Jerking legs that shake the bed might be PLMS

Keith Roach
To Your Health

Dear Dr. Roach: My husband will be 82 in July. About three years ago, I became aware of his sudden movements during the night. We were renting in Florida, and the bed was smaller than our bed at home. His body would jerk, sometimes strongly. These movements would not wake him; he just seemed asleep. He does not remember anything about it in the morning.

We went to see his doctor at home, who said that he is in very good shape. He did not know what caused the movements.

We are once again staying in Florida, and his body movements are the same, sometimes strong enough to shake the bed. I find it hard to believe that this is normal. Do you have any advice?

B.N.S.

Dear B.N.S.: This is a classic description of a condition called periodic limb movements of sleep. These usually involve the legs, and typically involve pointing the toe while flexing the ankle, knee and sometimes the hip. Each movement lasts a few seconds and repeats every 30 seconds or so. Your story that he doesn't remember them is very typical: It's usually the sleeping partner who notices them. PLMS is more common in older adults.

PLMS by itself is not a disease and does not need treatment; however, it is often associated with other conditions, especially restless leg syndrome (Willis-Ekbom disease), rapid eye movement sleep behavior disorder (which includes sometimes violent movements) and narcolepsy.

Since your husband apparently has no symptoms, he does not need treatment. However, he should be specifically asked about symptoms like an urge to move the legs while awake, abnormal feelings in the legs, difficulty falling asleep and sleepiness during the day. These would be likely to indicate RLS or its close relative, periodic limb movement disorder.

Dear Dr. Roach: My wife, age 70, complains frequently of a sour taste in her mouth soon after eating. I thought she had esophageal reflux, but I did not find that sour taste is one of the symptoms. She has no heartburn, but the taste occasionally improves after taking an antacid.

B.P.

Dear B.P.: Gastroesophageal reflux disease can have no symptoms, or many. Sour taste is, in fact, a common symptom. This is the "reflux" of the condition's name, since it refers to the backward movement of stomach acid — all the way into the back of the throat or even into the mouth. Heartburn is perhaps the most common symptom, but so is difficulty swallowing. This is more common in people with longstanding symptoms.

Antacids neutralize the acid in the stomach, but do not prevent the reflux of stomach contents. Widely prescribed medications, including H2 blockers like Zantac or Pepcid ("H2" is a type of histamine receptor, a stimulus for acid production) and proton pump inhibitors (like Prilosec or Nexium, which directly reduce acid secretion), also act on the acid in the stomach, and do not reduce reflux. In order to reduce reflux, I recommend eating smaller meals, not reclining for two to three hours after eating, losing weight if appropriate and avoiding products that weaken the lower esophageal sphincter, the valve-like muscle at the bottom of the esophagus. Alcohol and tobacco are the biggest offenders.

Raising the head of the bed (traditionally with a brick, but foam wedges also are good) uses gravity to help the refluxed acid get out of the esophagus. Reducing reflux or acid at night is most important. While the body is in a horizontal position, the acid can stay longer in the esophagus and cause damage.

Email questions to ToYourGoodHealth@ med.cornell.edu.