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Sleep Disorders

Sleep Starts

08/05/2008

Question:

Since I was about a year old I have had episodes of disrupted sleep. After about two hours of sleep I would awaken because of a massive jerk. These jerks will continue throughout the night occurring approximately every 30 minutes and would prevent me from falling back asleep. The jerks affected my whole body and were characterized by a feeling of tightening in my legs that accelerated to the point of an involuntary jerk or jump. Once these jerks started, they would occur every 30 to 45 minutes and would continue throughout the night for about four or five hours. I do not experience any visual or auditory disturbances and I do not have a feeling of falling that occurs with the jerks. These "episodes" would occur about once every other week.

When I was a child, I was told that it was just due to stress or growing pains. However, these jerks or jumps have continued throughout my life and I am now 35 years old. As I got older, I was told it was RLS and then it was PLMD. However, I was recently advised by a physician that I have a problem with sleep starts. Do my symptoms coincide with that of sleep starts? Is there any course of treatment I can pursue?

Answer:

Sounds like this is something that has really been troubling you and you are correct in seeking help. Based on the limited information you provide, there are a number of possibilities to explain your symptoms, most likely of which would include a "normal" sleep-related phenomena, a sleep-related movement disorder or maybe even a parasomnia. Parasomnias are a group of disorders characterized by undesirable physical events or experiences that occur during entry into sleep, within sleep or during arousal from sleep.

To determine exactly what your problem is and how best to treat it, additional history and an examination will be needed. However, we can provide with you some information about the possible diagnoses we listed and hopefully this will be of some help.

Of the normal variants, sleep starts (also known as hypnic jerks) could be a possible explanation for your symptoms. This is the whole body "jerk" that frequently occurs at the onset of sleep and is considered a normal sleep-related phenomenon. However, sleep starts usually do not persist throughout the night and tend to be less persistent. In addition, they don't typically cause severe disturbance and difficulty returning to sleep. However, there are more severe forms of sleep starts that can have a severe sensory component.

There are a number of movement disorders that can be associated with sleep and the symptoms you describe could be consistent with one of these. Of the sleep-related movement disorders, your symptoms sound most consistent with periodic limb movements of sleep (PLMS). This is a condition in which the legs will twitch or jerk regularly during sleep and it may or may not be associated with fragmentation of sleep. Another condition that may be consistent with your symptoms is myoclonus. These are involuntary movements or jerks that originate from the spinal cord and affect all extremities.

Parasomnias make up a broad category of sleep disorders that usually have more extensive symptoms than just body jerks. There are a number of different parasomnias, ranging from sleepwalking and sleep terrors to behaviors associated with dreams to a number of other sleep-related behaviors (such as eating during sleep, bedwetting, etc). The symptoms you describe are least likely to represent one of these conditions.

Whenever jerks or twitches are described, nocturnal seizures must also be considered, though again, your symptoms sound atypical for this type of condition.

In order to sort out what is going on in your sleep, you will need a sleep study with expanded recording to fully evaluate for the conditions listed above. The frequency of this condition (every other week) makes it difficult for a one night sleep study to capture and evaluate. However the sleep study may also rule out other conditions that may exacerbate the original problem, and may even capture some of these events that may occur without waking you up. PLMS will likely occur every night, whether you wake up and remember them or not.

Pending evaluation by a Sleep Specialist, you should practice good sleep hygiene. This includes avoiding stimulants, such caffeine, alcohol, and tobacco, near bedtime, exercising regularly (a few hours before bedtime may be helpful), and maintaining a regular sleep-wake schedule..

Additional information regarding sleep can be obtained on the American Academy of Sleep Medicine website. This website contains a list of Sleep Centers across the country so you can find one if you need it.

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Response by:

Rami N Khayat, MD Rami N Khayat, MD
Clinical Assistant Professor of Pulmonary, Allergy, Critical Care & Sleep
College of Medicine
The Ohio State University