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Sleep Disorders

Movement While Asleep

09/24/2009

Question:

My husband is complaining that I move in my sleep, between the hours of 1 and 2 o`clock in the morning. The movement wakes him up, but what we can`t figure out is: 1) when he turns over, the movements stops (he assumes I`m awake) 2) I do not remember ever moving, I`m not tired during the day...It`s causing problems...can you help?

Answer:

Movement during sleep may not be noticed, be disruptive to the individual or be disruptive to the individual's bed partner as you are experiencing. There are many causes of movements during sleep and you are right to seek help.

Movements during sleep can be secondary to many causes, including normal sleep physiology (such as sleep starts or some leg jerks), sleep disorders (such as periodic limb movements in sleep, obstructive sleep apnea or parasomnias) and even the side effects of certain medications. The answer to this question really depends upon further history about the nature of the movements you mention. I’ll briefly review some of the sleep disorders associated with movements in sleep.

Obstructive sleep apnea (OSA) affects up to 5% of middle aged adults in America. It is due to the recurrent complete or partial closure of the airway during sleep. When one of these breathing disturbances occurs during sleep, a brief arousal usually results in order to establish normal breathing again. During this arousal, it is very common for patients to jerk or shake their body or limbs, depending on the severity of the sleep apnea. As a result, individuals with OSA suffer from fragmented sleep and tend to feel unrefreshed upon awakening as well as sleepy and tired during the daytime. Aside from unrefreshing sleep and daytime sleepiness, individuals with sleep apnea often complain of loud snoring, headaches upon awakening, a poor sense of well-being, decreased ability to concentrate and reduced alertness. Increasing research also suggests that OSA may impact other medical conditions, including blood pressure control and risk for cardiovascular disease (such as heart attacks, heart failure and stroke). Thus, it is important to diagnose and treat this condition. The diagnosis typically requires a sleep study.

Periodic limb movement disorder is another sleep condition that can lead to brief awakening associated with jerks, primarily in the legs. The main symptom seen with this is frequent leg jerks during sleep that disrupt sleep, resulting in unrefreshing sleep and daytime sleepiness. Often times, an individual’s bed partner is the first to complain about this problem. This condition also requires a sleep study to make the diagnosis and treatment is generally managed with medical therapy. Of note, these leg jerks may be part of normal sleep in some patients, particularly if they occur in the first third of the night and the patient is not aware of them nor do they complains of the associated symptoms.

Of the parasomnias that may result in abnormal movements in sleep, REM behavior disorder is the most likely to initially present as jerks or tremors, usually associated with dreams. Patients will often recall the dream and are usually attempting to act out a part of the dream when the movements occur. Usually, these movements are purposeful, such as running or hitting, and are often associated with bad or violent dreams. To diagnose this condition, a detailed history and sleep study are required.

There are a number of unusual movement disorders that can be associated with sleep (i.e. Alternating Leg Muscle Activation, Excessive Fragmentary Myoclonus, etc.). These often have specific features in the history that will help with making the diagnosis. A seizure disorder should also be considered, though this would be unusual to happen regularly only during sleep.

If these movements of sleep are disruptive to your life, you should see a sleep specialist, who can do a thorough evaluation including a full medical history, physical exam and possibly a sleep study.

If you would like further information about movements during sleep, I recommend the American Academy of Sleep Medicine website. In addition to information about sleep medicine, the website also contains a list of accredited Sleep Centers and may help you to locate one nearest you.

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Response by:

Aneesa M Das, MD Aneesa M Das, MD
Assistant Clinical Professor of Pulmonary, Allergy, Critical Care & Sleep Medicine
College of Medicine
The Ohio State University