The Doctor Is In: Feeling Restless? It might not be “in your head” - The Doctor Is In - Explorer

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The Doctor Is In: Feeling Restless? It might not be “in your head”

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Children are quite obviously always in motion.  As we grow up, most people outgrow that tendency to “squirm.” Some; however, continue to have difficulty “staying still.”  We all know someone who can’t seem to sit still through a meeting or rather than lying down, has to pace the room to fall asleep.  Those individuals may have a disorder called Restless Legs Syndrome (RLS).

RLS is a neurological condition characterized by the irresistible urge to move one’s limbs – usually the legs – when at rest.  This disorder affects up to 10 percent of the nation’s population. An additional 2 to 3 percent of American adults – approximately 5 million people – have severe RLS that affects their quality of life. 

 

Symptoms and Course

RLS is characterized by an uncomfortable pulling, creeping, itchy, or painful, sensation that is relieved by moving the affected limb(s).  The symptoms usually occur in the legs but can also affect other areas of the body.  Symptoms come and go, and vary in severity, but are usually more noticeable when sitting or lying down.  According to the National Institute of Neurological Disorders and Stroke (NINDS), symptoms are worsened by long periods of inactivity such as long car trips, sitting at a concert or theater, airline flights, or immobilization in a cast.

More than 80 percent of people with RLS also experience a more common condition known as periodic limb movement of sleep (PLMS), according NINDS. PLMS involves involuntary leg twitching or jerking movements during sleep, typically occurring every 15 to 40 seconds, sometimes throughout the entire night. 

RLS can begin at any age, but most commonly begins before age 40. It occurs more often in women than in men and runs in families. Symptoms typically become more frequent and obvious with age. In children, RLS is frequently attributed to “growing pains” or misdiagnosed as symptoms of attention deficit disorder (ADD). To complicate matters, there is a high tendency for the two disorders to occur together, making it challenging to distinguish between symptoms of ADD and RLS.  Adult RLS symptoms are often mistaken for nervousness, insomnia, stress, arthritis, muscle cramps or aging.

There is also a significant impact of RLS on sleep.  Patients with RLS frequently complain of insomnia.  The combination of the need to move the limbs when lying down as well as PLMS can cause difficulty falling asleep and staying asleep.  The patient’s movements can interrupt one’s partner’s sleep as well, impacting their family life.  

 

Causes and Triggers

The cause of RLS is multi-factorial, but there are several factors that are associated with RLS.  These disorders have never been shown to have a causal relationship, but do tend to occur more commonly together.  Parkinson’s disease, ADD, pregnancy, diabetes, peripheral neuropathy, and kidney problems have all been associated with increased likelihood of developing RLS.  

The symptoms of RLS can also be worsened by certain conditions and/or medications, including iron deficiency, alcohol, sleep deprivation and certain medications such as anti-nausea drugs, antidepressants, psychiatric medications and some cold and allergy medicines that contain antihistamines.

 

Diagnosis & Treatment

RLS is diagnosed through a physical exam, medical history (including individual and family), blood tests for iron and vitamin deficiencies as well as other chronic diseases typically associated with RLS, and in some cases, a sleep study.  The sleep study is an overnight study that measures several physiological indicators including: brain waves, heartbeat, how quickly the patient falls asleep, whether they stay asleep, rate of breathing, and limb movements can help identify the presence of RLS or other causes of sleep disruption.

While there is no cure for RLS, symptoms can be controlled through medication or lifestyle changes including:

• Reduced intake of caffeine, alcohol and tobacco.

• Vitamin supplements to correct iron, folate and magnesium deficiencies.

• Setting and maintaining good sleep habits.

• Hot baths, or a heating pad or ice pack.

• Management of any underlying medical conditions that may be worsening symptoms.

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