Restless Leg Syndrome
Restless leg syndrome (RLS) is a condition that occurs between 5 and 10 percent of the population- where symptoms of “restlessness” of the limbs cause daytime discomfort and nocturnal limb movements that may lead to sleep disruption. When the physiologic process-usually low dopamine levels in the brainstem- occur during sleep, the condition is known more specifically as periodic limb movements of sleep (PLMS). These common conditions usually manifest in adulthood and may affect nearly half of the elderly population. RLS and PLMS have been associated with pregnancy, advancing age, iron deficiency and kidney disease. There is also a familial form which is simply passed on genetically and tends to get worse as we get older.
Symptoms of restlessness of the limbs may include uncomfortable sensations of tingling, “bugs crawling” or “electrical impulses” throughout the limbs, causing patient to overcome these sensations by moving the limbs. These symptoms are usually more prominent in the evening hours, shortly before bedtime. With PLMS (causing PLMD or periodic limb movement disorder) the events may cause significant disruption in sleep continuity for the patient (and frequently the bed partner!)- often resulting in reduction of the valuable stages of Stage III and REM sleep. Patients may therefore develop excessive daytime sleepiness because of the fragmentation of sleep. The clinical diagnosis of RLS is based on the patient’s history. The diagnosis of PLMS may require an in lab sleep study/polysomnogram. Patients with RLS should have a measurement of iron stores with a blood test (ferritin level); as iron replacement therapy may be appropriate to improve symptoms.
Restless leg syndrome may be treated conservatively or if disturbing enough- with medications. Examples of conservative therapies are exercise or warm baths before bedtime. In patients with disabling symptoms treatment with medication may be required with dopaminergic agents such as Mirapex, Ropinirole, or Neupro patch. In some cases severe symptoms may require opiates or benzodiazepines.