Sleep Related Topics

Sleep and Wellness
Sleep Apnea
Snoring Is Not Funny
Not Enough Sleep
Restless Legs Syndrome (RLS)
What Is Parasomnia?
Sleep and Children
Sleep Hygiene
Sleep Study Procedure (PSG)
CPAP Titration
Actual Sleep Study

Restless Legs Syndrome

This is an interesting disorder that should be categorized as a movement disorder.  This is an illness of wakefulness.  Usually, the patients have the symptoms in the evening or afternoon while they are trying to prepare themselves to sleep.  The patients usually feel intense pressure to move around and have unusual sensation that is labeled by some as “creepy or crawly” sensation.  Some patients have intense pain and cramping in their limbs.  They feel an urge to rub their limbs and constantly move around in order to feel some comfort before they fall asleep.  These symptoms can continue for a few hours and can result in inability for the patient to fall asleep.

The proper name for this probably should be restless limb disorder because similar symptoms can occur in the arms, but without any doubt these symptoms are more prominent in the legs.  This condition affects the patient’s daytime sleep and can affect the quality of life and the lack of sleep.  With these symptoms it will be very hard to sit still in one position for a long time.  This condition may lead to other conditions such as insomnia, depression, anxiety, and impairment of daytime function.

When these patients finally fall asleep, majority of these patients have a sleep condition called periodic limb movements (PLMS).  The periodic limb movement at night varies from patient to patient, but in general involves the movement of the patient’s big toe, but it can affect the entire limb at night.  Increased limb movement at night causes frequent awakening throughout the night and major disruption in the sleep can occur.

Restless legs syndrome is a disorder that is very common in otherwise healthy people and can affect all ages including children and in pediatric age groups with diagnosis of hyperactivity or groin pain.  It is not uncommon alternative that has been provided to these patients.

Restless legs syndrome is not psychiatric, psychological, or emotional disorder.  Much research and studies have been done, especially in the last 20 years, and there is a relationship between the chemical dopamine and the restless legs condition.  The patients with restless legs syndrome should be tested:

  1. For anemia, especially measurement of their iron levels.
  2. Evaluated for nerve dysfunction in the limbs such as neuropathy.  Neuropathy can be caused by temporal disorders as diabetes, liver disease, patients on dialysis, and certain vitamin deficiencies.
  3. Poor circulation in the limbs also has been known to play a role in this illness.  In general, this is a syndrome that represents accumulation of multiple medical conditions that results in a constant urge to move with discomfort, pain, numbness, tingling, muscle cramps, pulling sensation in the limbs that ultimately affects our sleep and our daytime function.

The treatment of this disorder has a long history.  The patients on their own have tried many modalities from massaging, rubbing their limbs, and applying heat or cold to the limbs.  Of course, it is obvious that an underlying condition such as diabetes or other medical conditions should be diagnosed and treated.  Anemia plays a major role in this disorder and causation for the anemia and loss of blood should be investigated.  This could lead to the patients with GI disorder and ulcers or other loss of blood that can occur in these patients.

Medical treatment had made a major headway in the last few years.  The standard treatment probably is use of pramipexole (Mirapex) and ropinirole (ReQuip).  In the event that these medications are ineffective, other pain medications from codeine to gabapentin (Neurontin) and other medications have been used with different results in the patients.  The take-home message in restless legs syndrome is that this disorder is common, usually under diagnosed and not properly treated.  Presently, there are affective treatments available and patients are encouraged to seek advice from sleep centers for evaluation and treatment of this condition.
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