Abstract
Periodic movements in sleep (PMS) is a sleep disorder characterized by repetitive leg kicks accompanied by arousals. In our clinical experience, many patients with PMS anecdotally report that they suffer from cold feet. This study explored whether there is an increased incidence of cold feet complaints in patients with periodic movements in sleep. Results indicated that, indeed, significantly more patients with leg kicks complain of cold feet as compared to patients without leg kicks. A case study was then conducted to determine whether foot thermal biofeedback training would alleviate symptoms of periodic movements in sleep. The number of leg kicks decreased from a mean of 536 per night before biofeedback training to a mean of 19.5 after training. These data lend support to our hypothesis that poor circulation may be contributing to the severity of periodic movements in sleep and that thermal biofeedback may afford an alternative treatment strategy.
Similar content being viewed by others
References
Ancoli, S., & Kamiya, J. (1978). Methodological issues in alpha biofeedback training.Biofeedback and Self-Regulation, 3 159–183.
Ancoli-Israel, S., Kripke, D. F., Mason, W., & Kaplan, O. (1985). Sleep apnea and periodic movements in an aging sample.Journal of Gerontology, 40 419–425.
Ancoli-Israel, S., Kripke, D. F., Mason, W., & Messin, S. (1981a). Sleep apnea and nocturnal myoclonus in a senior population.Sleep, 4 349–358.
Ancoli-Israel, S., Kripke, D. F., Mason, W., & Messin, S. (1981b). Comparisons of home sleep recordings and polysomnograms in older adults with sleep disorders.Sleep, 4 283–291.
Association of Sleep Disorders Centers. (1979). Diagnostic classification of sleep and arousal disorders (prepared by the Sleep Disorders Classification Committee, H.P. Roffwarg, Chair).Sleep, 2 1–137.
Bixler, E. O., Kales, A., Vela-Bueno, J. A., Scarone, S., & Soldatos, C. R. (1982). Nocturnal myoclonus and nocturnal myoclonic activity in a normal population.Research Communications in Chemical Pathology and Pharmacology, 36 129–140.
Budzynski, T., Stoyva, J., Adler, C., & Mullaney, D. (1973). EMG biofeedback and tension headache: A controlled outcome study.Psychosomatic Medicine, 35 484–496.
Carskadon, M., Dement, W. C., Mitler, M. M., Guilleminault, C., Zarcone, V. P., & Spiegel, R. (1976). Self-reports versus sleep laboratory findings in 122 drug-free subjects with complaints of insomnia.American Journal of Psychiatry, 133 1382–1388.
Coleman, R. M. (1982). Periodic movements in sleep (nocturnal myoclonus) and restless legs syndrome. In C. Guilleminault & E. Lugaresi (Eds.),Sleeping and waking disorders: Indications and techniques (pp. 265–296). Menlo Park: Addison-Wesley.
Coleman, R. M., Bliwise, D. L., Sayber, N., deBruyn, L., Boomkamp, A., Menn, M. E., & Dement, W. C. (1983). Epidemiology of periodic movements during sleep. In C. Guilleminault & E. Lugaresi (Eds.),Sleep/wake disorders: natural history, epidemiology, and long-term evolution (pp. 217–229). New York: Raven Press.
Coleman, R. M., Miles, L. E., Guilleminault, C. C., Zarcone, V. P., van den Hoed, J., & Dement, W. C. (1981). Sleep-wake disorders in the elderly: A polysomnographic analysis.Journal of the American Geriatric Society, 29 289–296.
Coleman, R. M., Pollak, C., & Weitzman, E. D. (1980). Periodic movements in sleep (nocturnal myoclonus): Relation to sleep-wake disorders.Annals of Neurology, 8 416–421.
Coleman, R. M., Roffwarg, H. P., Kennedy, S. J., Guilleminault, C., Cinque, J., Cohn, M. A., Karacan, I., Kupfer, D. J., Lemmi, H., Miles, L. E., Orr, W. C., Phillips, E. R., Roth, T., Sassin, J. F., Schmidt, H. S., Weitzman, E. D., & Dement, W. C. (1982). Sleep-wake disorders based on a polysomnographic diagnosis.Journal of the American Medical Association, 247 997–1003.
Crockett, D., & Bilsker, D. (1984). Bringing the feet in from the cold: Thermal biofeedback training of foot-warming in Reynaud's syndrome.Biofeedback and Self-Regulation, 9 431–438.
Dzvonik, L., Kripke, D. F., Klauber, M., & Ancoli-Israel, S. (1984). Temporal relationship of body position changes and leg jerk episodes.Sleep Research, 13 92.
Ekbom, K. A. (1950). Restless legs, and report of 70 cases.Acta Medica Scandinavica, 138(Suppl 246), 64–67.
Freedman, R., Ianni, P., & Wenig, P. (1983). Behavioral treatment of Reynaud's disease.Journal of Consulting and Clinical Psychology, 51 539–549.
George, B., Ancoli-Israel, S., & Kripke, D. F. (1985). Comparison of sleep apnea and periodic movements in sleep in two age groups of females.Sleep Research, 14 156.
Gilman, A. G., Goodman, L. S., & Gilman, A. (Eds.). (1980).Goodman and Gilman's The pharmacological basis of therapeutics (6th ed.). New York: Macmillan.
Green, E. E., Green, A. M., Walters, E. D., Sargent, J. D., & Meyers R. G. (1975). Autogenic feedback training.Psychotherapy and Psychosomatics, 25 88–98.
Hauri, P. (1982). The sleep disorders. Kalamazoo, Michigan: Upjohn.
Kavey, N., Hening, W., Walters, A., Gidro-Frank, S., Cote, L., & Fahn, S. (1985). Treatment of restless legs and periodic movements in sleep with opioids.Sleep Research, 14 177.
Lugaresi, E., Coccagna, G., Berti Ceroni, G., & Ambrosetto, C. (1968). Restless legs syndrome and nocturnal myoclonus. In H. Gastant, E. Lugaresi, G. Berti Ceroni, & G. Coccagna (Eds.),The abnormalities of sleep in man (pp. 285–294). Bologna, Italy: Gaggi Editore.
Lugaresi, E., Coccagna, G., Mantovani, M., & Lebrun, R. (1972). Some periodic phenomena arising during drowsiness and sleep in man.Electroencephalography and Clinical Neurophysiology, 32 701–705.
Luthe, W. (1979). About the methods of autogenic therapy. In E. Peper, S. Ancoli, & M. Quinn (Ed.),Mind/body integration: Essential readings in biofeedback (pp. 167–186). New York: Plenum Press.
Mason, W. J., Kripke, D. F., Messin, S., & Ancoli-Israel, S. (1986). The application and utilization of an ambulatory recording system for the screening of sleep disorders.American Journal of Electroencephalographic Technology, 26 145–156.
Mitler, M. M., Browman, C. P., Gujavarty, K., Timms, R. M., & Menn, S. J. (1984). Nocturnal myoclonus: Treatment efficacy of clonazepam and temazepam.Sleep Research, 13 58.
Mosko, S. S., Shampain, D. S., & Sassin, J. F. (1984). Nocturnal REM latency and sleep disturbance in narcolepsy.Sleep, 7 115–125.
Mullaney, D. J., Kripke, D. F., & Messin, S. (1980). Wrist actigraphic estimation of sleep time.Sleep, 3 83–92.
Onada, L. (1983). Hand warming and relaxation in temperature feedback: Positive placebo effects.Biofeedback and Self-Regulation, 8 109–114.
Schulz, J., & Luthe, W. (1969).Autogenic training (Vol. 1). New York: Grune and Stratton.
Schwartz, G. F. (1973). Biofeedback as theory: Some theoretical and practical issues.American Psychologist, August, 666–673.
Surwit, R. S., Pilon, R. N., & Fenton, C. H. (1978). Behavioral treatment of Reynaud's disease.Journal of Behavioral Medicine, 1 323–335.
Taub, E. (1977). Self-regulation of human tissue temperature. In G. E. Schwartz & J. Beatty (Eds.),Biofeedback and practice (pp. 265–300). New York: Academic Press.
Ware, J. C. (1985). Nocturnal myoclonus: Possible mediation by the sympathetic nervous system.Sleep Research, 14 24.
Author information
Authors and Affiliations
Additional information
This work was supported by NIA AG02711, by NIA TNH AG03990, and by the Veterans Administration. Special thanks to Dr. Cheryl Spinweber, William Mason, and Daniel Mullaney for editorial and technical assistance. Parts of this manuscript were presented at the 1985 Annual Meeting of the Sleep Research Society and at the 1986 Annual Meeting of the Biofeedback Society of America.
Rights and permissions
About this article
Cite this article
Ancoli-Israel, S., Seifert, A.R. & Lemon, M. Thermal biofeedback and periodic movements in sleep: Patients' subjective reports and a case study. Biofeedback and Self-Regulation 11, 177–188 (1986). https://doi.org/10.1007/BF01003477
Received:
Issue Date:
DOI: https://doi.org/10.1007/BF01003477