What Is Restless Legs Syndrome?
Restless legs syndrome (RLS) is a sleep disorder in which a
person experiences unpleasant sensations in the legs
described as creeping, crawling, tingling, pulling, or
painful. These sensations usually occur in the calf area
but may be felt anywhere from the thigh to the ankle. One
or both legs may be affected; for some people, the
sensations are also felt in the arms. These sensations
occur when the person with RLS lies down or sits for
prolonged periods of time, such as at a desk, riding in a
car, or watching a movie. People with RLS describe an
irresistible urge to move the legs when the sensations
occur. Usually, moving the legs, walking, rubbing or
massaging the legs, or doing knee bends can bring relief, at
least briefly.
RLS symptoms worsen during periods of relaxation and
decreased activity. RLS symptoms also tend to follow a set
daily cycle, with the evening and night hours being more
troublesome for RLS sufferers than the morning hours.
People with RLS may find it difficult to relax and fall
asleep because of their strong urge to walk or do other
activities to relieve the sensations in their legs. Persons
with RLS often sleep best toward the end of the night or
during the morning hours. Because of less sleep at night,
people with RLS may feel sleepy during the day on an
occasional or regular basis. The severity of symptoms
varies from night to night and over the years as well. For
some individuals, there may be periods when RLS does not
cause problems, but the symptoms usually return. Other
people may experience severe symptoms daily.
Many people with RLS also have a related sleep disorder
called periodic limb movements in sleep (PLMS). PLMS is
characterized by involuntary jerking or bending leg
movements during sleep that typically occur every 10 to 60
seconds. Some people may experience hundreds of such
movements per night, which can wake them, disturb their
sleep, and awaken bed partners. People who have RLS and
PLMS have trouble both falling asleep and staying asleep and
may experience extreme sleepiness during the day. As a
result of problems both in sleeping and while awake, people
with RLS may have difficulties with their job, social life,
and recreational activities.
Common Characteristics of Restless Legs Syndrome
Some common symptoms of RLS include:
- Unpleasant sensations in the legs (sometimes the arms
as well), often described as creeping, crawling,
tingling, pulling, or painful;
- Leg sensations are relieved by walking, stretching,
knee bends, massage, or hot or cold baths;
- Leg discomfort occurs when lying down or sitting for
prolonged periods of time;
- The symptoms are worse in the evening and during the
night.
Other possible characteristics include:
- Involuntary leg (and occasionally arm) movements while
asleep;
- Difficulty falling asleep or staying asleep;
- Sleepiness or fatigue during the daytime;
- Cause of the leg discomfort not detected by medical
tests;
- Family members with similar symptoms.
What Causes It?
Although the cause is unknown in most cases, certain factors
may be associated with RLS:
- Family history. RLS is known to run in some
families--parents may pass the condition on to their
children.
- Pregnancy. Some women experience RLS during
pregnancy, especially in the last months. The
symptoms usually disappear after delivery.
- Low iron levels or anemia. Persons with these
conditions may be prone to developing RLS. The
symptoms may improve once the iron level or anemia is
corrected.
- Chronic diseases. Kidney failure quite often leads to
RLS. Other chronic diseases such as diabetes,
rheumatoid arthritis, and peripheral neuropathy may
also be associated with RLS.
- Caffeine intake. Decreasing caffeine consumption may
improve symptoms.
Who Gets RLS?
RLS occurs in both sexes. Symptoms can begin any time, but
are usually more common and more severe among older people.
Young people who experience symptoms of RLS are sometimes
thought to have "growing pains" or may be considered
"hyperactive" because they cannot easily sit still in school.
How Is It Diagnosed?
There is no laboratory test that can make a diagnosis of RLS
and, when someone with RLS goes to see a doctor, there is
usually nothing abnormal the doctor can see or detect on
examination. Diagnosis therefore depends on what a person
describes to the doctor. The history usually includes a
description of the typical leg sensations that lead to an
urge to move the legs or walk. These sensations are noted
to worsen when the legs are at rest, for example, when
sitting or lying down and during the evening and night. The
person with RLS may complain about trouble sleeping or
daytime sleepiness. In some cases, the bed partner will
complain about the person's leg movements and jerking during
the night.
To help make a diagnosis, the doctor may ask about all
current and past medical problems, family history, and
current medications. A complete physical and neurological
exam may help identify other conditions that may be
associated with RLS, such as nerve damage (neuropathy or a
pinched nerve) or abnormalities in the blood vessels. Basic
laboratory tests may be done to assess general health and to
rule out anemia. Further studies depend on initial
findings. In some cases, a doctor may suggest an overnight
sleep study to determine whether PLMS or other sleep
problems are present. In most people with RLS, no new
medical problem will be discovered during the physical exam
or on any tests, except the sleep study, which will detect
PLMS if present.
How Is It Treated?
In mild cases of RLS, some people find that activities such
as taking a hot bath, massaging the legs, using a heating
pad or ice pack, exercising, and eliminating caffeine help
alleviate symptoms. In more severe cases, medications are
prescribed to control symptoms. Unfortunately, no one drug
is effective for everyone with RLS. Individuals respond
differently to medications based on the severity of
symptoms, other medical conditions, and other medications
being taken. A medication that is initially found to be
effective may lose its effectiveness with nightly use; thus,
it may be necessary to alternate between different
categories of medication in order to keep symptoms under
control.
Although many different drugs may help RLS, those most
commonly used are found in the following three categories:
- Benzodiazepines are central nervous system depressants
that do not fully suppress RLS sensations or leg
movements, but allow patients to obtain more sleep
despite these problems. Some drugs in this group may
result in daytime drowsiness. Benzodiazepines should
not be used by people with sleep apnea.
- Dopaminergic agents are drugs used to treat
Parkinson's disease and are also effective for many
people with RLS and PLMS. These medications have been
shown to reduce RLS symptoms and nighttime leg
movements.
- Opioids are pain-killing and relaxing drugs that can
suppress RLS and PLMS in some people. These
medications can sometimes help people with severe,
unrelenting symptoms.
Although there is some potential for benzodiazepines and
opioids to become habit forming, this usually does not occur
with the dosages given to most RLS patients.
A nondrug approach called transcutaneous electric nerve
stimulation may improve symptoms in some RLS sufferers who
also have PLMS. The electrical stimulation is applied to an
area of the legs or feet, usually before bedtime, for 15 to
30 minutes. This approach has been shown to be helpful in
reducing nighttime leg jerking.
Due to recent advances, doctors today have a variety of
means for treating RLS. However, no perfect treatment
exists and there is much more to be learned about the
treatments that currently seem to be successful.
Keeping on Top of Your Condition
Keeping in tune with your disease or condition not only makes treatment less intimidating but also increases its chance of success, and has been shown to lower a patients risk of complications. As well, as an informed patient, you are better able to discuss your condition and treatment options with your physician.
A new service available to patients provides a convenient means of staying informed, and ensures that the information is both reliable and accurate. If you wish to find out more about HealthNewsflash's innovative service, take the tour.
|
