Muscle Spasms and Leg Movements During Sleep
Original Post: When I wake up in the morning, before I can get out of bed I have to stretch and make my arms and legs go as rigid as I can. I have to do this two or three before I can function properly.
Dr. Bruno’s Response: Painful muscle spasms when you wake from sleep in the morning, usually happens during REM (dream) sleep when your brain actually paralyzes your muscles, sounds like another polio paradox. But the clue as to why muscles go into spasm after you wake lies in the brain's ability to control your motor neurons and your muscles.
Spinal cord motor neurons are like misbehaving, stubborn children. They want to make muscles contract all the time. Its what motor neurons do! But, to prevent the "kids" from doing what they want their "parent," the brain, sends signals to the spinal cord telling the kids when and how much they should turn muscles on and, just as important, turn muscles off. If something interferes with the signal to turn muscles off -- like a sleeping, poliovirus-damaged brain -- the kids indeed do what they want:
They turn muscles on! And when turned on for too long you get rigid muscles and painful spasms come morning.
You can see the result of this brain/spinal cord disconnection in a condition that continued . . .
polio survivors know well: Leg movements in sleep. Poliovirus-damage to brain muscle control neurons prevents the sleeping brain from automatically sending a "turn off" signal to the spinal cord and allows motor neurons to do what they want: Contract! Our studies of sleep in polio survivors found that these contractions don't just happen in leg muscles but can happen in muscles anywhere -- arms, abdomen, chest and, maybe most painfully, the back and neck.
How do you prevent sleep spasms? Since alcohol turns brain output signals down, you shouldn't drink in the evening. Over using your muscles during the day "irritates" poliovirus-damaged motor neurons and makes them more likely to cause those muscles to contract. Stretching and painless posture during the day, stretching and a hot bath before bed and keeping the muscles that spasm warm while you sleep (using a heating pad with an automatic shut off or a little dab of Capzasin) can help.
The most effective treatment is 0.5 - 2.0 mg of alprazolam (Xanax) 30 minutes before bed. Alprazolam, like its grandfather diazepam (Valium), directly turns off spinal cord motor neurons during sleep when the post-polio brain can't. We hope your doctor won’t say "No" to alprazolam because "it's addictive." The potentially addictive effect of the drug -- relaxation -- occurs when you can't feel it, i.e., during sleep. Alprazolam is a Valium-like drug that directly quiets the spinal cord motor neurons that cause your muscles to twitch at night. In 30+ years, we never have had a Post-Polio Institute patient become addicted to alprazolam or even require higher doses over time. Once the right dose is found, that's the dose the polio survivors' stay on.
Sweet spasm-free dreams!
There is more information under the topic of “Sleep” in the index for the Encyclopedia of Polio and PPS.