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I remember a wonderful case. I once had. It was a gentleman who came in complaining of sleep problems. He said he’d never had problems sleeping his entire life, and this had all started quite recently in the past year. And he insisted that he slept eight hours each night, but he woke up tired every day. And I went through his sleep symptom questionnaire, and I couldn’t see anything too impressive, but I sent him off for a sleep study. And during that sleep study, it turned out he kicked his legs 378 times during the seven hour recording. And he was absolutely unaware of it. And unfortunately, about six or eight months prior to that time, he became widowed. And so he had nobody sleeping next to him so there was nobody reporting his kicking. But after he lost his wife, he developed some depression and he saw his primary care physician.
He was prescribed a common antidepressant, Prozac. And when I saw those kicks, didn’t know anything about it himself. He had nobody to tell him that he was doing it, but clearly they were on the recording. I looked at his medication list and saw that he was on Prozac, which is associated with leg kicks. And so all I did was withdraw that medication and replaced it with another. And lo and behold, his sleep was greatly improved. He no longer kicked. So restless leg syndrome is a very obvious aspect of kicking. But what he had was called periodic limb movement disorder, and patients with restless leg syndrome, 70 to 80% of them, also kick during the night. But if you kick, you don’t necessarily have to have restless legs. Whereas if you do have restless legs, you’re more likely to kick. So he just had the kicking aspect of it, and it was all a side effect of a drug.
And once we took the drug away, he slept fine. But periodic limb movement disorder is related, it’s on the spectrum of a movement disorder, just like restless legs and sometimes hidden, sometimes very obvious, if the person sleeping next to the patient gets kicked all night long, we can make that diagnosis, but sometimes we just don’t know. What had happened is that the kicking didn’t wake him up during the night in any conscious way. He was unaware of it. What it did was simply kick him out of deep stages of sleep. So he slept, just light sleep all night long. It wasn’t restorative, he wasn’t rested. And that’s how he ended up in my office.
