Articles written by me on Self-care and Palliative Medicine
On Self-Care & Palliative Medicine

Just for Kicks

Did you know that between 5 and 15% of the population has a disorder that creates an irresistible urge to move their legs? This is a neurologic movement disorder called Restless Legs Syndrome (RLS), and unfortunately, it tends to get worse later in the day and often peaks when a person is lying down–hoping to sleep. Consequently, sleep disturbances are very common in RLS patients. Imagine trying to fall asleep as a creeping, crawling, tingling, cramping, burning sensation worsens in your legs. Additionally, RLS patients often experience intermittent leg twitching and jerking throughout the night making bedtime no picnic for their bed partners either!

So, if current estimates indicate 12 million Americans suffer from this disorder, why haven’t you heard more about it? One reason is that people tend to under report the problem–believing that they’re just getting more “fidgety” or sometimes that they’re “going nuts”. Additionally, the Johns Hopkins Sleep Disorders Center contends that the diagnosis is often elusive even when patients do seek help. On average, it estimates that patients visit four to five doctors over a period of years before correct diagnosis is made. Patients may complain chiefly of fatigue or daytime sleepiness. . .not realizing that their nocturnal restlessness and associated insomnia secondary to RLS generate these symptoms.

Although symptoms can be traced to childhood in some patients, most of the people ultimately diagnosed with this condition are middle-aged or older. The disorder occurs equally in men and women and can be seen with greater frequency in particular families; so genetics may play a role in etiology. There is a characteristic circadian (daily) rhythm to RLS with symptoms being significantly greater in the evening (esp 10 p.m. to 2 a.m.) and almost nonexistent for most patients between the hours of 7–10 a.m. even if they remain in bed. Inactivity of any kind seems to bring on the symptoms–with longer periods of inactivity generating the worst symptoms. Unfortunately, such activities include: sitting in movies or lectures, riding in cars and airplanes, and of course, lying down to sleep at night. What a bummer!! But, if you’re getting a little antsy to find out what helps, read on.

Movement, especially walking provides almost immediate relief of symptoms, and the relief persists as long as the walking continues. Focused attention on projects(such as needlepoint, woodworking), social interaction (esp emotional arguments) and lifestyles punctuated by very little “down time” can minimize the symptoms of RLS. Along these lines, there are RLS Support Groups that advocate a variety of “cognitive therapies” to help sufferers cope with their symptoms. Minimizing or even discontinuing caffeine consumption totally can decrease symptoms significantly. Some patients have found that Vitamin E, Calcium, and Magnesium supplements have been helpful. Conversely, certain prescription medications such as anti psychotic drugs, some antidepressants, and some drugs for nausea can worsen the symptoms. Mild sleeping pills,tranquilizers, certain pain medications, and a broader class of drugs known as dopaminergic medications can all be helpful with treatment. Dopaminergic drugs increase the amount or effect of the chemical, dopamine, in the brain. One of the best known of these drugs is Sinemet (which is used widely to treat Parkinson’s Disease as well). Unfortunately, all of these medications need to be used with caution; the sleeping pills, tranquilizers, and pain medication are addictive, and the dopaminergic agents can actually augment symptoms of RLS overtime–even if used properly. Iron deficiency anemia, kidney failure, and peripheral neuropathy can also be associated with a secondary form of RLS; so specific treatment of these problems can help the symptoms of RLS in these conditions. Unfortunately, there is also a higher incidence of RLS in pregnancy. Thankfully, that is always a self-limited condition!

Okay, enough. I suspect any of you with RLS reading this Insight are already jumpy. So, go take a hike; and tell your physician about the symptoms. There are treatments that can help you sleep better and manage the discomfort. “What’s shaking?” shouldn’t be your bed in the middle of the night.

Stephen L. Hines, M.D.
July 2000

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