Restless Legs Syndrome
” Worms crawl under my skin if I don’t keep moving my legs “
” My legs decide they want to run and I have to follow “
” After I get in bed a gremlin grabs my legs and leads me around like a puppet “
These statements may sound bizarre or unbelievable to someone who haven’t experienced Restless Legs Syndrome (RLS), but the feelings are all too real for suffers of this disorder.
WHAT IS RESTLESS LEGS SYNDROME?
Restless Legs Syndrome (RLS) is a movement disorder. Restless Legs Syndrome (RLS) is characterised by an irresistible urge to move and stretch your legs. The more effort put in to keeping them still, the stronger the urge becomes to move them. While symptoms vary, many people say their legs feel “creepy” or “crawly”. This is quite different from the pain of a muscle cramp.
SYMPTOMS OF RESTLESS LEGS SYNDROME
- Uncontrollable urge to move legs
- Uncomfortable feelings in the legs
- Feelings of itching, crawling under the skin or pins and needles in the legs
- Feeling of heat radiating from legs
- Symptoms are worse when resting or inactive, especially sitting or lying down
- Symptoms are relieved when you move your legs
Some people with RLS have symptoms only at certain times. Others have them on a regular basis.
PROBLEMS ASSOCIATED WITH RLS
- May prevent you from falling asleep or staying asleep, resulting in poor sleep quality
- May experience tiredness during the day
- Inability to perform well at work or take part in social activities
- May experience difficulty travelling by car or airplane during the day due to being still
- May interfere with your ability to stay seated at the movies, concerts and in business meetings
- The sleep loss and disturbance of daytime activities can even lead to anxiety and depression.
PERIODIC LIMB MOVEMENTS (PLM)
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 have no control over them. On rare occasions you may notice the PLMs may cause movement when you are awake. They are an involuntary response to an 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 restless 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 the bed.
HOW COMMON IS RLS?
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. Studies show that more than 80% of people with RLS also have PLMs, but the majority of people with PLMs being the primary concern, do not have RLS.
RLS IN CHILDREN
While it occurs more often in women and in older people, recent reports show that RLS 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 IN PREGNANCY
RLS also can be severe during pregnancy, especially during the last six months due to hormonal changes and reductions in essential minerals in the blood.
CAUSES OF RLS
RLS may be hard to describe, but it is not a psychological or emotional condition. Researchers 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
- Alcoholism
- Specific vitamin or mineral deficiencies
RLS IS HEREDITARY
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 genetic element for this disorder in some people. For unknown reasons, hereditary cases of RLS tend to more severe 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. 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 tests, 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:
- You have intense urge to move your legs
- You have unpleasant sensations in your legs that you might describe with these words: creeping, crawling, pulling, tingling or electric feelings
- Symptoms are worse when resting or inactive, especially when sitting or lying down
- Moving your legs relieves the symptoms
- 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 anaemia
- Diabetes
- Arthritis
- 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 the inherited a form of RLS that is not caused by any other disorder.
HOME REMEDIES
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
- Staying mentally active in the evening sometimes relieves symptoms. Try a crossword puzzle or play a board game (although stimulating the mind can sometimes hinder the initiation of sleep).
PRESCRIPTION MEDICATION
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 medications that you take will also have an impact on your treatment success. All medications have potential side effects. A doctor needs to monitor carefully your treatment for RLS.