Restless Legs Syndrome
What is Restless Legs Syndrome?
"After I get in bed, a gremlin grabs my legs and leads me around like a puppet."
"My legs decide they want to run, and I have to follow."
Restless Legs Syndrome is a movement disorder. It involves an intense urge to move your legs at bedtime. RLS symptoms vary from person to person. These symptoms can be hard to describe. Many people say their legs feel “creepy” or “crawly.” This is quite different from the pain of a muscle cramp. The uncomfortable sensations of RLS appear most often in the calves of the legs. They are usually worse when sitting or lying still. You can find temporary relief by stretching or moving the legs. Some people also have symptoms in the arms and other parts of the body.
“Periodic limb movements are exhibited during sleep rather than while awake and usually occur in the legs but may also affect the arms.”
Some people with RLS have symptoms only at certain times. Others have them on a regular basis. Nightly symptoms can create a constant need to stretch or move the legs. This may prevent you from falling asleep or staying asleep. As a result, people with RLS often have poor sleep quality. They may be very tired during the day. They also may be unable to perform well at work or take part in social activities.
Sleepiness is only one daytime problem that RLS causes. RLS symptoms also can make it hard to travel by car or airplane during the day. This is because it is hard to sit still for long periods of time. RLS also may interfere with your ability to stay seated at movies, concerts, and in business meetings. The sleep loss and disturbance of daytime activities can even lead to anxiety and depression.
Most people with RLS also have periodic limb movements (PLMs). These movements tend to consist of an extension of the big toe. This occurs together with an upward bending of the ankle, knee, or hip. The movements are sometimes described as jerks or kicks. PLMs occur at regular intervals. They usually happen every 20 to 40 seconds. They also tend to occur in clusters in the first half of the night. PLMs usually occur in the legs but may also affect the arms.
PLMs occur most often when you are asleep. You are unaware of them and you have no control of them. On rare occasions you may notice the PLMs while you are still awake. In contrast, RLS may cause movements when you are awake. They are a voluntary response to uncomfortable feelings in your legs.
Like RLS, PLMs may contribute to poor sleep quality. These leg movements often cause you to briefly wake up from your sleep. These brief awakenings are called “microarousals.” They can cause your sleep to feel unrefreshing or disturbed. You also may find yourself falling asleep easily during the day. This can occur while you are reading, watching TV, working or driving. PLMs also may disturb the sleep of your bed partner. He or she may complain of being kicked or bumped during the night. Your leg movements may also twist or pull the covers off bed.
"Five to 15 of every 100 people experience the discomfort of RLS at some time in their lives."
RLS often appears in otherwise healthy people. It can occur at any age in both men and women. Between five and 15 of every 100 people have the discomfort of RLS at some time in their lives. It may come and go over the years without any obvious cause. It occurs more often in women and in older people. Recent reports show that it can affect children. RLS in children may be called “growing pains” by mistake. Children with RLS also may be misdiagnosed with attention-deficit/hyperactivity disorder (ADHD). RLS causes them to be restless and inattentive. RLS also can be severe during pregnancy, especially during the last six months. Studies show that more than 80% of people with RLS also have PLMs. But the majority of people with PLMs do not have RLS.
“Home remedies are effective for some people with RLS. These remedies include: hot bath, leg massage, applied heat, ice packs, aspirin, or other over the counter pain relievers”
What Causes RLS?
RLS may be hard to describe, but it is not a psychological or emotional condition. Researches are unsure of its exact cause. Current studies are focused on a brain chemical known as dopamine. Medications that increase dopamine in the brain have been effective at relieving RLS symptoms.
Some people have medical conditions that seem to increase the chance of developing RLS. These conditions include the following:
• Low blood iron levels
• Poor blood circulation in the legs
• Nerve problems in the spine or legs
• Muscle disorders
• Kidney disorders
• Certain vitamin or mineral deficiencies
RLS may also be inherited from a parent. If you have this form of RLS there is a good chance other members of the family are affected. About 50% of people with RLS who don’t have one of the medical conditions listed above have a family member with similar symptoms. This strongly suggests a “hereditary” cause for this disorder in some people. For unknown reasons, hereditary cases of RLS tend to be more sever and harder to treat.
No matter what the cause, some medications may trigger RLS. These include over-the-counter allergy and cold medications. Caffeine, alcohol, and tobacco use may make the condition worse.
How is RLS Diagnosed?
You may need to see a sleep specialist or neurologist who has expertise with RLS. There is currently no blood test or x-ray that detects RLS. Your doctor will base a diagnosis on a complete medical history and physical exam. Additional tests may help determine if your complaints are related to another medical condition. These tests might include blood work, x-rays or an overnight sleep study. Most of the time RLS symptoms are so unique that the diagnosis will be obvious.
Having all of these symptoms clearly indicates that you have RLS:
1. You have an intense urge to move your legs.
2. You have unpleasant sensations in your legs that you might describe with these words: creeping, crawling, pulling, tingling, or electric feelings.
3. Symptoms are worse when resting or inactive, especially when sitting or lying down.
4. Moving your legs relieves the symptoms.
5. Symptoms are worse in the evening or at bedtime.
How is RLS Treated?
The first step in treating RLS is to see if you have any other conditions that are related to the problem. Other conditions that might be related to RLS include the following:
• Iron deficiency anemia
• The use of medications
Detecting and treating these conditions may sometimes relieve the symptoms of RLS. For many people with RLS, their symptoms continue even after they receive treatment for other conditions. Other people may have inherited a form of RLS that is not caused by any other disorder.
“Many people with PLMD need no treatment because they sleep through the limb movements and have no significant symptoms.”
Home remedies are enough to help some people with mild or occasional RLS. These remedies include:
• Hot baths
• Leg Massage
• Applied Heat
• Ice Packs
• Aspirin or other pain relievers
• Regular exercise
• The elimination of caffeine
Some people also find that staying mentally active in the evening relieves their symptoms. They might do crossword puzzles or play a board game.
When symptoms are severe or home remedies are ineffective, you can take prescription medications to treat RLS. Some people respond better to certain medications than to others, so your doctor may have you try several drugs over a period of time. Several factors will affect the success you have with any of these drugs. The severity of your condition will be important. Other medical problems that you have will also be a factor. Other medications that you take will have an impact on your treatment success. All medications have potential side-effects. A doctor needs to carefully monitor your treatment for RLS.
What are the signs and symptoms of Obstructive Sleep Apnea?
If you or someone you know snores regularly and has one or more of the following symptoms, it may be Obstructive Sleep Apnea:
• Snoring, interrupted by pauses in breathing
• Gasping or choking during sleep
• Restless Sleep
• Excessive sleepiness or fatigue during the day
• Poor judgment or concentration
• Memory loss
• High blood pressure
• Large neck size (>17" in men; >16" in women)
• Crowded airway
• Morning headache
• Sexual dysfunction
• Frequent urination at night
What should you do if you suspect you may have Obstructive Sleep Apnea?
See your doctor; evaluation by a doctor specializing in sleep disorders is recommended. Have a sleep study done; a sleep study can provide the doctor with information about how you sleep and breathe. This information will help the doctor to determine your diagnosis and treatment options.
“Temporarily stopping one or more medicines may help determine if one of them is making your sleep disorder worse."
Courtesy of the American Academy of Sleep Medicine (http://www.aasmnet.org)