Uncontrollable Urges: Restless Legs Syndrome

Some things just don't make sense. Jack lies down to relax and, just as he starts to fall asleep, his legs twitch and wake him up with a start. He has a hard time sitting still during business meetings, and his associates have started to comment about the distraction caused by his constant foot jiggling. Jack is worried that the cause is bad circulation, but it is something quite different.

Until about ten years ago, Restless Legs Syndrome (RLS) was barely known and certainly not understood. Even today, the cause of this neurological disorder is uncertain, but the symptoms are classic: The legs feel uncomfortable, aching, tingling, itching, or burning when sitting still or lying down. Some sufferers say that deep inside in their legs they have sensations that feel like crawling insects. The "creepy" feelings won't go away until they move, jerk, jiggle, or twitch their legs, or get up and pace around the room.

While most often reported to occur between the knee and the ankle, symptoms can also occur in the feet, thighs, arms, or hands, and they tend to occur on both sides of the body. The symptoms can happen at any time, but generally they are worse during periods of inactivity. Long car trips or airline flights, sitting through a movie or business meeting, or simply taking a nap, are all known symptom triggers. Symptoms can occur at any age, but generally seem to begin in middle age or older and tend to worsen, occurring more frequently and for longer periods of time.

The uncomfortable feelings and urge to move are relatively easy to combat during the day by moving around, but these become extremely bothersome at night. People who suffer with RLS will flex and extend (bend and straighten) their legs, often without knowing it, hundreds of times a night. All of the flexing and extending results in a poor night's rest for the individual and his or her bed partner. This disruption of sleep can have a major impact on both mental and physical health. Many people with RLS report exhaustion during the day, poor memory, strained marital relationships, and inability to concentrate or complete tasks. RLS is considered mild if symptoms happen periodically and do not cause much interruption in sleep. Symptoms that occur a couple of times a week, cause long delays in sleep onset, and start to interfere with daytime function are considered to be moderately severe, and RLS is considered severe if it occurs more than twice a week and causes significant daytime impairment.

RLS can be a primary or secondary condition. In primary conditions, the cause is unknown, but there may be a genetic factor, because about half of the cases of people with RLS have family members who suffer from it as well. Secondary RLS is caused by unrelated conditions such as pregnancy and stress. Alcohol and caffeine are known to aggravate the condition.

Iron deficiency, with or without anemia, has been linked to RLS, but no blood tests have been developed to diagnose the syndrome. Fortunately, once the secondary condition has been treated, RLS symptoms tend to disappear without further treatment.

To make a diagnosis of RLS, providers ask for a description of symptoms, current and past medical history, family history, and a list of medications. Blood tests can detect secondary causes of RLS such as low iron levels, anemia, diabetes, and poor kidney function. Sleep studies can be performed to determine the severity of sleep interruption. Nerve studies can also help make an RLS diagnosis by ruling out other possible problems, such as muscle or spinal problems. RLS is not caused by blood circulation problems. Although RLS and vascular disease both affect the legs, that is where the commonality ends. Symptoms of vascular disease are different, whether affecting the veins or arteries.

While there is no known cause or cure for restless legs, there are treatments available. Because researchers suspect that the chemical messenger dopamine plays a role in RLS, medications that alter dopamine levels, such as those used for Parkinson's disease, have been successful. Narcotic medications can offer temporary relief, but patients who use these run the risk of becoming addicted. Sleep aids may be helpful, but they do not reduce the leg movements. Medications used for epilepsy have worked for some people.

Prescription medications are not the only answer. There are self-help activities that can reduce the symptoms of RLS such as the following:

• Develop good sleep habits by going to bed and getting up at the same time each day
• Take over-the-counter pain relievers at the beginning of restlessness
• Take warm baths alternating with cool packs
• Try massage therapy
• Use relaxation techniques such as yoga and meditation
• Avoid caffeine
• Limit or eliminate alcoholic beverages
• Exercise regularly, but not too late in the evening
• QUIT SMOKING!

Lifestyle changes alone may be enough to provide relief for mild cases of RLS. Contact your health care provider if you have symptoms so that together you can develop a treatment plan that works for you. For more information, contact the RLS Foundation at 877-INFO RLS or www.rls.org.