Restless Leg Syndrome

The leg sensations themselves have been described in a number of ways, from crawling, creeping and pulling, to itchy, throbbing and achy. There are two commonalities. The first is that they are felt when you are just going to sleep, in a prone position, or after sitting or resting for a long period of time, as when you are in a movie theatre or plane. The second is that you feel an overwhelming need to move to try to ease the sensations.

Although the syndrome lasts all night long, there is a period of time towards early morning when it goes away, leaving you with a small window of time to get better sleep. It usually affects both legs.

Secondary symptoms are those related to lack of sleep. These include increased irritability, daytime sleepiness and an inability to focus.

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The condition has no known cause, although there are several theories that are being explored. It is thought to be related to an imbalance of dopamine in the brain, as this neurotransmitter is responsible for sending messages that control movement. Iron deficiency has been recognized in patients that have restless legs syndrome, and it may cause or worsen the condition. Other minerals that may be deficient are folate and magnesium. Kidney failure might also be a culprit, because if your kidneys are not working properly it lowers the stores of iron in your blood and may cause other chemical changes.

If the onset of the condition is before age 40, a hereditary factor is noted. Women also sometimes experience restless legs syndrome beginning with pregnancy, but the syndrome goes away after delivery.

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As with other sleep-related disorders, decreasing or eliminating caffeine, alcohol and tobacco, especially within four to six hours of bedtime, is recommended for better sleep.

It’s possible that your symptoms can improve if you take iron, magnesium or folate supplements. However, you need to check with your health care provider at St. Luke’s before you take any vitamins or supplements; too much iron, for example, can be dangerous. Blood work should be done to determine if your levels of these minerals need improvement.

Taking a hot bath, getting a massage, and using a heating pad or ice packs can also relieve any muscular or other stress and prove beneficial in relieving symptoms.

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At St. Luke’s, your physician will give you a thorough physical examination and take your medical history. Generally, a diagnosis of restless legs syndrome is made if no other condition can explain the following:

• You feel an overwhelming need to move your legs in response to the unpleasant feelings they have.
• These sensations start when you are just going to sleep or when you have been resting for a period of time.
• The symptoms can be partially relieved by walking, stretching, or similar motion.
• The symptoms occur at night.

Your physician may refer you for a neurological exam, to rule out any other causes. You may also be asked to take a blood test, to check for iron or other mineral deficiency.

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There is no known cure for restless legs syndrome, but it is important to treat because it interferes so severely with sleep that your ability to function and cope with life is compromised.

Your health care professional at St. Luke’s will talk with you about the treatment options that work best for you.

Medication

It’s been found that, when there is an iron deficiency, taking an iron supplement helps alleviate the symptoms. Always check with your health care provider before taking supplements.

There are four types of medication that may be given, based on the results of tests you take.

• Anti-seizure medicines have been shown to have a positive effect on the condition, without a need to worry about a buildup of resistance or a boomerang effect where the condition worsens.
• Medicines that increase the level of dopamine in your brain can decrease the leg sensations at night. However, these medicines can have side effects, including an increase in impulsive behavior, like gambling or shopping. This connection is being researched.
• Medicines that target calcium channels can also be effective.
• Muscle relaxants may help you sleep better at night, but can leave you with a different kind of drowsiness the next day.

It’s important to talk about all the medicines you take with your physician, because a medication you take for a separate condition may intensify the symptoms of restless leg syndrome.

Devices

Two recent developments may be beneficial for your condition. Both are devices that you wear at night. One is a foot wrap that is designed to put pressure under your foot. The other is a pad that delivers vibration to the backs of your legs.

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