sleep related rhythmic movement disorder

Rhythmic movement disorder

Sleep-related rhythmic movement disorder is a benign (harmless) condition that comprises a variety of disorders characterized by repetitive, stereotyped, rhythmic, repeated body movements of the large muscle groups of different parts of the body associated with sleep 1). Sleep-related rhythmic movement disorder usually emerges during transition from wakefulness to sleep but also during consolidated sleep. Sleep-related rhythmic movement disorder affects mostly infants and toddlers, with a frequency drop from 59% at 9 months to 5% at 5 years and usually disappears spontaneously before adolescence 2). Rhythmic movement disorder rarely persists into adulthood 3), where they can be idiopathic or associated with other sleep disorders including sleep apnea 4). Rhythmic humming or other sounds are sometimes made along with the body motions. These sounds can be quite loud.

Sleep-related rhythmic movement disorder is characterized by repetitive, stereotyped, and rhythmic motor behaviors occurring predominantly during drowsiness or stage N1 sleep, involving large muscle groups, with possible significant consequences such as sleep disruption and injuries. Based on the anatomical district and the type of rhythmic movement events, sleep related rhythmic movement disorder is classified in body or head rocking, banging, rolling, or combinations thereof 5).

Following are the three types of rhythmic movement disorder 6):

  1. Body rocking – The child may rock his entire body while on hands and knees. It may also occur when he rocks his upper body while sitting up.
  2. Head banging – This often occurs with the child lying face down. He lifts his head or entire upper body. Then he forcibly bangs the head back down into the pillow or mattress. This action is repeated over and over again. It may also occur when the child is sitting up. He will bang the back of his head against the wall or headboard one time after another.Body rocking and head banging may also be combined. The child will rock on hands and knees. At the same time, he will bang the front of his head into the wall or headboard.
  3. Head rolling – The head is rolled back and forth. The child is normally lying on his back.Head banging is the most disturbing form of the problem. Typical cases in infants and toddlers pose little risk of serious injury. Strong motions can cause loud noises when the child hits the bed frame. The bed may also bang against the wall or scrape the floor.

The noises can greatly distress other family members. It is normal for a parent to be concerned. No cases of serious injury caused by rhythmic movement disorder have been found. It is important for parents to discuss the child’s actions with other caretakers, family members, or baby sitters.

Less common rhythmic movement forms include the following:

  • Body rolling
  • Leg banging
  • Leg rolling

Episodes often occur when the child is almost asleep. They may also occur at any point in the night. At times, they may even happen during quiet activities when the child is awake. He or she may be listening to music or riding in a car.

The rate may vary, but the actions are rapid. One or two motions tend to occur every one or two seconds. An episode will often last up to 15 minutes. The motions may stop when a noise, movement or voice disturbs the child. Children who are old enough to talk will usually not recall the event in the morning.

These actions are common in normal infants and children. These motions alone do not qualify as a disorder. It is only a disorder if the actions severely injure the child or greatly disturb his or her sleep.

Sleep rhythmic movement disorder causes

The cause of sleep related rhythmic movement disorder remains unknown 7). Self-soothing behavior, vestibular self-stimulation, or anxiety relief have been suggested, and sleep related rhythmic movement disorder can be associated with psychiatric comorbidities or developmental disabilities 8). Other conditions, possibly mimicking sleep related rhythmic movement disorder, need to be ruled out: sleep-related seizures, parasomnias, periodic limb movement disorder, rapid eye movement sleep behavior disorder, and sleep myoclonus or tics. Familial occurrence seems to be rare 9). Walen reported on a pair of twins with jactatio capitis nocturna 10), but other sleep related rhythmic movement disorder cases in twins, have not yet been published.

Rhythmic movement disorder is very common in healthy infants and children. In childhood, sleep related rhythmic movement disorder is usually idiopathic; however, other sleep disorders can trigger or exacerbate motor events. Rarely, adult cases have been described; 39 cases of adult sleep related rhythmic movement disorder have been reported in the literature 11), 12), 13). Of these, 24 were assumed to be idiopathic, 7 associated with sleep apnea, 5 with REM sleep behavior disorder, and 3 with restless legs syndrome or periodic limb movements while you sleep (PLMS). Few cases were reported to improve with continuous positive airway pressure (CPAP). Sleep related rhythmic movement disorder in adult patients may imply sleep-disordered breathing, possibly associated with longer respiratory events. This may speak against an unsafe treatment with benzodiazepines, which are usually the first-line therapy for idiopathic sleep related rhythmic movement disorder, but which can aggravate sleep apnea 14). When sleep apnea is confirmed, treatment with CPAP might be beneficial also for rhythmic movement events.

The relationship with a previous sleep related rhythmic movement disorder in infancy or with other sleep disturbances is unclear 15).

Body rocking begins at an average age of six months. Head banging begins at an average age of nine months. At nine months of age, 59% of all infants have been reported to have one of the following rhythmic movements:

  • Body rocking (43%)
  • Head banging (22%)
  • Head rolling (24%)

At 18 months of age, the overall rate drops to 33%. It commonly goes away by the second or third year of life. By five years of age, the rate is only 5%.

It seems to occur at the same rate in both boys and girls. It may be more likely to occur among family members. One study found that children with body rocking had a higher level of anxiety.
rhythmic movement disorder has been rarely reported in teens and adults. The condition may appear at an older age due to an injury to the central nervous system. In older children or adults, these actions may be related to one of the following:

  • Mental disability
  • Autism
  • Pervasive developmental disorder

In most of these cases, the motions are not sleep related. They tend to occur when the person is awake.

Sleep rhythmic movement disorder symptoms

Your child may have rhythmic movement disorder if:

  • They make repeated body motions, such as body rocking, head banging, or head rolling
  • These body motions tend to occur when your child is drowsy or asleep
  • These actions interfere with the child’s sleep, make the child sleepy or grumpy during the day, or the child suffers an injury that requires medical treatment

It is also important to know if there is something else that is causing your child’s sleep problems. They may be a result of one of the following:

  • Another sleep disorder
  • A medical condition
  • Medication use
  • A mental health disorder
  • Substance abuse

Sleep rhythmic movement disorder diagnosis

Most children who display these actions do not need help. It is a common part of the way their sleep process develops. Talk about your concerns with your child’s doctor. You should see a sleep specialist if the motions injure your child or keep him or her from sleeping well.

First, the doctor will need to know when the motions began. He or she will also want to know what else has been going on in your child’s life. You should complete a two-week sleep diary for your child. Make note of any times when the actions occur. This will give the doctor clues as to what might be causing your child’s problems. The doctor will need to know your child’s complete medical history. Be sure to inform him or her of any past or present medication use. Also tell your doctor if your child has ever had any other sleep disorder.

No tests are needed to detect rhythmic movement disorder in most children. Your doctor may have your child do an overnight sleep study if the motions are severe. This study is called a polysomnogram. It charts your child’s brain waves, heart beat, and breathing as he sleeps. It also records how his or her arms and legs move. This will also show if there are other disorders, such as sleep apnea, that are causing the sleep problems.

The best sleep study will also record your child’s sleep on video. This will help show if your child moves or does anything unusual during the night.

In adults, experts recommend the investigation of sleep-related breathing patterns by means of a full video-polysomnography in all adults with sleep related rhythmic movement disorder, particularly in those with a new-onset disorder or a recent aggravation, as well as in those whose rhythmic movement events tend to occur also in consolidated sleep 16).

Sleep rhythmic movement disorder treatment

Medications such as clonazepam may be prescribed if the movements are disturbing the child, interfering with the child’s sleep or causing injuries 17).

Sleep rhythmic movement disorder prognosis

Sleep rhythmic movement disorder affects mostly infants and toddlers, with a frequency drop from 59% at 9 months to 5% at 5 years 18). Sleep related rhythmic movement disorder rarely persists into adulthood 19).

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