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Disorders - Restless Leg Syndrome and Periodic Limb Movement Disorder |
Table of Contents:
What is Restless Legs Syndrome?
What is Periodic Limb Movement Disorder?
How Common are RLS and PLMD?
What Causes These Disorders?
How are These Disorders Diagnosed?
How are These Diorders Treated?
What is Restless Leg Syndrome?
This disorder, which often appears in otherwise healthy people, is not related to emotional or psychological disorders. Although it affects mostly the legs, as the name suggests, it can also affect the arms.
People experience restless legs in many different ways, but all describe very unpleasant "creepy, crawly" sensations that occur in the legs when they are sitting or lying still, especially at bedtime. If you have RLS you know it is not like the pain of a leg cramp, or the numbness someone feels if a leg "falls asleep." RLS sensations are also different from the "pins and needles" or burning feeling a person with diabetes may experience. The uncomfortable feelings of RLS appear most often in the calves of the legs and are temporarily relieved by stretching or moving the legs.
In more severe instances, restless legs syndrome can be painful, or disturbing enough to cause insomnia. The constant need to stretch or more the legs to rid of the RLS sensations often prevent a person with RLS from falling asleep. As a result, the person may be extremely tired during the day and unable to perform well at work or take part in social activities.
The sleepiness that results from a restless night is not the only daytime problem you might experience if you have RLS. During the day, RLS can interfere with the length of time you can travel by car, airplane, or any other kind of transportation requiring you to sit still for long periods of time. RLS may disturb your ability to sit still at movies, concerts, and in business meetings. The sleep loss and disturbance of daytime activities can make you feel anxiety and depression.
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What is Periodic Limb Movement Disorder?
Another disorder that affects the limbs as well as a person's ability to sleep at night and function normally during the day is periodic limb movement disorder (PLMD), also known as nocturnal myoclonus. While the movements of RLS are a voluntary response to uncomfortable feelings in the limbs when a person is awake, the movements of PLMD occur more often when a person is asleep and are involuntary (that is, not consciously controlled).
People with periodic limb movements are often not aware of these movements, although on rare occasions they may notice the involuntary movements of PLMD while they are still awake. Most people with RLS have periodic limb movements, but patients with PLMD often do not have RLS.
Periodic limb movements usually occur in the legs but may also affect the arms. As the name implies, the movements occur at periodic (regular) intervals, usually every 30 seconds. They typically consist of an extension of the big toe, together with an upward bending of the ankle, knee, or hip. The movements are sometimes similar to jerking or kicking. They usually do not occur continuously throughout the night, but instead cluster in the first of the night.
If you experience periodic limb movements five or more times during each hour of your sleep, they may be serious enough to prevent you from sleeping. You may be awakened by leg movements occurring immediately after you fall asleep but when you awaken not ever realize you had fallen asleep. When this happens, you may complain of difficulty of falling asleep.
If you report difficulty staying asleep you may in fact be experiencing leg movements throughout the night that are accompanied by "micro arousals" (very brief awakenings) that create an overall feeling of a poor night's sleep. You may have only a general complaint of restless or poor sleep.
Some people may not be awake of any nighttime disturbance, but many brief awakenings do disturb sleep and cause excessive daytime sleepiness. This person might have no complaint about sleep at night, but fall asleep during the day, while reading, watching TV, working, or driving.
Periodic limb movements may cause several other problems, some of which may affect your bed partner and some of which affect you. Your bed partner may complain of being kicked at night, do the bedcovers being twisted or knocked off the bed, or that limb movements shake the bed. You may complain that the frequent leg movements are wearing hair off your legs.
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How Common are RLS and PLMD?
Restless Legs Syndrome
Five to 10 of every 100 people experience this discomfort of RLS at some time in their lives. The disorder is more common in older individuals but can occur at age in both men and women. RL can also be severe during pregnancy, especially during the last six months. Over the course of years, RLS may come and go without any obvious cause.
Periodic Limb Movement Disorder
PLMD is rare in people under 30 years of age, but becomes more common as people grow older. PLMD affects a small percentage of people 30 to 50; one-third of people age 50 to 65; and almost half of people over age 65. Men and women are equally likely to be affected. PLMD contributes to the inability to sleep in two out of every ten people who have been diagnosed with insomnia.
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What Causes These Disorders?
Although we don't know the actual cause of RLS or PLMD, there are some related conditions and hereditary signs to consider.
Restless Legs Syndrome
Approximately 30% of RLS cases have a hereditary cause; this means that in 30 cases out of 100, the disorder had been passed through the genes of either the father or mother to the child. The causes of the other 70% of RLS cases are not clearly known. The cases of RLS that run in families often have more sever symptoms and are often more difficult to treat.
A number of situations seem to be related or produce the symptoms of RLS. These situations include anemia, poor blood circulation in the legs, nerve problems, muscle disorders, kidney disorders, alcoholism, and vitamin or mineral deficiencies. Other things that may trigger RLS are stopping or starting certain medications, consumption of caffeine, smoking, fatigue, hot temperatures, or extended time in cold temperatures.
Periodic Limb Movement Disorder
The same factors that are associated with RLS are associated with PLMD. Periodic limb movements are more common in people who have kidney disease or narcolepsy. Some antidepressant medications can also increase the frequency of periodic limb movements.
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How are These Disorders Diagnosed?
Restless Legs Syndrome
Before prescribing for a specific treatment, your health care professional needs to be certain you have RLS. You may need to see a sleep specialist. PLS has such unique symptoms that diagnosis of this disorder can often be made basis of your description of symptoms. Some words used to describe these symptoms include creepy, crawly, pulling and gnawing. These feelings create an almost irresistible need to move the affected limb.
Another sign that points to a diagnosis of RLS is that movement of the affected limb relieves the uncomfortable feelings. However, healthcare providers need to write out your medical history to perform a physical examination to exclude other problems that may have been mistaken for RLS.
Periodic Limb Movement Disorder
PLMD often requires more extensive study to make a proper diagnosis. People with PLMD usually do not feel their nighttime movements and may complain of restless sleep or excessive daytime sleepiness. If you suspect this, you may need to have your nighttime sleep studied in order to discover the PLMD.
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How are These Disorders Treated?
The first step in treating RLS or PLMD is to determine where related conditions (such as iron deficiency anemia, diabetes, arthritis, or the use of antidepressant medications) are contributing symptoms and movements. Sometimes proper diagnosis and treatment of these conditions may relieve the symptoms of RLS or PLMD. Still, many patients find that their disturbing movements continue even after they receive proper treatment of other conditions.
Restless Legs Syndrome
Home remedies are effective for some people with RLS. These remedies include hot bath, leg massage, applied heat, ice packs, aspirin or other pain relievers, regular exercise, and the elimination of caffeine. Vitamin E and supplemental calcium have helped some people, although no studies have proven the effectiveness of these treatments.
When home remedies are not effective, RLS can be treated with prescription medications. Because a particular medication may help one RLS sufferer, and not another, several drugs may be tried over a period of time. The drugs that most often help RLS are listed in Table 1. The effectiveness of a particular drug will depend on the severity of the condition, the patient's other medical problems, and other medication that the patient is taking.
Periodic Limb Movement Disorder
Many people with PLMD need no treatment because they sleep through the limb movements and have no disturbing symptoms like unusual daytime sleepiness. Others with PLMD, who sleep lightly and are easily disturbed by the movements, maybe be able to reduce or eliminate their sleep complaints by improving the soundness of their sleep.
You may want to take a look here to view the guidelines on how to sleep well.
You may want to take a look here to view the guidelines on how to sleep well.
Selected Prescription Drugs Used to Treat RLS and PLMD |
Types of Drugs
|
Common or Trade Name |
Dopamine agonist
Benzodiazepines
Anticonvulsants
Opioids
|
Sinemat, Permax,
Parlodel,
Eldepryl, Miarapex
Klonopin, Restoril,
Valium, etc.
Neurontin, Tegretol,
Depakene
Codeine, Oxycodone,
Propoxyphene, Tramadol,
Mathadone, etc. |
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Some Drugs that Worsen RLS and PLMD |
| Types of Drugs |
Common or Trade Name
|
Antidepressants
Antihistamines
Antiemetics
Lithium
Calcium channel blockers
Major tranquilizers |
Elavil, Prozac, Paxil, etc.
Cold and allergy
preparations
Compazine, Reglanm, etc.
Eskalith, Lithobid,
Lithonate, Lithotabs
Heart disease and
hypertension
Haldol, Phenothiazines
(i.e. Trilafon, Thorazine) |
To view how to help yourself sleep better, click here to view some guidelines.
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