one step closer to the magic number of questions - 10
I could phrase this as a very short question:
What is the connection between WED and PLMS?
But this doesn't explain what I really want to know. Let me break it down into several detailed questions.
- WED and PLMS are clearly correlated, but is there a cause and effect relation (whatever causes PLMS is likely to cause WED, or the other way around)? Or are they different symptoms of one disease, do they have a common cause?
- As far as I know there are two kinds of PLMS: The ones that do not disturb sleep (but may disturb the spouse ), and the ones that cause arousals (the sleeper will wake up) or micro-arousals (preventing deep sleep, usually unnoticed by the sleeper), causing fragmented and less restful sleep. Are WED sufferers more likely to have the PLMS causing arousals?
- Are the sleep arousals caused by the PLMS, or are the PLMS just a reaction to an arousal that was caused by something else (like WED symptoms)?
- Is it interesting to monitor PLMS at all?
- Can the presence and severety of PLMS give an indication on how the WED should be treated? Are certain forms of WED (painful/electric, ideopathic/secondary) more associated with PLMS than others?
I'm asking these questions because I notice rather significant variations in my sleep quality. I went through a long list of WED drugs during the last year, and had months where the total amount of sleep wasn't that bad (5-7 hours per night), yet I was completely in "zombie" mode - significant daytime sleepiness, memory problems, the whole package, even after nights with decently long sleep. During the last months my WED symptoms were just as bad and I had perhaps less sleep than before, but I felt fairly refreshed after a good night - and even a few bad nights wouldn't cause "zombie" mode. I can rule out sleep apnea because I have a CPAP machine, but my sleep neuro says I don't really need it because the number of apneas per hour without the CPAP is rather low - with the CPAP it's a solid zero. So I guess there must be other factors at work, and since I know that I have micro-arousal-type PLMS, it is likely that the PLMS made the difference.
The bottom line is: The efficiency of WED medication should not exclusively be measured on how good it relieves the waking symptoms, but also how efficiently it treats the PLMS. But it seems clear that we need to get a better understanding of the connection between WED and PLMS.