What You Should Know About Restless Leg Syndrome
You’ve had an exhausting day, you’re dead tired and you can’t wait to climb into bed. You crawl under the covers, flip off the light, and sleep begins to overtake you. Suddenly you have an overwhelming compulsion to move your legs, not just once but over and over again. Each time you settle down and start to fall asleep, you need to jerk your legs. You try to control it, but the urge recurs.
You have restless leg syndrome (RLS), also known as Willis-Ekbom Disease (WED). It doesn’t matter what it’s called, you just want it to stop so you can get some sleep. If this condition has been distressing you, the family practice doctors at Cohen Medical Associates in Delray Beach, Florida, want you to know we can help.
Signs and Symptoms
Despite what some cynics have claimed, RLS is not an imaginary illness. It afflicts between seven percent and 10 percent of the population and the effects can range from annoying to debilitating, as sleep is disrupted and daily living is impacted.
The main characteristic of RLS is a need to move the legs repeatedly, and sometimes the arms as well, when one is at rest, usually late at night and most often in bed. Sufferers have difficulty explaining the compulsion, even to themselves. They will describe the sensations they’re feeling as:
- itching
- twitching
- crawling
- electric
- aching
- pins and needles
- throbbing
- creeping
- pulling
Whatever the description, it’s disconcerting, uncontrollable, and disruptive to a good night’s sleep. RLS occurs in people of all ages and in both sexes, although it’s predominant in women, becoming more common after the age of 40. To complicate the issue, RLS can be intermittent, occurring from a few times a month to a few times a week, and symptoms can range from mild to severe.
Because of the resultant sleep deprivation, the secondary effects of moderate-to-severe RLS can produce exhaustion and daytime sleepiness and can impact mood, concentration and memory, and school and job performance, as well as personal relationships, in turn producing depression and anxiety.
Causes
The National Institute of Neurological Disorders and Stroke (NINDS) at the National Institute of Health (NIH) characterizes RLS as a neurological sensory disorder with symptoms that are produced within the brain. That does not mean, however, that researchers have uncovered a definitive cause.
What is known, however, is that it tends to have a genetic component, with many sufferers having a close relative who also experiences RLS. The NINDS reports that specific gene variants have been associated with RLS and that low levels of iron in the brain may also be a contributing factor.
Although RLS as a primary disorder has not been associated with a disease process by itself, it can be a secondary product of other illnesses including:
- end-stage renal (kidney) disease and hemodialysis
- iron deficiency
- pregnancy, especially in the last trimester (though it normally subsides within four weeks after delivery)
- neuropathy (nerve damage)
- certain spinal cord conditions
- use of alcohol, nicotine, and caffeine
- use of certain medications such as: anti-nausea drugs, antipsychotic drugs, antidepressants, and some cold and allergy medications containing older antihistamines (e.g., diphenhydramine)
Sleep deprivation and such sleep disruptors as sleep apnea may also trigger RLS symptoms in some people.
Treatment
The good news is that RLS, while disruptive, chronic and usually lifelong, is not deadly unless it is a symptom of a more serious disease as described above. There are several approaches to treating RLS. First, we will perform such tests as neurological and physical exams, review your family and medical history, and take detailed notes regarding symptoms, triggers, and what you do to relieve symptoms.
Our first-line treatment approach will include recommending such lifestyle changes as regular moderate-to-aerobic exercise; leg and calf stretches, decreasing or avoiding the use of caffeine, alcohol, and nicotine; relaxation techniques, especially before bed; and leg massages, hot baths, or ice packs or heating pads. A vibrating pad called Relaxis has also proven to help many people. It also seems to help if you keep the temperature in your bedroom below 68 degrees. If your blood tests indicated low or low-normal iron content, a trial of iron supplements will also be one of the first things we try.
If these approaches fail to mitigate the symptoms, we will next prescribe anti-seizure drugs, which have proven successful in relieving the condition in many people. The next step would be prescribing dopaminergic drugs since researches believe that impaired transmission of dopamine signals in the brain’s basal ganglia may play a role in RLS. Finally, in severe cases, very low levels of opioids or benzodiazepines are often effective in relieving symptoms. Of course, use of these drugs for any condition requires careful monitoring. You should also be aware that some drugs may help some people while worsening the condition in others, so we may need to adjust or change medication over time.
Although restless leg syndrome can be intolerable, you don’t have to continue to suffer. Let us help design an approach that can alleviate these distressing symptoms.
