Katy has no difficulty falling asleep by herself at home. While staying with her grandmother during the summer, she likes her grandmother to stay in the room until she falls asleep. Her grandmother has noted a jerking movement involving her entire body shortly after Katy falls asleep. Katy has no memory of these events and describes no leg discomfort or motor restlessness.
- Sleep starts occur shortly after sleep onset. Patients usually have no recollection of the movements but there may be associated sensations such as falling, vivid dreams or some sort of noise appreciated by the patient.
- RLS may cause leg discomfort and motor restlessness worsened in the evening and at rest. This may delay sleep onset.
Katy is well rested during in the morning without issues of daytime sleepiness.
- Sleep starts do not typically result in daytime sleepiness unless the patient is having severe or intense events that lead to sleep avoidance or sleep onset insomnia.
- PLMs/RLS may result in daytime sleepiness if sleep is sufficiently disrupted (see previous case).
Katy does not have problematic awakenings during the night.
- Sleep starts may occur during sleep onset after awakenings.
- RLS may result in difficulty returning to sleep after awakenings during the night leading to prolonged awakenings and difficulty returning to sleep.
Katy has a consistent bedtime and wake time. She has a regular bedtime routine with enough time in bed to obtain adequate sleep.
- This history is important to determine diagnosis particularly if symptoms of non-restorative sleep and daytime sleepiness are felt to be an issue. It is important to determine if a child has adequate sleep duration based on age related needs before attributing daytime sleepiness to an underlying sleep disorder.
Katy has no signs or symptoms of sleep disordered breathing such as snoring, difficulty breathing during sleep or sleep apnea.
- Screening for obstructive sleep apnea is important as leg movements during sleep can be noted at the termination of respiratory events. Knowing the cause of the leg movements (ie PLMs versus OSA) is important for determining the appropriate treatment.