Jerking legs shake the bed

#Middlebury #ToYourGoodHealth

DEAR DR. ROACH: My husband will be 82 in July. About three years ago, I became aware of his sudden movements during the night. We were renting in Florida, and the bed was smaller than our bed at home. His body would jerk, sometimes strongly.

These movements would not wake him; he just seemed asleep. He does not remember anything about it in the morning.

We went to see his doctor at home, who said that he is in very good shape. He did not know what caused the movements.

We are once again staying in Florida, and his body movements are the same, sometimes strong enough to shake the bed. I find it hard to believe that this is normal. Do you have any advice? – B.N.S.

ANSWER: This is a classic description of a condition called periodic limb movements of sleep (PLMS). These usually involve the legs, and typically involve pointing the toe while flexing the ankle, knee and sometimes the hip. Each movement lasts a few seconds and repeats every 30 seconds or so. Your story that he doesn’t remember them is very typical: It’s usually the sleeping partner who notices them. PLMS is more common in older adults.

PLMS by itself is not a disease and does not need treatment; however, it is often associated with other conditions, especially restless leg syndrome (Willis-Ekbom disease), rapid eye movement sleep behavior disorder (which includes sometimes violent movements) and narcolepsy.

Since your husband apparently has no symptoms, he does not need treatment. However, he should be specifically asked about symptoms like an urge to move the legs while awake, abnormal feelings in the legs, difficulty falling asleep and sleepiness during the day. These would be likely to indicate RLS or its close relative, periodic limb movement disorder.

DEAR DR. ROACH: What can an 80-year-old woman expect to have checked as part of an annual physical examination? – H.M.

ANSWER: The annual physical exam has gotten some bad press lately. Some of it is well-deserved: The actual physical exam occasionally finds some unsuspected problems, but this is quite uncommon and there is no proof that the annual physical saves lives.

This argument misses the point, in my opinion. The “annual physical” is a scheduled time for important conversations about screening and prevention. These include checking blood pressure and considering cholesterol screening (cholesterol is a less-important risk factor in 80-year-old women than it is in men or in younger adults). Similarly, it’s time to come to a mutual decision on whether a mammogram should be done (again, the evidence at age 80 is unclear).

Most importantly, your doctor or provider should be doing a depression screen, thinking about ways to reduce fall risk, assessing osteoporosis and giving good advice on diet and exercise. People at high risk may need other labs checked or advice given (for example, people with high blood pressure should be screened for diabetes).
It’s a long list, and that’s why a dedicated visit for health promotion makes sense to me.

Dr. Roach regrets he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. To view and order health pamphlets, visit www.rbmamall.com, or write to Good Health, 628 Virginia Drive, Orlando, FL 32803.

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