutes, and if you find yourself with tons of energy and don't need to nap anymore, I will grudgingly admit that would be a good gauge of treatment effectiveness, too.  Stay in touch.
sleepydave