PLMI predicts total sleep time in older people with cognitive impairment, sleep disturbance

• Sleep Aid • Feb 01, 08

A higher periodic leg movement index (PLMI) predicted less sleep at night in older people with cognitive impairment and sleep disturbance, according to a study published in the February 1 issue of the journal SLEEP.

The study, authored by Kathy C. Richards, PhD, of the University of Pennsylvania, focused on 102 people (58 men and 44 women) between the ages of 59-96 years who had a clinical diagnosis of cognitive impairment (categorized as unspecified, Alzheimer disease, other, mixed, multi-infarct, and mild cognitive impairment) as well as average nightly sleep of seven or less hours and daytime sleep of 30 minutes or longer.

Ten characteristics associated with sleep disturbance (including PLMI, time in bed, cognitive status, painful conditions and depression) were assessed with one night of polysomnography.

The participants also submitted to a Mini-Mental State Examination (MMSE), a 30-item standardized screen of orientation, registration, short-term memory, attention/concentration, language, and constructional capacity items. MMSE scores range from zero to 30, with greater numbers indicating higher cognitive functioning.

The average MMSE score was 17.3. In addition, 21.6 percent had at least one painful condition and 45.1 percent were diagnosed with depression. The participants’ average PLMI was 17.3 with 33.3 percent having a PLMI greater than 15. Time in bed at night exceeded eight hours, yet participants averaged only 5.5 hours of sleep. PLMI, time in bed, and age explained 43.6 percent of the variance in total sleep time.

“Sleep disturbance in persons with Alzheimer disease and related dementias is a highly prevalent and disabling symptom that often leads to caregiver exhaustion and institutionalization for the person with dementia,” said Dr. Richards. “Sedative-hypnotics are not effective and often worsen daytime cognitive functioning and cause nighttime falls. This study demonstrates that frequent periodic leg movements at night are predictive of reduced total sleep time in older adults with Alzheimer disease and related dementias. This finding is important because treatment of periodic leg movements may result in improved nighttime sleep and improved quality of life in this vulnerable population.”

Periodic leg movement disorder (PLMD) is a condition that causes people to jerk and kick their legs every 20 to 40 seconds during sleep. As with restless legs syndrome, PLMD often disrupts sleep—not only for the patient, but the bed partner as well. One study found that roughly 40 percent of older adults have at least a mild form of PLMD.

It is recommended that older adults get between seven and eight hours of nightly sleep.

The American Academy of Sleep Medicine (AASM) offers the following tips on how to get a good night’s sleep:

* Follow a consistent bedtime routine.

* Establish a relaxing setting at bedtime.

* Get a full night’s sleep every night.

* Avoid foods or drinks that contain caffeine, as well as any medicine that has a stimulant, prior to bedtime.

* Do not bring your worries to bed with you.

* Do not go to bed hungry, but don’t eat a big meal before bedtime either.

* Avoid any rigorous exercise within six hours of your bedtime.

* Make your bedroom quiet, dark and a little bit cool.

* Get up at the same time every morning.

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Those who suspect that they might be suffering from periodic leg movements, or another sleep disorder, are encouraged to consult with their primary care physician or a sleep specialist.

SLEEP is the official journal of the Associated Professional Sleep Societies, LLC, a joint venture of the AASM and the Sleep Research Society.

SleepEducation.com, a patient education Web site created by the AASM, provides information about various sleep disorders, the forms of treatment available, recent news on the topic of sleep, sleep studies that have been conducted and a listing of sleep facilities.

For a copy of this article, entitled, “Periodic limb movements predict total sleep time in persons with cognitive impairment and sleep disturbance”, or to arrange an interview with an AASM spokesperson regarding this study, please contact Jim Arcuri, public relations coordinator, at (708)492-0930, ext. 9317, or .(JavaScript must be enabled to view this email address).