The topic this month is an overview of restless leg syndrome/RLS, also called Willis-Ekbom disease, which is a neurological condition distinguished by an overwhelming urge to move the legs, often accompanied by unpleasant sensations. These sensations can be described as crawling, itching, tingling, burning, pulling, twitching, jerking or throbbing, and usually becomes worse when sitting or lying down, especially in the evening. Moving the legs provides temporary relief from the discomfort. Between 7-10% of the United States population has restless leg syndrome. It’s more common among white people and females. The risk of developing RLS increases with aging. There are two types of RLS: (A) early onset: a diagnosis happens before age 45, it usually runs in a biological family history, and the condition progresses slowly; and (B) late onset: RLS progresses more quickly, and a diagnosis happens after age 45.
Restless leg syndrome can sometimes occur as a complication of another health condition. It can also be the result of another health-related factor, which includes having iron deficiency/anemia, certain medications, alcoholism and some chronic medical conditions such as chronic kidney disease, diabetes, Parkinson’s, peripheral neuropathy, rheumatoid arthritis, underactive thyroid, and fibromyalgia. Some medicines for other conditions may worsen symptoms of RLS. These medications include some antidepressants, some antipsychotic medicines, some antinausea medicines, and some cold and allergy medicines. Discuss with your physician what medications you are taking and if they might be affecting your RLS. It’s common for symptoms to get better and worse, then sometimes they disappear for periods of time, then come back. There isn’t a cure for RLS, but treatment is available.
People with RLS sometimes have mood changes, fatigue, exhaustion and daytime sleepiness, trouble concentrating, impaired memory, sleep deprivation and other sleep conditions, including sleep apnea, problems with everyday activities, depression and anxiety. For some people there are “triggers” causing RLS and/or or aggravating their symptoms, including alcohol, caffeine, nicotine, certain medications, and stress. If you recognize any of these triggers, do not use/take them before you rest or go to bed, as they’re more likely to set off /worsen your symptoms. Additionally, a lack of sleep can lead to worsening symptoms. If you need help identifying what triggers your symptoms, talk to a physician. There is no one test to diagnosis RLS. Your physician will perform a physical and a neurological exam, take a family medical history, and possibly order a blood test to rule out other conditions to determine the cause of your symptoms. You may be referred to a sleep specialist or have a sleep study if another sleep condition such as sleep apnea is suspected. However, a diagnosis of RLS usually doesn’t require a sleep study.
The goal is to find the cause/condition that is creating RLS and treatment of it based on the cause. Options will be developed in a treatment plan which may include: (A) Electrical stimulation of a nerve on the side of your knee may help RLS symptoms; (B) Develop an at-home therapy program: Getting regular exercise but avoiding heavy or intense exercise within a few hours of bedtime, avoid reading, watching television or being on a computer or phone while lying in bed. Not getting enough sleep can make RLS symptoms worse. Soaking your legs in a warm tub and applying a heating pad or cold compress to your legs – these may provide temporary relief. As much as possible, reduce your overall stress, avoid stimulating beverages before bedtime – coffee, alcohol, caffeine beverages, etc.; (C) Medications – There are different categories/classes of medications. Each one works differently and have their own possible side effects such as dizziness, unsteadiness, mental fog, weight gain, worsening of symptoms and possible spreading of the ‘restlessness’ into the arms – called augmentation. Discuss with your physician the medications prescribed and any possible side effects. Like any medication, side effects do not affect all people. However, if you do develop any kind of unexpected/unpleasant side effect with any medication you are taking, contact your physician soonest. It may take several trials to find the right medicine or combination of medicines that work best for you.
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