Sleep disorders can affect personal health, causing nightmares and depression and contributing to traffic and industrial accidents
By: Michael Nolledo, M.D.
"My legs decide they want to run, and I have to follow."
"Worms crawl under my skin if I don’t keep moving my legs."
"After I get in bed, a gremlin grabs my legs and leads me
around like a puppet."
These quotes are all from people who suffer from something
called Restless Legs Syndrome (RLS), a condition which, just as the name suggests,
produces extremely unpleasant sensations in the legs or other extremities,
including the arms, feet, calves or thighs.
Five to 15 out of every 100 people experience the discomfort
of RLS at some point in their lives. Four out of 5 people who have RLS also
have Periodic Limb Movement Disorder (PLMD), which is related to RLS but happens
during sleep rather than during the waking hours.
While both conditions are uncomfortable, PLMD can be unhealthy
when it disrupts sleep and interferes with normal daytime routines. Two out
of every 10 people who have been diagnosed with insomnia can blame PLMD for
their inability to get a restful night’s sleep.
If you suspect you have RLS or PLMD, how can you tell?
Here are questions you can ask yourself, compiled by the American
Academy of Sleep Medicine:
- Do you sometimes have an urge to move your legs, often
accompanied by "creepy, crawly," unpleasant sensations in your legs? - Do these
symptoms get worse in the evening or at night, especially if you are sitting,
maybe trying to read or watch TV? - Are these symptoms uncomfortable enough make
it hard for you to fall asleep or stay asleep? - Have you been told that you kick
or jerk your legs or your arms when you are asleep? - Do you suffer a restless
sleep and wake up tired in the morning, with your legs sore as if you have
been moving them all through the night?
If you can answer yes to more than one of these questions,
you may have Restless Legs Syndrome (RLS) and its associated disorder, PLMD.
In most cases, these conditions do not indicate a serious
underlying medical condition. There are some factors, however, that predispose
people to both RLS and PLMD. These include a deficiency of iron and folic acid,
certain medical disorders such as Parkinson’s disease, kidney problems, poor
blood circulation in the legs, or any disorders involving the nerves in the
limbs or spinal cord.
Women who are pregnant tend to develop symptoms, especially
in the third trimester, though the condition is usually resolved at the end
of the pregnancy.
Genetics can also play a role. About 30 percent of cases
can be linked to a parent, grandparent or other close blood relative.
While these factors are the first a health care professional
will look at, the majority of patients with PLM and RLS do not have any clear
predisposing factor. So then, who suffers from these disorders?
Children can be affected by RLS. The discomfort of "growing pains" may
actually be symptoms of Restless Legs Syndrome. RLS affects both men and women
and can begin at any age, though it is more common in older people.
PLMD is rare in people under the age of 30. It affects a
small number of people between the ages 30 and 50, one-third of people between
50 and 65, and almost half of all people over 65.
Many people are hesitant to seek treatment because they are embarrassed. Some even convince themselves that their symptoms are all "in their head." But
the reality is that these disorders can lead to problems falling asleep and
staying asleep. Sleep disorders can affect personal health, causing nightmares
and depression and contributing to traffic and industrial accidents.
But people do not have to suffer in silence. Both RLS and
PLMD lend themselves very well to treatment.
When patients come to the Sleep Center at the University
Medical Center at Princeton complaining of non-refreshing sleep, PLMD is one
of the primary considerations. A diagnosis begins with an extensive study of
sleep history, habits and tendencies, signs and symptoms, family history, and
blood tests that help determine levels of iron and folic acid.
If sleep problems persist, an overnight sleep study can also
help in arriving at an accurate diagnosis for a sleep disorder.
Medications are effective for many people. They include the
dopamine-agonists such as Pramipexole (Mirapex) or Ropinirole (Requip). Another
class of drugs used is benzodiazepines, particularly Clonazepam (Klonopin).
Simple lifestyle changes can also help. Moderate, regular
exercise that stimulates blood circulation can provide relief, though overdoing
it can actually make the symptoms worse.
Cutting back on caffeine can help restless legs, as can cutting
back on alcohol and tobacco.
Soaking in a warm bath and a gentle massage can relax the
muscles, and so can yoga.
It is also important to establish good sleep habits, including
a regular sleep schedule.
For more information about the University Medical Center
at Princeton Sleep Center, call (888) 742-7496 or visit www.princetonhcs.org.