What happens at sleep onset? |
Does the child seem fidgety and have difficulty settling? |
At sleep onset Amir does seem fidgety and has difficulty settling down. Despite 11 hours of sleep, he is difficult to get up in the morning and seems not well rested.
|
Does the child move his legs? Does the child complain of leg discomfort? |
He does move his legs but does not complain of leg discomfort. He goes to bed at 7 pm and it can take him 45 minutes to fall asleep. |
Are their prolonged awakenings during the night with similar issues noted at bedtime? |
Once he is asleep he does not recall kicking his legs or waking up with leg discomfort. His family reports he is a very restless sleeper and “tears up the bed". In fact, they can sometimes hear him kicking the wall. |
Does the caregiver note kicking during sleep? |
How often does this happen at night? |
When on vacation no one wants to share a bed with Amir because his kicking makes sleep very difficult. |
How long has this been going on? What was the age when this started? Are the events becoming more or less frequent? |
His family has noticed this problem for the past year and they feel it is getting worse. |
Screen for other sleep issues (OSA, restless leg syndrome) |
|
No other sleep issues reported. |
Review of Medications |
Is this child taking medications which can worsen leg movements including antihistamines, antidepressants or metoclopramide? |
Mom reports that she has given him an diphenhydramine at bedtime for the past 6 months because she found information on a parents’ chat room on the internet that this could help his sleep. He takes no other medications.
|
Are there are medical issues that are associated with RLS or PLMs such as sickle cell anemia, spinal cord injury, iron deficiency or uremia?
|
Mom reports that she was told that Amir had “low blood” from their previous pediatrician. He has no other serious medical problems. |
PSG was ordered showing a sleep onset latency of 45 minutes and otherwise normal sleep architecture. He had rare respiratory events with an AHI of 0.1 and no snoring. He was noted to kick his legs prior to sleep onset and during sleep. His PLM index was 15 and the arousal index associated with his leg movements was 10. |
Assess for family history of sleep disorders |
|
Mom is uncertain if any family members have a history of PLMD or RLS. |
Dietary intake should also be reviewed specifically for iron containing foods or the lack of these foods. Is the child observing a special diet?
|
|
Amir is a picky eater and does not like to eat meat. He prefers vegetables and his older sister is a vegetarian so the mom cooks to allow both Amir and his older sister to eat the same foods. |
Caffeine intake is associated with PLMs/RLS and should be specifically reviewed.
|
|
Amir has adopted the southern tradition of drinking sweet tea at dinner and has 2 glasses each night. |
Any family history of PLMD or RLS? |
Mom is uncertain if any family members have a history of PLMD or RLS.
|
No known family history of PLMD or RLS. |
Are there any additional psychosocial stressors affecting the child or family? |
|
The social worker has learned that there has been parental conflict and Amir may be kicking the wall when he hears arguing. School issues may be partially related to this conflict which is upsetting to Amir. |