What
is it?
Restless legs syndrome (RLS)
is when you have a strong urge
to move your legs. This urge
is very hard to resist. It often
comes with other uneasy feelings
deep inside the legs. You can
have a very hard time trying
to explain what this feels like.
The sensation might be like
burning, prickling, itching
or tingling. It can even be
more extreme and feel painful.
These feelings, along with the
urge to move, are made worse
by rest. Lying or sitting still
can be very hard. Temporary
relief is found when you walk
or move the legs. This relief
tends to come right away.
The urge to move the legs grows
worse at night and eases in
the morning. RLS makes it very
hard for you to rest or go to
sleep. People with severe RLS
may get less than five hours
of sleep each night. This total
sleep time is lower than with
almost any other sleep disorder.
Milder RLS will not disturb
your sleep as much. People with
RLS feel very tired and have
less energy during the day.
They are also more likely to
suffer from depression or anxiety.
A related problem is that your
leg muscles might tighten or
flex while you are still. These
movements can be out of your
control. In extreme cases, they
can take the form of periodic
limb movements. These simple,
repetitive muscle movements
can occur when you are awake
(periodic limb movements of
wakefulness or PLMW). This can
make it even harder for you
to go to sleep. They can also
occur while you sleep (periodic
limb movements of sleep or PLMS).
This can wake you up and make
it harder for you to fall asleep
again. Eighty to 90% of patients
with RLS also have PLMS.
Mild RLS may show up for only
a short period of time. It may
also return after being gone
for a long while. Symptoms tend
to become more intense and last
longer over time. It normally
starts in the legs but may progress
to more of the body. It will
occasionally start in the ankles
or feet. How bad it feels can
vary from day to day. It is
made worse when you are not
active for a long period of
time. This could be due to sitting
in a theater, working at a desk,
or taking a long plane or car
ride.
Who gets it?
RLS occurs between 1.5 and
two times more often in women
than in men. Studies show that
adults in the U.S. and Northern
Europe have it at a rate of
5% to 10%. Studies also show
that fewer people seem to have
it in Asia.
It can occur at any age, from
early childhood to late adult
life. In children, RLS can be
wrongly called “growing
pains.” Some think that
RLS in children may be related
to attention-deficit/hyperactivity
disorder. This idea has not
yet been proven.
Secondary RLS is caused by
other disorders or medical conditions.
It is resolved when the other
conditions are treated. It has
clearly been shown to be associated
with the following:
Pregnancy
End-stage renal (kidney) disease
Iron deficiency and all conditions
that produce low iron
Peripheral neuropathy (a disease
or abnormality of the nervous
system)
Some medications
Most antidepressants (one antidepressant
that does not trigger RLS is
buproprion)
Sedating antihistamines
Virtually all centrally active
dopamine-receptor antagonists,
including anti-nausea medications
Primary RLS is not directly
caused by another sleep disorder
or medical condition.
There may be a link between
some sleep related eating disorders
and RLS. This idea needs to
be studied further.
RLS has an “early onset”
when it starts before the age
of 45. Signs of it may show
up very slowly over time. Daily
feelings of uneasiness in the
legs do not always start right
away. But these feelings usually
occur on a daily basis after
the patient is 40 to 65 years
old. Late-onset RLS occurs more
quickly and more often. Sometimes,
it will occur daily from the
time that it starts.
More than 50% of people with
primary RLS report a pattern
of it in their family. The risk
of RLS is about three to six
times greater when an immediate
relative has it. Early onset
of RLS points to a higher rate
of RLS in the family.
How do I know if I
have it?
1. Do you have an urge to move
your legs or uncomfortable sensations?
2. Is this urge worse when
you are at rest?
3. Do your legs seem to feel
better when you walk, stretch
or make other movements?
4. Are these feelings worse,
or do they only occur, in the
evening or at night?
If your answer to each of these
questions is yes, then you might
have RLS.
It is also important to know
if there is something else that
is causing your sleep problems.
They may be a result of one
of the following:
Another sleep disorder
A medical condition
Medication use
A mental health disorder
Substance abuse
The feelings related to RLS
can be very hard to describe.
This can also make it hard to
know for sure if someone has
it. This is true for adults,
but even more so for children.
They often don’t have
the words to tell someone what
is wrong. This makes it more
important to know if the child’s
parent or other relative has
RLS.
Do I need to see a sleep
specialist?
Mild RLS may not bother you
enough to seek medical help.
You will want to see a sleep
specialist if you think you
may have a more severe case
of RLS. It can greatly disturb
your sleep. This can hinder
you at work and at home by making
you very tired during the day.
It can also play a part in causing
depression or anxiety. Your
overall quality of life can
suffer greatly.
What will the doctor
need to know?
You should complete a sleep
diary for two weeks. This will
give the doctor clues as to
what might be causing you problems.
You can also rate your sleep
with the Epworth Sleepiness
Scale. This will help show how
your sleep is affecting your
daily life. The doctor will
need to know your complete medical
history. Be sure to inform him
of any past or present drug
and medication use. Also tell
him if you or a relative have
ever had a sleep disorder.
Will I need to take
any tests?
Your doctor may have you do
an overnight sleep study (polysomnogram),
but this is not usually needed
to detect restless legs. The
polysomnogram charts your brain
waves, heart beat, and breathing
as you sleep. It also records
how your arms and legs move.
The best sleep study will also
record your sleep on video.
This will help show in clear
detail how your legs move during
the night.
Your doctor may order blood
tests, including measuring iron.
How is it treated?
A regular exercise program
may help restless legs. Reducing
caffeinated drinks, alcohol
use or smoking may also help.
You may also reduce RLS by keeping
mentally active while you are
sitting down. When restless
legs occurs, any of the following
activities may help:
Walking
Riding an exercise bike
Massaging the legs
Soaking in a hot tub
Many medications are available
to treat restless legs. The
most commonly used ones are
drugs that replace a chemical
in the brain called dopamine.These
drugs are also used to treat
Parkinson disease. However,
if you have restless legs, you
are not at an increased risk
of getting Parkinson disease.
Other medications used include
the following:
Sleeping tablets
Some anti-seizure medications
Narcotic pain killers
If you are shown to have iron
deficiency, your doctor may
recommend iron treatment. However,
you should not take iron without
a doctor’s advice. This
is due to the fact that too
much iron can be harmful to
the liver.
Information taken from
the American Academy of Sleep
Medicine web site: www.sleepeducation.com
|