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March 6, 2006

A University of Michigan Health Minute update on important health issues.

Restless legs sending your partner to the other room?

This common, often under-diagnosed problem can keep sufferers from falling asleep and send bed-partners packing

ANN ARBOR, MI – Approximately 10 percent of Americans suffer from a common, yet under-diagnosed neurological disorder characterized by uncontrollable, often painful urges to kick and thrash the legs when trying to fall asleep.

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This condition, known as restless legs syndrome (RLS), can have progressively negative affects on an individual’s ability to fall asleep and stay asleep, often causing fatigue – and it can send bed partners in search of more comfortable sleeping quarters.

“Restless legs syndrome for many people can be an annoyance and not something they are likely to seek treatment for - but for others, it can be debilitating,” says Raman Malhotra, M.D., clinical lecturer in Neurology at the University of Michigan Medical School. “For many, it’s very difficult to fall asleep, which can lead to fatigue or daytime sleepiness. And because of the involuntary kicking and jerking of the legs, often, bed partners have to move to another bed to get a good night’s sleep as well.”

Symptoms of this disease often occur in adolescence and can go untreated or undiagnosed for years, even misdiagnosed as growing pains, says Malhotra. Symptoms often are described as creepy-crawly feelings in the legs, tingling, burning or prickling sensations when lying down, such as at bed time or when sitting. They usually are relieved only by walking or flexing the legs, he says.

Long-term effects of RLS can include daytime sleepiness, loss of concentration, mood swings and depression and often a decrease in family, social and work functioning. And for one couple, RLS nearly drove their marriage apart.

“I think my restless leg started when I was younger,” says 42-year-old Thomas Novak. “I thought it was a nervous condition and part of growing pains. It was more of a creepy-crawly, sort of ticklish feeling that went away when I moved my legs. But as I got older it got a little worse. I didn’t realize I had a real problem until I got married and my wife told me.”

“Tom’s restless leg syndrome aggravated me to no end,” says wife Dana Novak. “He would flip and flop and just flail in the bed and he would kick me. I finally had to make him get help because I told him if this isn’t taken care of, I’m leaving.”

And so, Novak heeded his wife’s warning and sought help. First with his family doctor who he says didn’t diagnose the RLS, but treated him instead with vitamins that provided no relief.

“Once I finally went to U-M, they started me on different medications and adjusted them properly to the point where I started to feel better. The symptoms aren’t completely gone, but I’m doing much better now,” Novak says.

Two types of RLS
Health Minute ImageRLS occurs more frequently in women than in men, according to Malhotra.  While RLS can be used to describe the same constellation of symptoms, there are two known types of RLS: Primary and Secondary.

Primary RLS is the most common type of RLS, but its cause is not known. It usually becomes a lifelong condition, beginning with mild symptoms in late childhood or early adulthood that get worse over time. Primary RLS tends to run in families and is more commonly diagnosed during middle-age with the onset of sleep disturbances, says Malhotra.

Secondary RLS is usually caused by another disease or condition such anemia, pregnancy or diabetic neuropathy. It also can be caused from taking certain types of medication. 

“Many women who become pregnant suffer from Secondary RLS during their pregnancy and there are other diseases that make people predisposed to it,” Malhotra says. “People in an iron-deficient state, such as those who are anemic, often suffer from RLS. Also, people with peripheral neuropathy – a disorder of the nervous system often described as tingling or numbness in the hands and/or feet due to nerve damage – and, people with kidney disease, are more likely to have RLS.”

Caffeine and alcohol use also contribute to the severity of symptoms in this type of RLS.

Periodic Limb Movement Disorder
According to the Heart, Blood and Lung Institute of the National Institutes of Health, most people diagnosed with RLS have an accompanying disorder called Periodic Limb Movement Disorder (PLMD), which is responsible for the uncontrolled jerking and twitching of the legs that occur during sleep. PLMD can cause repeated awakenings, and reduce the quality and duration of sleep in its sufferers. Malhotra says that about 80-percent of patients with restless legs syndrome also have PLMD.

Treating RLS
“Luckily, we have many treatments available,” says Malhotra. “We usually start out with non-medical treatments by looking at what medications a patient is taking. We look for over-the-counter medications or anti-depressants that have been known to cause RLS symptoms and try to eliminate them. We also look to see if a patient smokes tobacco or drinks alcohol, which can worsen their symptoms.”

Malhotra suggests performing the following before bedtime and in general to help reduce the symptoms of RLS:

  • Practice good sleep hygiene. Get seven to eight hours of sleep each night
  • Perform acupressure, stretch or massage leg muscles before going to bed
  • Practice relaxation techniques such as biofeedback, meditation or yoga
  • Wear long socks to bed
  • Use a hot water bottle or cold compresses on painful areas before bed
  • Take a hot bath or shower before bed
  • Avoid or cut back on caffeine (coffee, hot tea or cocoa)
  • Avoid or cut back on alcohol
  • Eat a healthy diet and exercise

“If these techniques aren’t working, we have several medications available, most of which increase the levels of dopamine, a chemical in the brain usually associated with happiness and pleasure, similar to those used to treat Parkinson’s disease,” Malhotra says.  

Treatment can include dopaminergic agents such as Levodopa or Sinemet, sedatives, anticonvulsants and pain relievers, as well as supplements such as vitamin E, folate, magnesium and iron. Treatment is usually determined by the patient’s age, severity of symptoms, the frequency and regularity of symptoms, the presence of other illnesses and whether a person is suffering from kidney disease or failure.

For more information, visit these Web sites:
UMHS Health Topics A-Z: Restless Legs Syndrome
www.med.umich.edu/1libr/aha/aha_restlegs_sha.htm

National Heart, Blood and Lung Institute: What is RLS?
www.nhlbi.nih.gov/health/dci/Diseases/rls/rls_WhatIs.html

RLS Foundation
www.rls.org/  

National Institute of Neurological Disorders: NINDS Restless Legs Syndrome Information
www.ninds.nih.gov/disorders/restless_legs/restless_legs.htm

 

Written by Jessica Soulliere

 

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