How important are PLM's (Periodic Leg Movements)?

During my first sleep study I had 287 PLM's, 51.6 PLM's/hr. Moderate AHI = 22.3, with Supine (back) AHI = 69.3.

During my titration sleep study I had 345 PLM's, 65.6 PLM's/hr. For both of the study interpretations, frequent leg movements were noted. This did not concern my general practioner doctor or my sleep specialist. The only thing that mattered to them was my sleep apnea.

I received my CPAP on March 14 and have been 100% compliant. My average AHI is around 1.0

I only feel a little better and am going to see my general practioner doctor on Tuesday to discuss my tiredness. Do you think my PLM's are significant? What else could it be?

Thanks for your help!

It depends on how many of them are associated with arousals

There's a big controversy about this. There is less controversy if they are associated with arousals, but I would be sure that they are true PLMS and not muscle contractions associated with SDB. You probably can't show that unless you had another sleep study in which you spent the night on a therapeutic CPAP setting, or unless on your titration study there was sufficient time spent at therapeutic pressures.

For my first sleep study, 10 of the 287 PLM's were with arousal. PLM Arousal Index was 1.8.
For my titration sleep study, 31 of 345 PLM's were with arousal. PLM Arousal Index was 5.9.
Do you think my PLM's with Arousal are significant? What else could it be?

Did the report call the movements PLMD? When the movements worsen with CPAP, my non-professional notion is to suspect PLMD.

If it is PLMD, it can be hard to really know what's going on because as one sleeps better and more with CPAP, even more movements can manifest. The numbers from your titration study may or not be representative of what you legs are doing now as you've adjusted to using your machine. If your data from your CPAP treatment looks good but how you feel is not improving, your movements could be significant to you. Just wondering, do you have muscle and/or joint pain in the lower half of your body? I did. This was as significant to me as well as the arousals. At one point my doctor repeated my sleep study with me using my familiar mask at my usual pressure to better see what a night looked like for me. That's the best way to tell, but with the numbers you showed already, I'm guessing the answer is already there. If your doctor suggests meds, I would suggest that you first have your doctor order some tests, particular iron studies to include a ferritin level. A level in the lower end of the normal range for the general population can be problematic for a person with limb movements. Meds most often prescribed are dopamine agonists, and it's thought that starting the meds with a lower ferritin level can be an indicator of the med later causing augmentation. Wouldn't hurt to also have your vitamin D and magnesium levels checked, as well as any medical conditions known to cause your symtoms.

In all fairness to the doc, treating OSA is a medical priority over limb movements, and some people find CPAP treatment reduces or resolves their movements. I would want that to be known before starting meds that may prove to be unnecessary. Just surprised they didn't ask for followup on this much sooner, or maybe they figured if you still had problems you'd tell them. At any rate, do let us know how this pans out.

Did the report call the movements PLMD?

No mention of Periodic Limb Disorders. Here are the actual reports:
First Sleep Study:

Titration Sleep Study:

Just wondering, do you have muscle and/or joint pain in the lower half of your body?

None what so ever. No aches or pains anywhere. Other than apnea and cholesterol, I am very healthy. Yes, I know how that sounds.

If your doctor suggests meds, I would suggest that you first have your doctor order some tests, particular iron studies to include a ferritin level.

I had my iron checked as part of a normal blood test for my yearly physical. It was normal. Are you suggesting a different test?

Wouldn't hurt to also have your vitamin D and magnesium

These are both normal.

I would want that to be known before starting meds that may prove to be unnecessary.

I prefer not to take meds, but would if I was convinced I would benefit. I do not take medicine for cholesterol because I'm not convinced they help. The companies make a lot of money off these meds.

At any rate, do let us know how this pans out.

I will. She does seem to be genuinely concerned.

Thanks, kteague!

Those reports are quite interesting. I'm surprised your report includes PLM's during wake time. Twice I had to ask that the sleep lab go back and give me that info, as it was important to my case. I do hope some of our tech type people weigh in on your reports. As to iron levels, it is specifically the ferritin level I was speaking of. Not sure which iron tests you had done.

I really only have experience with RLS and PLMD. If your movements are something else, I'm not much help. However, your report didn't say you DON'T have PLMD. It didn't label your movements at all as far as diagnosing a cause. I wouldn't be surprised if it turns ot you do have PLMD. I'm just not qualified to say that. Let us know what comes out of your visit.