Restless Leg Syndrome: Why Can’t I Sleep?

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Restless Leg Syndrome: Overview

Restless leg syndrome (RLS) is a neurological disorder in which there is an urge or need to move the legs to stop unpleasant sensations, such as pain, creeping, cramps, itchiness, aching or burning.  RLS is sometimes called shaking leg syndrome. It can cause pain, which is usually the most intense when the person is at rest.

The cause of the condition is unknown although there are many conditions associated with it. Treatment depends on identifying the underlying cause.

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Restless Leg Syndrome: Causes

The cause of RLS remains unknown. However, there are a number of possible causes and triggers for restless leg syndrome, including:

  • pregnancy
  • obesity
  • smoking
  • iron deficiency and anemia
  • arthritis
  • Parkinson’s Disease
  • nerve diseases
  • hormonal diseases such as diabetes
  • kidney failure
  • caffeine and alcohol, when consumed in large quantities.
  • varicose veins
  • medications used to treat nausea, seizures, depression, or psychosis

Sometimes, RLS runs in families. It is more common in older people.

Restless Leg Syndrome: Symptoms

RLS is characterized by an urge to move the legs in order to relieve abnormal sensations such as pain, creeping, cramps, itchiness, aching or burning. In fact, some people say it feels like insects are crawling around inside their legs. The sensations of RLS ease when you get up and move, which is what gives the condition its name. The symptoms of RLS tend to begin gradually and intensify as time goes on. Often, they worsen in the night, causing insomnia. Although the condition is called restless leg syndrome, the symptoms can occur in the arms as well.

Over 80% of people with RLS also experience uncontrollable movements of the arms or legs during sleep, a phenomenon known as periodic limb movements in sleep (PLMS). This causes you to involuntarily flex and kick your legs while sleeping — without being aware you’re doing it. People don’t have control over this movement, which generally occurs every 20 to 60 seconds and may continue throughout the night. Often the biggest impediment to quality of life with RLS is the lack of sleep often associated with the condition.

Restless Leg Syndrome: Diagnostic Tests

Diagnosis of RLS requires finding the patient history and symptoms. In addition, your doctor may take blood or other tests to find out the underlying cause (e.g. anemia). For a RLS diagnosis, the National Institutes of Health says that four criteria must be met:

  1. A strong urge to move your legs: This urge often, but not always, occurs with unpleasant feelings in your legs, such as aching, pain, burning, creeping, tugging, tingling and itching. When the disorder is severe, you also may have the urge to move your arms.
  2. Symptoms that start or get worse when you’re inactive: The urge to move increases when you’re sitting still or lying down and resting.
  3. Relief from moving: Movement, such as walking and stretching, helps relieve the unpleasant feelings.
  4. Symptoms that start or get worse at night. The intensification of your symptoms in the evening or before you sleep may cause insomnia which can further exacerbate the condition.

Restless Leg Syndrome: Treatment Options

If your symptoms are not severe, your doctor will likely suggest a number of natural and non-medications to help manage and alleviate the symptoms. If anemia (iron deficiency) is the cause, your doctor may prescribe iron supplements. Non-pharmalogical treatments include walking or stretching, taking a bath, massage, applying hot or cold packs, and relaxation techniques are all first lines of treatment. Meditation and yoga can also help reduce the symptoms. Boredom and drowsiness before bedtime may worsen RLS. Mentally stimulating activities such as video games or crossword puzzles can help you stay alert and may reduce symptoms of RLS. Over-the-counter pain medications such as ibuprofen (Advil, Motrin, others) may help lessen the pain and twitching.

If these are not successful, even in combination, your doctor may prescribe a number of stronger medications to complement the other non-pharmological treatments. The most common are those that are used for Parkinson’s, such as ropinirole (Requip) and pramipexole (Mirapex); benzodiazepines such as clonazepam (Klonopin) or opioids (such as codeine). Certain epilepsy medications, such as gabapentin (Neurontin), may work for some people with RLS.

Your doctor will likely prescribe these medications on a trial run to find the right one that works for you. Over time, people usually develop a tolerance for these medications, which may require increasing the dosage or switching medications.

Restless Leg Syndrome: Prevention

Alcohol, caffeine can both be triggers for RLS so cutting down on consumption will likely improve your symptoms. Regular exercise, meditation and yoga are all good preventative techniques. Lack of sleep can worsen symptoms too, so try to get a good night’s rest, although this may be challenging because of twitching caused by the condition. The quality of sleep can be improved by going to bed at the same time every night and rising at the same time, sleeping in a place cool, comfortable environment without many distractions. Do not bring work, cell or smart phones, laptops, etc. into the bed: creating a distraction-free and calming sleep environment will affect the quality of your sleep, concentration habits, quality of life and strength of your body and immune system.

Restless Leg Syndrome: Conclusion

From 2% to 15% of people around the world may have RLS. It can cause pain, burning, creeping, tingling, itching and aching in the legs or in rare cases, in the arms too. The biggest complication is insomnia or disturbed sleep. There are a number of natural treatments, such as massage, hot and cold packs, relaxation techniques that are used as a first line of treatment for this condition.

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