Healthy Living Newsletter
Restless Legs... don’t want to sleep
 My legs just don’t want to go to sleep, complained a woman who was later diagnosed with restless legs syndrome.
While ‘restless legs’ may sound like a phrase from a country song, the disorder it describes is far from trivial. The 68-year-old woman experienced the hard-to-describe feeling in both legs starting at about 9:30 each night. While not painful, the sensation was uncomfortable and unsettling, making it difficult for her to relax and get to sleep. Around 4 a.m. the feeling ceased, and she would sleep until 7 a.m. The chronic lack of sleep zapped her energy and made her feel tired.
Restless legs syndrome (RLS) is a neurological condition that may cause greater sleep disturbance than any other disorder. Nearly 50 percent of RLS patients get four hours’ sleep or less a night.
Recent approval of a medication to treat RLS has led to television and magazine ads promoting awareness, but even so the disorder is widely misunderstood, and many persons suffer the symptoms without knowing there is effective treatment.
Well conducted surveys in the United States and Europe indicate that RLS affects about 10 percent of the population, with a much greater prevalence among persons age 60 and over. Women are twice as likely as men to have the disorder, and the disorder tends to run in families. About 60 percent of patients have a close relative with RLS.
Legs That Want To Go
A National Institute of Health consensus panel in 2003 determined that a diagnosis of RLS requires four basic criteria:
- an urge to move the limbs because of abnormal or uncomfortable sensations,
- symptoms that get worse when the person is in bed or resting,
- improvement of symptoms with physical activity, and
- worsening of symptoms at night.
The sensation experienced varies. Terms used by patients, in order of frequency, include: need to move, crawling, tingling, restless, cramping, creeping, pulling, electric, tension, discomfort and itching.
Doctors believe the symptoms follow a circadian pattern — more likely to occur with greater intensity during evening hours as the body unwinds in preparation of sleep.
It’s important to distinguish RLS from periodic limb movements during sleep (PLMS), defined as repetitive and highly stereotyped jerking movement during sleep. Restless legs make it difficult to get to sleep. Periodic limb movements lead to frequent awakenings and fragmented sleep.
About 80 percent of RLS patients — and particularly seniors with the disorder — also have periodic limb movements during sleep: a double dose of trouble. But it’s not a necessary symptom for diagnosis. Many persons have PLMS without RLS.
RLS is a primary disorder in its own right. Similar symptoms may be brought on by other conditions such as anemia, kidney failure, diabetes, and Parkinson’s disease, or medications such as antihistamines, anti-nausea, anti-seizure, antipsychotic and antidepressant medications.
Whatever the cause, recent research indicates that the symptoms are usually related to a low level of iron. The disorder is believed to involve a malfunction in the way iron is regulated in the central nervous system.
Also playing a key role is the neurotransmitter dopamine. Dopamine drugs have traditionally been used in treatment, and the medication recently approved by the Food and Drug Administration is ropinirole (Requip), a drug that activates dopamine receptors.
After diagnosis, the first step is usually to try to find lifestyle changes that might make a difference. Mild to moderate symptoms can often be relieved by cutting back on alcohol and caffeine and ceasing to smoke. If there’s a vitamin or iron deficiency, supplements may help.
Medications, including over-the-counter cold and allergy remedies, should be evaluated to see if they may be contributing to the problem. Exercise, a regular sleeping pattern, hot baths, massage and heat or ice packs for the legs may also help.
Over the long term, poor sleep is associated with heart disease, hypertension and an increased risk of early death. So, if your legs are keeping you awake at night, talk to your doctor to determine a treatment plan that’s right for you.
Need help in finding a doctor near you? Go to the “Find a Physician” section of this website.
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