When legs feel uncomfortable people do not take it seriously. After all, it might just go away by stretching, moving them a bit or perhaps simply by walking around. But what they do not realize is that it could be a neurological disorder that affects close to 10% of Americans. The name of these tingling, often painful and often pulling sensations in the legs is known as Restless Legs Syndrome. As incredible as this may sound, though centering on the legs, it is grouped along with common sleep disorders.
When the sufferer finds it difficult to realize its seriousness, it is understandable that the syndrome might also be hard to diagnose since individual perceptions of such feelings are varied and subjective.
To help doctors and clinicians diagnose this ailment, which can have very serious health implications if not diagnosed and treated on time, the International Restless Legs Syndrome Study Group (IRLSSG), and National Institutes of Health (NIH), have recognized four characteristic signs for diagnostic purposes. They are:
- Leg discomfort along with cramps and insensitivity. The individual may also feel pain, as well as sensations of burning and creeping which begins with the lower limbs but with time moves on to the arms and the chest.
- Partial or complete relief from such discomforts is possible if the individual moves or stretches the limbs.
- Such signs intensify during sitting or sleeping positions.
- They deteriorate further at night.
There exists a parallel condition associated with RLS, called periodic limb movement disorder or PLMD. It has been found that close to 80% of people who have RLS have periodic limb movements of sleep. They feel spontaneous twitching of the legs or the legs may jerk involuntarily during sleep. Recurrences of such events cause major sleep interruption for the individual.
Types and causes of RLS
RLS can be of two types – primary and secondary. Despite extensive research on this illness, doctors are yet to be sure about any lone factor responsible for causing onset of this illness. Primary RLS is the more common type. It can also be called idiopathic (no known cause) or familial (hereditary).
Secondary RLS is believed to be caused by another concealed medical condition or the ailment could be associated with the intake of certain types of drugs like medicines to reduce nausea, sleep medicines and anti-depressants, cold relieving medicines that contain anti-histamines. The medical conditions that can result in RLS include: kidney failure, pregnancy, iron deficiency, peripheral nerve diseases (dysfunction of nerves that make us feel pain, numbness, or muscle uncontrollability), excessive stress, wrong diet, environmental causes, etc.
Who is the likely candidate for RLS?
No matter what age, sex or race, RLS can affect anyone. More often than not, the preliminary signs of the ailment initially show up during childhood when most parents tend to ignore them in the child thinking that the pain and discomfort are part of growing up. But such signs tend to worsen with age and start to recur often during young adulthood. Women tend to be affected more by RLS than men.
Lack of physical activity, continuous sitting posture (at home or in the car) can worsen the symptoms. The usual time of arrival of such discomfort is during evenings or night which can majorly interfere with sleep.
As far as age of onset is concerned, the average age appears to be around 46 years, though one study showed that close to 35% of the subjects started to experience the signs as early as 20 years. Another study showed the age of experiencing the signs for the first time as 10 years.
The ailment seems to run in families. Research shows that close to 63% of patients of RLS have at least one member in the family who suffers from this ailment.
It is estimated that around 6% of the population could suffer from period limb movements of sleep which is also called periodic limb movement disorder (PLMD). Advancing age enhances the risk further by 25 to 58% and aged women are more susceptible. RLS is prevalent alongside many sleep disorders like sleep apnea and narcolepsy as well as certain medications like specific anti-depressants, anti-seizure drugs, etc.
Symptoms are likely to appear during pregnancy, primarily during the last stages. But there is assured relief a month after the baby is born.
What is the prevalence of sleep apnea in people with RLS?
The co-relation between restless legs syndrome and sleep apnea can be indirect or direct. For example, we all know that obesity is one of the prime triggers for the onset of sleep apnea. In a study it was found that obese people runs an extra risk of being affected by RLS. This can be an example of how sleep apnea is linked to RLS via the obesity route. Excessive accumulation of abdominal fat and its association has also been studied and confirmed in another study. www.aan.com
Many patients suffering from diabetes and obesity are advised to consult chest physicians, also called pulmonologist or pneumologist. These doctors check whether these types of patients have sleep apnea also, because of high incidences of complaints related to unexplained over-sleepiness.
In the yearly telephonic interview poll, to check the association between RLS and sleep apnea, conducted by National Sleep Foundation, in 2005 consisting of randomly-selected American adults, it was found that the high-risk individuals for RLS were also highly prone to develop sleep apnea and insomnia. The interview involved 1506 adults of which, 775 were women and their average age was 49 years.
Sleep apnea features amongst the several common health conditions linked to Restless Legs Syndrome. The other conditions include osteoarthritis, varicose veins, obesity, hypertension, hypothyroidism, chronic alcoholism, deprivation from sleep, etc. As is clear from this list, there are many illnesses which have direct association with sleep apnea. It has also been found that sleep apnea further complicates and worsens the signs of periodic limb movements of sleep.
How do they diagnose this syndrome?
In the absence of any laboratory test to detect RLS, your primary health care doctor can diagnose the problem with the help of some very simple indications. They are:
– Whether the leg movements become restrictive because of certain strange kinds of feelings.
– Whether these feelings further deteriorate when you are remaining idle, like sleeping or sitting.
– Whether you get relief from these disturbing sensations when you walk or move or stretch.
– Whether these sensations aggravate towards evening or night.
Physical examination, checking the functioning of nervous system, taking medical and genetic history and the medicines that the individual is having presently are some of the steps doctors take to diagnose RLS.
Tests done at a laboratory could include: checking iron and vitamin deficiencies with the help of blood test; and polysomnography to rule out the existence of other co-existing sleep disorders like sleep apnea. Presence of sleep apnea usually interferes with the treatment of RLS.
Actigraphy, though not as accurate as PSG, is the use of a tiny device which detects several sleep disorders as well as audits quality of sleep of in ailments like sleep apnea, RLS, periodic limb movements of sleep, insomnia, etc. Worn around the wrist, this device records frequency and duration of muscle movements in sleep, whether the leg jerking is affecting one or both legs, its impact on sleep, etc.
How is Restless Legs Syndrome treated?
As far as drug therapy is concerned there were no medicines approved by FDA in the market for treating this condition. However since 2005 a formulation containing ropinirole hydrochloride has provided significant relief in mild and moderate conditions. Incidentally, the same drug is used to treat Parkinson disease. The other medication known to improve patient condition, reduce pain and frequency of symptoms are: opiates, benzodiazepines, dopaminergic group of drugs and dopaminergic agonists.
There are plenty of side effects of such medication including nausea, sleepiness during the day, hallucinations, drug dependency and irregular bowel movements.
Many self-help strategies work well with this illness. These include physical exercise by way of walking, etc. Leg massaging, stretching, using temperature-controlled packs, vibration therapy, acupuncture are effective. Yoga, deep breathing and meditation have yielded beneficial results for many sufferers.
Many people have found great relief from this illness by treating the concealed condition and implementing strategies that help cope better. If it is a case of restless legs syndrome with sleep apnea, you may need to focus on treating apnea first – as the rest will soon follow.