PLMD

[Bill Field]

This is my first post ever. I just joined. I was diagnosed with PLMD (I am 70 years old) after a sleep study in the summer of 2021. The neurologist started me on 600 mg of Gabapentin "GA". I am now up to 1800 MG. I take 600 at 9 PM and then another 600 when I am ready to sleep and then when I get up in the middle of the night to the bathroom, I take the final 600 MG. It really helped my sleep but I noticed that when I played 2+ hours of competitive table tennis or pickleball in the morning, on those nights, I slept poorly despite the GA. (4-5 hours). I have since stopped playing those two sports, and my sleep has improved dramatically (now 7 hours). But I miss those two sports.

What does this heavy exercise do to my nerves in my legs? Is it just general leg muscle inflammation or the pounding of the nerves in my feet? It's not just these two activities. If I try to walk fast (3 miles in 45 minutes), I sleep poorly. But I can do upper body weight training with bands without a problem.
Thank you in advance for any ideas that you might have.
Bill

[Polar Bear]

It is generally understood that moderate exercise is ok for RLS but that strenuous exercise is to be avoided.
Some similarities exist between PLMD and RLS regarding symptoms and treatment, and some people consider them part of the same condition.
Playing table tennis and walking energetically is very different from weight training with bands. What exactly the strenuous exercise does that causes this sleep issue, I don't know. But your body is telling you that there is a difference,

[Rustsmith]

Bill, I will second PolarBear's comment about moderate vs strenuous exercise, BUT exercise that is strenuous for one person isn't for the next (assuming similar age groups). Further, exercise that might be taxing today due to what you did yesterday may be fine tomorrow.

I am also 70 years and was a serious runner up until a few years ago. I ran full marathons and competed at 800m and the only time that this had any effect on my RLS was if I tried to do a hard workout an hour or two before bedtime or if I made a major increase in the severity of my training.

Therefore, my suggestion is that you don't stop playing racket sports or power walking, but that you ease up on how hard you participate and then SLOWLY increase how hard you play/walk. When I first started running, it took me two years to go from being sedentary to running in my first and slowest 10k (6.2 miles). The secret is simply not to push your body too hard, but push it slowly enough to keep fit and hopefully improve without causing any RLS problems.

[Dr.Placebo]

Bill, I would just like to add my 2 cents. I, too, enjoy running, and in the past found that if I had to stop for some reason I became very depressed, and when I ran regularly the depression got better. Since depression is a big problem with RLS/PLMD I would agree with Steve that it wouldn't be a good idea to completely give up your exercise, either from a fitness standpoint or a mental health standpoint.

Paul
Not a moderator, just a fellow PLMD-sufferer.

[Bill Field]

Wow, thank you Polar Bear, Rustsmith, and Dr. Placebo! All of you have contributed some great insights. Currently, I am doing upper body weight training with bands and then slow-walking 1.5 miles. My sleep has improved as a result. My goal with sleep: 7 hours. Last night wasn't ideal; I slept 4.25 hours straight and then woke up for 2 hours (mostly reading with an orange light lamp) and then 2.75 hours straight. I felt surprisingly good this morning. So, yes, I will see if I can increase my amount of exercise. A small part of my motivation for playing table tennis and pickleball was a scientific study that showed that people who played racket sports had much less Alzheimer's disease and dementia. So, I might be able to go back and start playing a small amount and then increase it. Thank you again.

[Bill Field]

Oops.. I meant to say that people who play racket sports have less Alzheimer's and less dementia than people who play other sports

[ViewsAskew]

Oops.. I meant to say that people who play racket sports have less Alzheimer's and less dementia than people who play other sports

I had been playing pickleball last summer until I injured my hip. Maybe I need to get back to it. If only I could figure out what was causing the hip problem, darn it.

[Bill Field]

I have nocturia in addition to PLMD. My urologist has suggested to me to put my feet over my heart (lying in bed and putting feet up again the wall) for 45 minutes in the afternoon. It reduces the water retention in the legs. I have noticed that on days that I do that, muscle inflammation in my quad muscles is reduced and it improves my sleep. Has anyone else had the same experience? Bill

[badnights]

I have nocturia in addition to PLMD. My urologist has suggested to me to put my feet over my heart (lying in bed and putting feet up again the wall) for 45 minutes in the afternoon. It reduces the water retention in the legs. I have noticed that on days that I do that, muscle inflammation in my quad muscles is reduced and it improves my sleep. Has anyone else had the same experience? Bill

Fascinating! How long before bedtime do you do the feet-up pose? Can it be 8 hours before or does it have to be within 4 hours before or ,...?

[Dr.Placebo]

Anyone with edema (even a little bit) should elevate their legs for a while (45 minutes sounds good) before bed so all that fluid can go downhill to your kidneys. Then stand up for a bit and maybe walk around and it goes down to your bladder! And then into the toilet! So less getting up during the night to pee! Just simple physics (gravity).

I love effective medical treatments that don't require drugs! Even just lying flat helps, or a few degrees of leg elevation. Not everyone wants to put their feet up the wall, though that does sound kind of relaxing and may work faster.

Beth, as for how long before bed, well, if your goal is to reduce nocturia then you want your bladder to be empty when you go to bed, so it's best to do the above procedure sometime in the evening after the last time you're going to drink any fluids. Right before bed is easy to remember.

[badnights]

Beth, as for how long before bed, well, if your goal is to reduce nocturia then you want your bladder to be empty when you go to bed, so it's best to do the above procedure sometime in the evening after the last time you're going to drink any fluids. Right before bed is easy to remember.

My goal is to see if I can reproduce the side benefit that Bill had, of reduced WED/RLS symptoms! As such I think I will prop them up against the wall at 90 degrees instead of just elevate a bit - thanks for the reminder, I had forgotten I wanted to try this!

[Bill Field]

My urologist suggests putting feet over heart during the late afternoon. I think it also helps reduce inflammation in my quad muscles. A physican's assistant said that made sense.

[badnights]

Ah, thank you. I tried it once, at bedtime. It didn't have any effect. I will try it a few more times just for the heck of it. I actually like the feeling. (It's a yoga pose, too!)

[Bill Field]

I only can consistently get five or six hours of sleep a night. I recently read, "5 or 6 hours of sleep may be appropriate for older adults". I hope the author is correct. Does any of you get seven or more hours of sleep per night?

[Rustsmith]

I get about 9 hrs each night, but I don't know how much of that time I am actually asleep. I know that I probably get the most rest between 6A and 7:30A each morning. And with all of that, I still need about an hour or longer nap later each morning.

To do this, I need to take a number of meds each night. But I should also add that in addition to RLS, I also have RBD (REM Sleep Behavior Disorder) and UARS (a mild form of sleep apnea). During my last two sleep studies, my sleep efficiency was only 44%, so although nine hours may sound good, I am probably only getting about 4 hrs of actual sleep each night.