Restless legs

http://www.abc.net.au/health/thepulse/s ... 355482.htm

Restless legs

by Peter Lavelle

Do your legs itch and twitch at night? You've probably got restless legs syndrome, a mysterious condition that plagues one in 10 people.

Published 11/09/2008
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[Image source: iStockphoto]

Are you in control of your own legs?

This may seem like an odd question. Toes have a tendency to tap when there's a catchy tune in the air; other than that, our legs generally do what they're told. They walk, run, jump and kick a ball on demand, as we've trained them to do.

But for about one person in 10, legs seem to have a mind of their own. They itch, tingle, and crawl, and only when they are moved about, or their owners get up and walk about, do they settle down.

These people suffer from a condition called restless legs syndrome (RLS), in which a person experiences unpleasant sensations of creeping, crawling, itching, burning, searing, tugging, aching, alternating hot and cold, or electric current-like sensations in their legs, only relieved by physically moving the legs about.

The symptoms can occur during the day, but they're more common at night, when lying down in bed. They may last from a few minutes up to an hour, anytime from the evening until the early hours of the morning. (Oddly, the more mentally rested and physically quiet a person is at night, the worse the sensations seem to be.)

Restless legs sensations are usually felt deep inside the leg, between knee and ankle, though they can also sometimes be felt in the feet, thighs, arms and hands. Just one side of the body may be affected, though it's more common for both sides to be affected.

To get rid of these sensations, the sufferer squirms and wriggles in bed, or gets up and paces about. Stretching the legs sometimes helps, as does resting the legs on a cold surface. Then they go back to bed, and the sensations start again.

No-one really knows what causes this mysterious condition, though it tends to run in families (50 per cent of cases are inherited), and it's more common in middle-aged and elderly people, in pregnancy, in people who are iron-deficient, and in people taking some types of medication, such as antidepressants. It's also more common in insomniacs (and makes insomnia worse because it stops them from drifting off back to sleep).

Most people with restless legs syndrome – more than 80 per cent – also get involuntary leg twitching or jerking movements while they are asleep, which they're not aware of, though the twitching can wake them. There's a name for this associated disorder: periodic limb movement disorder (PLMD).
Treatment options

So what gets rid of restless legs syndrome?

In this respect, there's good news and bad, according to Dr Dominic Thyagarajan, Associate Professor and Head of Neurology at Flinders Medical Centre in Adelaide, who has reviewed the medical literature on the condition and its treatment in the latest edition of the journal Australian Prescriber.

If it's caused by an underlying condition like iron deficiency, or as a side effect of a drug, then treating the condition or stopping (or changing) the drug will usually relieve the symptoms. (Doctors should do a blood test for iron levels and treat with iron supplements if iron levels are low.)

The bad news is that in most cases there is no underlying condition causing restless legs syndrome, and in these cases, there's no outright cure. There are often remissions, however – periods of weeks or even months when the symptoms improve or disappear, only to eventually return. The condition usually persists for life and may worsen with age.

But the good news is that in most people the symptoms are mild and can be fairly well controlled. The condition is basically a sleep disorder, so taking steps to get a good night's sleep will relieve the symptoms in most people. Thyagarajan advises you to:

* Establish a regular sleep pattern. Don't sleep in of a morning; and don't nap for long periods during the day.
* Get yourself in a pleasant state of tiredness before going bed. Don't do anything stressful before going to bed – do something relaxing, like reading a book. Have a light snack or a warm bath before bed.
* Make sure the bedroom is quiet and dark.
* Exercise regularly (but not in the late afternoon or evening).
* Cut out stimulants like alcohol, caffeine and nicotine.

If the symptoms are severe and they don't respond to these measures, the next step is medications. Simple analgesics like aspirin or paracetamol may help. If not, a doctor may prescribe a drug called a dopamine agonist.

Doctors used to prescribe the dopamine agonist levodopa (the same drug used to treat Parkinson's disease), but it's no longer used for restless legs syndrome due to a side effect known as 'augmentation', in which symptoms can develop at an earlier time in the day, only worse.

Some so-called 'ergot-derived' dopamine agonists (such as cabergoline and pergolide) have also fallen out of favour because of the risks of heart valve disease and lung fibrosis (these drugs have been withdrawn from the market in the US).

So now, the preferred drugs are non-ergot-derived dopamine agonists such as ropinirole (brand name Repreve), available only on private prescription in Australia, and pramipexole (Sifrol).

The idea is that a person with restless legs syndrome starts with small doses of a suitable dopamine agonist drug like ropinirole, and increases the dose until symptoms are controlled.

If dopamine agonists don't work, benzodiazepines, narcotic analgesics or anticonvulsants may be tried.

Ideally, the drugs are only used intermittently, during periods when the symptoms are particularly troubling, and are stopped during remissions.

But most people don't need drugs at all – the symptoms are mild and are well controlled by getting a good night's sleep.

Thank you very much for this post. This is good information.

I suspect that I have this condition. On my sleep report, there were 134 spontaneous limb movements in 224 minutes of sleep.
There were 18 "leg jumps" per hour.

But I decided to get the apnea under control first, and then I would worry about the leg problem. I go back to the doctor on Tue.
when I will certainly bring this up. I am fearful of taking medication, favoring more of the relaxation and exercise route. I realize, now that this is brought to my attention, that my legs are always in motion. Even while reading, eating or sitting at my computer, I've noticed that my legs have to be in motion, as if keeping time to music.

I will continue to do more research on this interesting subject.
thanks,
Jay

This problem has plagued me as much during the day as at night. This condition has caused me to nearly stomp a hole in the floorboard of the car. To be honest, the symptoms have greatly decreased since I started cpap therapy.

I was diagnose with this about six months after my sleep study. Actually it was Identified during my first study in 1994 but improved with therapy and the sleep doc sent me for a second study.

put me on klonopin 1.5 mg per night have taken it every night since then and sleep like the dead.

Went on a business trip two weeks ago and forgot my Klonopin for the first time in over a decade.

After two nights without it I almost drove off of the road from lack of sleep two nights in a row....

Do not underestimate the restless legs syndrome ability to pull you out of REM sleep or kee you from getting into it

best wishes to you

It's very possible, and in my opinion advisable, to work on getting sleep apnea, RLS and PLMD under control simultaneously. It doesn't need to be a "I'll work on this first" thing. For more to consider about this subject, here's a good thread: viewtopic/t34686/viewtopic.php?f=1&t=34 ... md#p293068

Marsha

My husband B also has Restless Legs, but fortuneately only at night. He was prescribed Levodopa (Sinemet) but luckily didn't take them before I researched them. They should not be taken within 12 months of being cleared from a cancerous melanoma. The doctor that prescribed was unaware of this.
Lucky for B that he hadn't taken them as he had had a cancerous melanoma removed just two weeks before.
As his legs were very active and I can vouch it's no fun being kicked all night- especially for no reason we searched for an alternative .
He has been taking a magnesium/manganese chelate table of naturopath strength for the last 12 months. These have been a great help . He has had no trouble for 10 months.

MMCGOWAN wrote:Do not underestimate the restless legs syndrome ability to pull you out of REM sleep or kee you from getting into it

If you're sleeping, then that wouldn't be Restless Leg Syndrome, that would be Periodic Limb Movement Disorder.

Also, PLMs rarely extend into REM.

SAG

that's what I thought after reading all the posts yesterday but the doctor here did diagnose restless legs and I haven't heard anyone say that they have plmd , of all the people I've come across here that have the same complaint.. must be an Australian thing! (generalising instead of being specific I mean not the complaint.)

I've had RLS for years, but I never called it that mainly because I didn't know it had a 'real' name

It's real name is actually .......... "The Heebie-Jeebies"

When I was a kid my Mom would wiggle her legs and rub them and say she had the 'heebie-jeebies' and of course I didn't know what the hell she was talking about but when I was in my 20's (long time ago) I got them and knew exactly what they were!

I've had them off and on for years and more frequently the last 5 years and they can just drive you ape-shit if you aren't already there

You can rub, you can walk, you can wiggle, you can stretch and massage, but nothing helps and you want to get the chain saw and cut your legs off. I have had them progress from my legs to my whole body. NOW, isn't that a scary sight Imagine having the 'heebie-jeebies' affect your entire body Well, it isn't a pretty sight and it can drive you over the edge. I've also had them during the day, but not as often as at night.

HOWEVER ............. since I became a hose-head I have NOT had the heebie-jeebies (knock on wood). I just realized that fact after reading this thread. But, I didn't realize I hadn't been dreaming until I started reading this forum so you just get a wealth of information here !!!!

Good luck with your RLS and if CPAP helps that is good, but if it doesn't, then researching and trying different drugs to help is also ok. Drugs beat a bloody chain saw any day

hey, B's mum had the 'heebie-jeebies' too.
I stand corrected--- B has had trouble with his legs jumping around since he was a kid.( now that was a long time ago..) He was that bad that none - there were 16 of them ( no, that's not a typo) of the other kids wanted to share the bed with him.
As a adult he always had trouble with his legs burning and aching , whether at the freezers in the supermarket or from walking too long. When I first met him (12 years ago) his legs used to shake when he was sitting down. I just thought he was being annoying
They haven't down that for awhile though and I forgot about them.
My Mum has the 'heebie-jeebies' too. Her legs are like 'jack-hammers' when she's sitting down, so I should have remembered that when B's were shaking.
So the ' heebie-jeebies" aren't just an Aussie thing