Q. My husband jerks constantly during the night, and sometimes the jerks are so violent that his whole body is lifted from the bed. He does not wake up from these jerks, but I cannot fall asleep due to them.
Is there anything he can do to reduce or stop this? I have read that iron can help, but I'm not sure if this is true in a case so extreme.
- J.M., Carlsbad, Calif.
A. Based on the many letters and e-mails I get from people concerning this problem, it must be greater than many in the medical profession realize. The problem is not so much the leg movement but, as you point out, the impact on quality of life caused by lack of sleep.
Your husband's problem may be one of two syndromes: nocturnal (at night) myoclonus syndrome (NMS) or restless legs syndrome (RLS).
Myoclonus is the medical term for the sudden contraction of a muscle or group of muscles. This is a neuromuscular problem. It can happen anywhere but is common in the legs. Myoclonus may be an indication of an underlying seizure disorder like epilepsy. It is also characteristic of some hereditary disorders such as lipid storage diseases or metabolic diseases that cause an increase in urea in the bloodstream.
Some drugs have side effects that cause abnormal muscle movements. Alcohol and drug withdrawal may also be a cause.
Treatment of nocturnal myoclonus begins by trying to identify a specific cause and eliminating it or treating it directly. When no definite cause is found, treatment is directed at generally reducing muscle activity just before going to bed.
Some people have told me that they get relief from such things as mild stretching and exercise, hot baths or massage just before bedtime. Others have indicated that the old cliche of warm milk before bedtime is helpful. Although I've not seen any scientific studies on these approaches, they are not harmful and probably beneficial to your health anyway.
Restless leg syndrome is one of a group of sleep disorders known as parasomnias. It is a relatively common disorder (affecting up to 15 percent of the general population) that usually affects people over age 50.
People often have this syndrome when they're under stress or have other psychological problems. The symptoms - jerky leg movements that may be preceded by creepy-crawly or electric current sensations - worsen when the people are sitting or lying down and also worsen at night.
The primary cause is unknown, but many with the syndrome also have a family history of it. Secondary causes include iron deficiency anemia as you noted, and peripheral neuropathy.
Pergolide has been used successfully for short-term treatment of restless leg syndrome. Results of a recent study showed that it continued to decrease symptoms by two-thirds for people who took it for over a year.
Treatment of both these syndromes may require stronger medication. For some, anticonvulsant medications, especially valproic acid, help. For others, benzodiazepines (the family of drugs that contains Valium) work. One of these, clonazepam, seems to be particularly helpful.
I hope you can encourage your husband to find out which of these syndromes he has, find out what is causing it and get relief. For more information on these syndromes, check out the Web site www.rls.org.
Update on epilepsy: Fortunately for many people, newer drugs for the treatment of epilepsy have been very effective. But seizures are not controlled in some people and the long-term side effects of these drugs and drug combinations can be a major problem for others.
A recent study showed that stimulating the vagus nerve (one of the largest nerves that comes directly from the brain) with electrical stimulation is especially effective when used for up to 12 months.
As with any medical device, using the NeuroCybernetic Prosthesis System may cause side effects, but for many this may be the best treatment.
Write to Dr. Allen Douma in care of Tribune Media Services, 435 N. Michigan Ave., Suite 1500, Chicago, Ill., 60611; or contact him at DRFamily@aol.com. This column is not intended to take the place of consultation with a health-care provider.