Magazine article Clinical Psychiatry News

Sleep Disorder Manifestations Vary by Patient

Magazine article Clinical Psychiatry News

Sleep Disorder Manifestations Vary by Patient

Article excerpt

SAN JUAN, P.R. -- Treating the manifestations of sleep disorders requires a broad understanding of patients' circumstances, Donald Bliwise, Ph.D., said at the annual meeting of the American Association for Geriatric Psychiatry.

For example, both restless legs syndrome (RLS) and periodic limb movement disorder (PLMD) become more prevalent as patients age, said Dr. Bliwise, professor of neurology at Emory University in Atlanta. "RLS is really a symptom," he said. PLMD is a polysomnographic finding, and the two often overlap. However, neither is necessary nor sufficient to make the diagnosis of the other. In order for RLS to be diagnosed, communication between the patient and the physician is critical. A diagnosis of PLMD often must be preceded by a report from the patient's bed partner of excessive movement.

RLS is characterized by uncomfortable leg sensations. These sensations are worse in the evening and at night, and worse with inactivity. Leg movement relieves the discomfort. "If someone has constant pain and discomfort, it's probably less likely to be RLS," said Dr. Bliwise, director of the program in sleep, aging, and chronobiology at Emory. RLS is associated more with motor hyperactivity.

PLMD is characterized by stereotypic, repetitive movements of the legs--and less often the arms--during sleep or inactivity; these movements are detected by EEG in the sleep laboratory. Movements occur every 20-40 seconds and usually occur in groups of four. These movements may be associated with arousals from sleep. Sometimes the movements occur in only one limb or may switch back and forth between limbs.

Dr. Bliwise also said RLS and PLMD are very dependent on ferritin levels. "So one of the first things we do, especially with our geriatric patients, is check ferritiniron levels," Dr. Bliwise said. If the patient has low levels, he or she is put on iron supplementation.

RLS and PLMD are also associated with chronic renal failure, neuropathies, myelopathies, radiculopathies, pregnancy, and folate and vitamin [B.sub.12] deficiencies. Some medications can worsen RLS and PLMD; in particular, tricyclic antidepressants and selective serotonin reuptake inhibitors can aggravate these two conditions. Dopamine agonists are often used off label for these two conditions. Ropini-role (Requip) is indicated for the treatment of RLS. …

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