Restless Leg Syndrome
There are many sleep disorders which rob people of a good night's sleep. Several of these disorders involve excessive movement taking place during sleep, including periodic limb movement, bruxism and restless leg syndrome. Although all of these disorders can disrupt sleep to some degree, one of the most common is restless leg syndrome, also known as RLS.
Overview
RLS is a neurological disorder occuring in 10 to 15 percent of the adult population and just 2 percent of children. The primary feature of RLS is a compelling urge to move the legs while waking. An uncomfortable sensation is usually present in the legs, becoming more pronounced during periods of inactivity and in the evening.
The condition is sometimes (though rarely) present in other parts of the body. RLS can typically be temporarily improved by walking or other movement.
Causes
While no exact cause for RLS has been found, there does seem to be a genetic component to this condition. A specific gene that accounts for about half of the cases of RLS has been identified.
RLS can also occur as a secondary feature of another medical condition such as iron deficiency, pregnancy, kidney failure and some medications. Medications which have been known to aggravate RLS are antihistamines, antidepressants, beta-blockers and diuretics. Some of the medical conditions which can affect the severity of RLS are varicose veins, diabetes and arthritis.
Some researchers suspect neurological problems may be at the root of RLS. These conditions could include nerve impairment in the spinal cord or an imbalance in the brain's neurotransmitters (chemical messengers), particularly the chemicals serotonin and dopamine.
Lifestyle factors are also thought to contribute to RLS, including smoking, excessive use of alcohol, fatigue, caffeine and emotional stress.
Women have RLS one and a half times more often than men.
Symptoms
The overwhelming urge to move one's legs is frequently associated with what can be described as "an uncomfortable feeling" during inactivity. The sensation has been described as itching, pulling, tingling, or even a "creepy-crawly" feeling which cannot be relieved by touch or scratching.
Other symptoms can include an involuntary jerking of the limbs. This jerking often is worse in the evenings and can be relieved by movement.
Because these movements usually happen at night, individuals with RLS can have trouble falling asleep or staying asleep. RLS is also associated with insomnia, thus producing chronic sleep loss. This often leaves the person feeling fatigued and sleepy during the day and causes mild to moderate cognitive impairment.
RLS can also be associated with another sleep movement condition called periodic limb-movement disorder.
Diagnosis
While there is no specific test to determine RLS is present, a doctor or sleep scientist can make the diagnosis based on a person's description of their symptoms. A blood test can also be prescribed to determine wheter an iron deficiency is present.
Treatment
Until recently there were no drugs specifically for the treatment of RLS, although some medications had been used for years to treat this disorder. These medications fall into three main classes:
- Opiates typically used to treat pain.
- Sedating medications used to improve one's sleep.
- Medications for treating movement disorders such as Parkinson's disease, called dopaminergic agents.
There are two drugs that increase dopamine in the body: ropinrole and mirapexin. When prescribed for RLS the doses are typically lower than those used for Parkinson's disease. Both drugs can cause side effects such as dizziness and nausea and can cause patients to fall asleep with little or no warning. In some patients these drugs can also lead over time to a reappearance or worsening of the symptoms of RLS. This is known as augmentation.
Two doctors from Johns Hopkins University first described in 1996 the phenomenon now known as augmentation. In these cases, where dopaminergic agents led to RLS symptoms which were more severe and spread to other parts of the body, the symptoms also began earlier in the evening. Augmentation can usually be managed by adjusting medications.
Managing Restless Leg Syndrome
There are several self-directed activities which can be utilized for managing the symptoms of RLS. These include massaging the legs, walking, stretching, vibration, acupressure and the use of hot and cold packs.
Meditation and other relaxation techniques (such as meditation and yoga) have also been known to alleviate some of the symptoms of RLS.
Regardless of what treatment methods are used, continued consultations with a health care practitioner are recommended.
Many people who suffer from this condition find it beneficial to take a warm bath before bedtime, adding 2 cups of Epsom salts and several drops of calming, essential oils.
References
- Lack, L. et al.(2003). Insomnia : how to sleep easy. Double Bay, N.S.W. : Media 21 Publishing.
- Servan-Schreiber, D. (2006). The Duke encyclopedia of new medicine : conventional and alternative medicine for all ages. London : Rodale.
- Vukovic, L. (2005). Overcoming sleep disorders naturally. Laguna Beach, CA : Basic Health.
- Wilfred, P. (2010). Sleepmanual : how to achieve the perfect night's sleep. London : New Holland.
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