Periodic leg movements during wake epochs.

Moderator: labman2

Periodic leg movements during wake epochs.

Postby ineedmoresleep123 » Wed Jun 01, 2016 10:31 am

Hi,

This was asked a few years ago I see - I just wanted confirmation it hasn't changed.

Even if the patient is asleep during the segment in an epoch scored as W, it cannot be scored, is that right?

Even if they are having periodic leg movements for a great period of time during sleep epochs before and after that. If it is a W epoch with leg movements, it cannot be scored?

Thanks for any clarification!
ineedmoresleep123
New Member
 
Posts: 3
Joined: Wed Jun 01, 2016 10:28 am

Re: Periodic leg movements during wake epochs.

Postby somnonaut » Wed Jun 01, 2016 3:22 pm

Not sure what you mean here:

"Even if they are having periodic leg movements for a great period of time during sleep epochs before and after that."

If the LM OUTSIDE of a W period are within the PLM periodicity rules, then the scoring of LM PAST W epochs should continue, ignoring the LM in Wake epochs.

"When a period of wake <90 seconds separates a series of LMs, this does not prevent LMs preceding the period of wake
from being included with the subsequent LMs as part of a PLM series."


Figure 8
Image

My opinion: I think it silly to not differentiate the preceding time BEFORE the LM (as in arousals) to qualify LM. Why should we throw out LM just because they happen within an epoch of W, when they could have been the CAUSE of the epoch of wake. They could have happened in the beginning of the epoch during the first half (while in sleep) but caused the arousal (15+ sec) causing the epoch to be scored W, but in reality the LM is totally a SLEEP related event. Another of the silly confines of using arbitrary 30 second epochs to categorize sleep/wake when in reality it is a fluid/dynamic process. Just another silly thing in the sleep field. Chalk it up besides the silly usage of:
Insomnia, why insomnia, what happened to Hyposomnia? Shouldn't there be a spectrum from Hyper to Hypo wakefulness, just like Hypo to hypersomnolence?
Sleep Inertia, It is NOT inertia it is MOMENTUM. Sleep is dynamic, ergo the ability to change states differs as a function of sleep state (easier from REM than from SWS) so the issue is our Sleep MOMENTUM is different (ability to change out brain state is dependent on which brain state we are in) Inertia, be definition, is stationary and only has ONE characteristic. This has really ticked me off.
When you look at sleep as a truly moment by moment dynamic process such as done by using Z-ratio, you can appreciate these subtleties. http://www.z-eeg.com
User avatar
somnonaut
Senior Member
 
Posts: 14134
Joined: Thu Dec 11, 2003 6:03 pm
Location: http://tinyurl.com/righteousdude

Re: Periodic leg movements during wake epochs.

Postby ineedmoresleep123 » Wed Jun 01, 2016 5:23 pm

somnonaut wrote:Not sure what you mean here:

"Even if they are having periodic leg movements for a great period of time during sleep epochs before and after that."

If the LM OUTSIDE of a W period are within the PLM periodicity rules, then the scoring of LM PAST W epochs should continue, ignoring the LM in Wake epochs.

"When a period of wake <90 seconds separates a series of LMs, this does not prevent LMs preceding the period of wake
from being included with the subsequent LMs as part of a PLM series."


Figure 8
Image

My opinion: I think it silly to not differentiate the preceding time BEFORE the LM (as in arousals) to qualify LM. Why should we throw out LM just because they happen within an epoch of W, when they could have been the CAUSE of the epoch of wake. They could have happened in the beginning of the epoch during the first half (while in sleep) but caused the arousal (15+ sec) causing the epoch to be scored W, but in reality the LM is totally a SLEEP related event. Another of the silly confines of using arbitrary 30 second epochs to categorize sleep/wake when in reality it is a fluid/dynamic process. Just another silly thing in the sleep field. Chalk it up besides the silly usage of:
Insomnia, why insomnia, what happened to Hyposomnia? Shouldn't there be a spectrum from Hyper to Hypo wakefulness, just like Hypo to hypersomnolence?
Sleep Inertia, It is NOT inertia it is MOMENTUM. Sleep is dynamic, ergo the ability to change states differs as a function of sleep state (easier from REM than from SWS) so the issue is our Sleep MOMENTUM is different (ability to change out brain state is dependent on which brain state we are in) Inertia, be definition, is stationary and only has ONE characteristic. This has really ticked me off.
When you look at sleep as a truly moment by moment dynamic process such as done by using Z-ratio, you can appreciate these subtleties. http://www.z-eeg.com



Thanks for the reply.

Yeah, the studies I have been analyzing have PLMS of over 100 an hour, with many many arousals. of course there are going to be wake epochs. It doesn't make sense to me to ignore the ones that are in the wake epochs. Oh well. That's how the rules are I guess
ineedmoresleep123
New Member
 
Posts: 3
Joined: Wed Jun 01, 2016 10:28 am

Re: Periodic leg movements during wake epochs.

Postby ineedmoresleep123 » Wed Jun 01, 2016 5:38 pm

Image

terrible picture, but point should kinda be there
ineedmoresleep123
New Member
 
Posts: 3
Joined: Wed Jun 01, 2016 10:28 am

Re: Periodic leg movements during wake epochs.

Postby StuKing » Wed Jun 08, 2016 2:36 am

Agree with somnonaut.

Here's another question: Version 2.3 of the AASM rules specify that...
An arousal and a limb movement that occur in a PLM series should be considered associated with each other if they occur simultaneously, overlap, or when there is <0.5 seconds between the end of one event and the onset of the other event regardless of which is first.


Then the arousal rule states that an arousal must have at least 3 seconds duration, and may (must? - wording ambiguous in Note 5) be scored prior to a transition to W.

So, if you score an arousal that leads to a period of wake, that entire period of wake should be considered as the arousal (as per AASM rules). So if there is a limb movement as the person goes BACK into N1, within 0.5s of sleep onset, then that arousal should be considered as associated with that limb movement. While I agree with the new rule that an arousal should be scored prior to a transition to wake, what happens with limb movements AFTER that period of wake. Common sense should prevail, but what's the upper time limit for arousals to be considered as associated with limb movements at resumption of sleep? 10 seconds? 30 seconds? 1 hour? Transition to W?

Strictly applying these rules could mean that if you recorded a full 24 hour study, a transition to sleep in the evening with a limb movement within 0.5s of sleep onset would result in the awakening at the start of that day being associated with that limb movement, let's say 12 hours later.
StuKing
Member
 
Posts: 61
Joined: Sun May 04, 2008 10:24 pm

Re: Periodic leg movements during wake epochs.

Postby somnonaut » Wed Jun 08, 2016 12:34 pm

Not sure I fully understand your question:'
"...what's the upper time limit for arousals to be considered as associated with limb movements at resumption of sleep? 10 seconds? 30 seconds? 1 hour? Transition to W?"

An arousal and a limb movement that occur in a PLM series should be considered associated with each other if they occur simultaneously, overlap, or when there is <0.5 seconds between the end of one event and the onset of the other event regardless of which is first.

It seems the rule takes care of LM POST wake period.

In your example, "Strictly applying these rules could mean that if you recorded a full 24 hour study, a transition to sleep in the evening with a limb movement within 0.5s of sleep onset would result in the awakening at the start of that day being associated with that limb movement, let's say 12 hours later."

A single LM in this scenario is not a "PLM episode" so it does not matter. There cannot be a chain of these types of events as this one event accounts for the full 24hr. period. There is no room for other events so the issue is moot.

What am I missing?
User avatar
somnonaut
Senior Member
 
Posts: 14134
Joined: Thu Dec 11, 2003 6:03 pm
Location: http://tinyurl.com/righteousdude

Re: Periodic leg movements during wake epochs.

Postby StuKing » Wed Jun 08, 2016 11:15 pm

Stupid me. I study these rules intensely, and seem to have missed seeing the "in a PLM series" bit. A bit embarrassing.
StuKing
Member
 
Posts: 61
Joined: Sun May 04, 2008 10:24 pm

Re: Periodic leg movements during wake epochs.

Postby somnonaut » Thu Jun 09, 2016 5:32 am

Stu,
No matter, it is not as embarrassing as my extremely poor understanding of bits a few years back here. I get all mucked up with these overly complex complex rules also. It seems a good dose of parsimony is needed.
User avatar
somnonaut
Senior Member
 
Posts: 14134
Joined: Thu Dec 11, 2003 6:03 pm
Location: http://tinyurl.com/righteousdude

Re: Periodic leg movements during wake epochs.

Postby StuKing » Thu Jun 09, 2016 11:53 pm

Mmmmm, parsimony. Delicious.
StuKing
Member
 
Posts: 61
Joined: Sun May 04, 2008 10:24 pm


Return to Scoring Sleep Studies

Who is online

Users browsing this forum: No registered users and 1 guest