Other Sleeping Disorders

RESTLESS LEG SYNDROME (RLS) "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."

Have you felt similar sensations?

You might have RLS!

Talk to your doctor if you have any of the typical symptoms:

1. An intense urge to your legs.
    
2. An unpleasant sensations in your legs that may feel like “creeping”, “crawling”, “pulling”, “tingling”, or “electric feelings”.
    
3. Symptoms are worse when resting, and relieved when walking or shaking the legs.
    
4. Symptom are worse in the evening or at bedtime.

Restless Legs Syndrome is essentially a movement disorder. It involves an intense urge to move your legs at bedtime . The symptom can be hard to describe but are quite different from the pain of a muscle cramp. Some people also have symptoms in the arms and other parts of the body. It can occur at any age in both men and women. It is also common, effecting about 1 out of every 10 people at some point in their lives.

Some people with RLS have symptoms only at certain times. Others have them on a regular basis. This may prevent you from falling asleep or staying asleep. As a result, people with RLS often have poor sleep quality and feel very tired or sleepy during the day. Sufferers may find it hard to travel by car or airplane because it is hard to sit still for long periods of time. The sleep loss and disturbance of daytime activities can even lead to anxiety and depression.

Most people (about 3/4) with RLS also have periodic limb movements (PLMs). These movements tend to consist of an extension of the big toe together with an upward bending of the ankle, knee, or hip. These “ jerks” or “kicks” occur at regular intervals (usually 20 to 40 seconds) and in clusters, when you are asleep. You are usuallty unaware of them. In contrast, RLS may cause movements when you are awake.

Like RLS, PLMs may contribute to poor sleep quality. These leg movements often cause you to briefly wake
up from your leep. These brief awakenings are called "arousals” and they disturb your sleep causing you to wake up unrefreshed or you may have difficulty falling asleep. PLM also may disturb the sleep of your bed partner who will no doubt complain when repeatedly kicked or bumped during the night.

To assess the severity of your symptoms. One of our staff will call you to advice on getting the right treatment.
 
WHAT Causes RLS?

We have not as yet found the exact cause but recent advances have shown a direct link to a problem with a brain chemical known as dopamine. Medications that increase dopamine in the brain have been effective at relieving symptoms. Some medical conditions may increase the chance of developing RLS. These include:

• Alcoholism
• Certain vitamin or mineral deficiencies
• Kidney disorders
• Low blood iron levels
• Poor blood circulation in the legs
• Nerve problems in the spine or legs
• Muscle disorder
   

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 Treated?

The first step in treating RLS is to see if you have any conditions predisposing to the problem. Iron deficiency is a typical situation where replacing the iron may help alleviate the symptoms. For many people however, symptom continue even after receiving treatment for the related conditions.

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 reliever Regular exercise
• The elimination of caffeine

When symptoms are severe or home remedies are ineffective, you can take prescription medications. There are many drugs and you will need to talk to your doctor or sleep specialist about tailoring one to suit your level of severity and acceptance of side-effects.

MEDICATIONS:

• DOPAMINE AGENTS
(Sinemet, Permax, Parlodel, Repreve, Sifrol)

Traditionally given for Parkinson’s, these drugs increase dopamine, which seems to limit unwanted muscle sensations and movement. The most common side effects from dopamine agents are daytime drowsiness, nausea, dizziness, and digestive problems. Note that while the drugs used to treat RLS are the same as those used for Parkinson's disease, people with RLS are no more likely to develop Parkinson's disease than other individuals.


• BENZODIAZEPINES.
(clonazepam, temazepam)

Usually given for milder or less frequent cases, these drug don't reduce the sensations or movements, but they may enable a person to sleep through them. Note that tolerance (becoming less effective over time) can develop after a few weeks, if taken regularly but is actually very uncommon.


• Opioids.
(Endone, Codeine)

There is potential for addiction when these drugs are misused and as such, many physicians are reluctant to use this class of medication as first line treatment. However, when all other medications have failed, these can be effective. The opiates decrease the discomfort of RLS and, for some patient, dramatically reduce leg movements at night. When taken under close guidance and medical supervision, they may provide long-term benefit with little risk of addiction. Side effects may include nausea, constipation, and sedation.

• Anticonvulsants.
(Neurontin, Tegretol, Valproate)

These can be especially helpful with painful RLS. Side-effects include unsteadiness, vision problems and congestion.


The medications do not cure RLS but can be very effective at controlling symptoms. Which one works the best for you is often a matter of trial-and-error.