Restless Legs Syndrome (RLS)

RLS is a neurological disorder. Symptoms include unpleasant sensations in the legs and an uncontrollable urge to move the legs while sitting and/or lying in bed. The sensations are described as burning, creeping, tugging, or insects crawling inside the legs and range from uncomfortable to painful. The most unusal aspect of this condition is that lying down to sleep can trigger it. It's possible for anyone no matter your age to have this disorder, but it does seem to get worse as we age.

Periodic limb movement disorder (PLMD) is a disorder that is often found in RLS patients. It's the involuntary leg twitching or jerking movements during sleep. These involuntary movements can occur every 10 to 60 seconds, and sometimes they occur on and off all night. While the patient has no control over PLMD, the patient has some control over the movements they make with RLS.

The cause of RLS is mostly unknown. There are some indications that there is a type that is hereditary. The familial form starts earlier and progresses more slowly. They have found that people with the following risk factors are more likely to develop the condition:

• low iron levels or anemia
• kidney failure, diabetes, Parkinson's disease, and peripheral neuropathy
• women who are pregnant
• Certain medications-such as antinausea drugs (prochlorperazine or metoclopramide), antiseizure drugs (phenytoin or droperidol), antipsychotic drugs (haloperidol or phenothiazine derivatives), and some cold and allergy medications-may aggravate symptoms.
• caffeine, alcohol, and tobacco may aggravate or trigger symptoms in patients who are predisposed to develop RLS

There is no single test that can say for sure whether the problem is RLS or not. These are the criteria a doctor uses to make the diagnosis:

• a desire to move the limbs
• symptoms that are worse or present only during rest and are partially or temporarily relieved by activity
• motor restlessness
• nocturnal worsening of symptoms

Most people with RLS have sleep disturbances, largely because of the limb discomfort and jerking. The result is excessive daytime sleepiness and fatigue.

Treatment, according to the National Institute of Neurological Disorders and Strokes, involves "...finding any possible underlying disorder. Often, treating the associated medical condition, such as peripheral neuropathy or diabetes, will alleviate many symptoms. For patients with idiopathic RLS, treatment is directed toward relieving symptoms.

For those with mild to moderate symptoms, prevention is key, and many physicians suggest certain lifestyle changes and activities to reduce or eliminate symptoms. Decreased use of caffeine, alcohol, and tobacco may provide some relief. Physicians may suggest that certain individuals take supplements to correct deficiencies in iron, folate, and magnesium. Studies also have shown that maintaining a regular sleep pattern can reduce symptoms. Some individuals, finding that RLS symptoms are minimized in the early morning, change their sleep patterns. Others have found that a program of regular moderate exercise helps them sleep better; on the other hand, excessive exercise has been reported by some patients to aggravate RLS symptoms. Taking a hot bath, massaging the legs, or using a heating pad or ice pack can help relieve symptoms in some patients. Although many patients find some relief with such measures, rarely do these efforts completely eliminate symptoms."

Medication is used to reduce the symptoms. Benzodiazepines (such as clonazepam and diazepam) may be prescribed for patients who have mild or intermittent symptoms, but they can induce or aggravate sleep apnea, so those with this condidtion shouldn't take this. There are many types of medication your doctor can prescribe for RLS.

There is no cure for RLS. Those with RLS can go into remission of the symptoms for days, weeks, even months, but the condition usually returns. A diagnosis of RLS does not indicate the onset of another neurological disease.

Researchers are investigating the possible role of dopamine function in RLS. Dopamine is a chemical messenger responsible for transmitting signals between one area of the brain and another. Researchers suspect that problems with the transmission of dopamine signals may play a role in RLS.

More information can be found at these links:

• Restless Legs Syndrome Foundation
• National Sleep Foundation
• WE MOVE (Worldwide Education & Awareness for Movement Disorders)
• National Organization for Rare Disorders (NORD)

Sleep apnea, RLS, and PLMD seem to go hand in hand. I've been diagnosed with obstructive sleep apnea and RLS. I also have the PLMD because I have trouble with my legs jerking and I'm not able to control it. I am also having trouble with my hands jerking and I have a feeling it's all related.

Dale L. Edwards