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Not all people can sleep soundly. Some tend to move their legs constantly while sleeping. A few among them also move their hands occasionally. As you can probably understand by now, it is a disorder of the nervous system. Since it interferes with the quality of sleep, experts categorize it as a sleep disorder. The seriousness of this disease can vary among the affected people.
Restless legs syndrome or Willis-Ekbom Disease (RLS or WED) is not a new disorder. It has been around since the beginning of humanity. It begins with an irresistible urge to move the legs. Some describe this sensation as “itchy” or “pins and needles.” The seriousness usually depends on how bad these sensations are. People often find respite during constant motion of the limbs. The feelings typically become worse during the evenings and nights. The itch or the pain can become intolerable when a person is in bed.
We often have trouble if we manage to hurt our leg or pull a muscle. It is easy to understand how disrupting persistent discomfort and itching of their lower limbs can be. It often leads to excessive daytime sleepiness, and RLS interferes with the daily quality of the affected individual’s life.
Restless legs syndrome affects about 10% of the US population. It affects both genders, but it is more common among women. Sometimes, women experience periodic limb movement and restless legs for the first time during pregnancy. There is no particular age for the onset. There are cases of children suffering a case of restless legs as well.
The prognosis is usually severe in the event of a middle-aged patient. It is a disorder that is not easy to diagnose. Doctors often misdiagnose it as other sleeping disorders. It is usually prevalent among Caucasians who are around 59 years old. It has a high incidence in the North American and European countries. It is not as familiar in Asia.
In the last decade, there has been a significant rise in the number of people suffering from WED. The numbers rose higher with each survey and study between the early 1990s and late 2000s. Since it is relatively easy to misidentify the syndrome and its symptoms, thorough diagnosis as per the ICSD criteria is necessary to confirm the presence of the disorder in predisposed individuals.
The symptoms of RLS are diverse that can range from “mild persistent itching” to “creeping crawly” feeling that won’t cease. Relaxing, sitting, reading or lying down exacerbates the symptoms. Experts have classified this as a “spectrum” disorder that potentially results in sleep deprivation and impairs the quality of life. The symptoms can start during the childhood of the affected person.
The uneasiness during resting state usually disappears on its own, but for a few, the sensation and difficulty to commit to a state of rest can continue well into adulthood. The Restless Leg Syndrome Foundation conducted a study that showed 45% of their patients experienced their first case before they were 20 years old.
The descriptions of the uneasy feeling due to RLS, as per the accounts of people suffering from this disorder, are as follows.
Depending on the symptoms and the causes, experts have categorized restless legs syndrome into two categories.
Since the manifestation of the disorder is diverse among individuals, the causes of RLS can also vary. In the last two decades, there have been several studies that have reported multiple contributing factors to the Willis Ekbom Syndrome.
The mechanism of the disease relies on the dopamine and iron system. Experts have noted several differences in the dopamine and iron-related markers in the cerebrospinal fluid of patients with diagnosed cases of RLS.
Currently, there are no specific tests for the diagnosis of restless legs syndrome. However, several non-specific laboratory tests can rule out vitamin deficiencies. Four symptoms confirm the diagnosis in adults and children.
Apart from these four symptoms, there can be several indicators that your doctors should be able to diagnose. It is wiser to consult a sleep specialist or a neurologist. Doctors need to conduct physical examinations on the patients for determining the underlying physical discomforts that can trigger RLS.
Sleep studies rarely help with the diagnosis of WED. A sleep study can measure the quantity and the quality of sleep. The disorder can cause sleep deprivation, but that is not sufficient to diagnose the disease. Research has been going on for improving the diagnostic procedures that can determine RLS.
Your GP can assess the intensity of your symptoms, for example –
Maintaining a sleep diary can help your GP or your sleep expert understand the progression of RLS. Recording your daily bedtime, wake-up time and other sleeping habits can help them understand the underlying cause of the disorder and the seriousness of it.
In most patients, the symptoms disappear and reappear autonomously. Right now, there is no particular cure for the disorder, yet there are ways to alleviate the unease it causes.
Some medications lessen the crawling feeling or electric pain in the legs, but there are several alternative treatments you should try to improve the quality of your night-time rest. Here are a few drug-free steps you can attempt to enjoy some relief from the symptoms.
Good sleep routine. Not having a regular sleep schedule can make RLS worse. Going to bed at the same time every night helps regulate your sleep regime. It helps your body conform to resting hours. It might help to get in bed at around 11 pm, or 12 am. Going to bed a couple of hours later than usual can help you fall asleep faster and stay asleep longer. Use non-blue LEDs, dim lighting, and keep digital screens out of your bedroom. Keep your bedroom dark, comfortable, and relaxed.
Mind your supplements. Iron plays a vital role in determining the severity of the disease. In the event of a definite diagnosis, your doctor is most likely to recommend regular iron supplements. Folic acid, Magnesium, and Vitamin B12 level fluctuations worsen the effects of this disorder. GPs often recommend daily supplements of the vitamins and minerals to combat restless legs.
Temperature. Try taking a hot shower or soaking in a warm bath before bedtime. Try using a heating pad under your legs or put an ice-pack under your calves. You can also the temperature of the muscles that suffer the most during the episodes. Sometimes, a change in the heat can help relieve the stress.
Massage. You can go for the occasional spa or give yourself a nice warm massage to soothe your worn muscles. Rubbing your calves can loosen the muscles and reduce the pain. Ligaments and tendons often suffer from tiredness due to the constant contractions. Massaging can help you get a good night’s sleep.
Electrical stimulation. A neuromuscular disorder like this one often benefits from electrical stimulation. This process involves controlled electrical vibration of your toes and your feet. People often find relief from the symptoms, when they practice it for a couple of minutes before sleep.
Acupuncture. It is a prevalent practice among people with RLS. No scientific study seconds this method. However, people try this to relieve their symptoms.
Exercise. Simple stretching exercises, yoga, and even regular walks can help with RLS. Working out on a regular basis can help you reduce your anxiety and stress levels. You can also try deep breathing and mindfulness meditations every day for relief. Research shows that Tai Chi, meditation, and progressive muscle relaxation helps with busting stress.
Several medications can make a difference. In several instances, RLS occurs sporadically in patients and GPs prescribe medications only when they have the symptoms. Here’s a list of medications that treat RLS.
Dopamine agonists. These are the first line of defense against RLS. This class of drugs includes pramipexole, rotigotine, and ropinirole. They act as a neurotransmitter in the brain. Dopamine agonists act like the molecule and bind to dopamine-receptors in the organ. It is not devoid of side effects such as nausea, lightheadedness, and excessive daytime sleepiness.
Dopaminergic agents. These molecules increase the level of dopamine in the brain. It can improve RLS symptoms over time. Some people often experience worsening of symptoms after daily use. Side effects can also include vomiting, dyskinesias, and hallucinations.
Opiates. These are common pain relievers, but they also work wonders on RLS. Hydrocodone is the most popular opiate that can treat this syndrome. However, they are highly addictive, and people can become dependent on them. Doctors usually prescribe opioids only when there are no alternatives available.
Benzodiazepines. Alprazolam, clonazepam, and temazepam are benzodiazepine derivatives that work as sedatives. Although they do not help with relieving symptoms, they help you sleep through the night.
Anticonvulsants. Restless legs syndrome is not a manifestation of convulsions or cerebral seizures, but medications like gabapentin can relieve RLS. It can ease nerve pain and chronic pain that people experience during WED.
Alpha2 agonists. These molecules activate nerve cells that can control the movements of the nervous system. They stimulate the alpha2 receptors in the hind part of the brain and dampen the involuntary movements.
Physical therapy is beneficial for the treatment of restless legs syndrome. However, all sorts of physical therapy give better results when patients couple them with proper sleep habit. Additionally, staying away from caffeine, nicotine, alcohol, and tobacco can help with redressal of the symptoms of the disorder.
Dopamine medications usually lose their effectiveness over time. You might even notice the symptoms returning earlier during the day. This process is augmentation, and during this stage, doctors typically substitute these medications with newer ones to combat the problem. Many of the drugs that treat RLS are not safe during pregnancy.
Sometimes, alternative therapies work during the first two trimesters, but the last trimester can be particularly bothersome. Sometimes, antipsychotic medications, anti-allergic medicines, cold medication and antiemetic can exacerbate the symptoms of RLS/WED. During medical treatment of restless legs, it pays off to stay away from stimulants like caffeine.
There might be multiple genetic factors that contribute to the incidence of the disease, but several environmental factors contribute to the beginning of each episode. There is more than one daily trigger of RLS and knowing them may help you control the symptoms and progression of the disorder.
Keeping a few daily triggers of RLS in mind can prevent you from staying awake all night or pacing around to alleviate the uneasiness.
Your lifestyle choices will have significant effects on the outcome of your RLS. Everything you do, eat and drink throughout the day contributes to the comfort level you experience while in bed at night. If you are suffering from WKD at the present moment, you need to ensure that you make all the right choices that may lead up to a sound night’s sleep. Releasing the stress at the end of a long day makes a lot of difference to people suffering from a severe case of RLS.
Patients with restless legs syndrome often find themselves wide awake at night. The pain, discomfort, and anxiety keep them sleepless night after night. Several studies show a strong correlation between RLS and excessive daytime sleepiness. It is understandable that people with RLS will not get enough rest during the night. Hence, they often feel overwhelming tiredness by 10 am next day. However, without professional medical assistance, they might find it difficult to fall asleep due to the chronic discomfort in their lower limbs.
Persistence of RLS for more extended periods often leads to similar crawling feelings, tugging sensations and pain in their hands as well. An article in the Journal of European Neurology states that treating RLS and EDS with dopaminergic agents can improve both cases dramatically.
Periodic Limb Movement Disorder (PLMD) and Restless Legs Syndrome (RLS) may appear to be synonymous with many, but they are two distinct disorders that disrupt regular rest for the patients. Since they have different causes and effects, it is essential for the doctors to figure out which disease you have to treat it effectively.
During PLMD, a patient’s limbs move multiple times during a particular period. It is different from the spasmodic movement of legs as one tries to fall asleep. These happen during the non-REM stage of sleep, and people often do not know if they suffer from this condition. It is possible since PLMD is an involuntary action and the patient can sleep uninterruptedly through the episodes.
In case of RLS, patients do not experience involuntary movements. They move their legs in the hope of finding relief from the unnatural feeling that arises from sensorineural dysfunction. It keeps the patient awake and interferes with the quantity of one’s sleep.
While RLS can occur in about 15% of the population in the US, PLMD is common among only 4% of the population. At the same time, excessive daytime sleepiness and extreme fatigue are the effects of both conditions.
Several prevailing medical conditions can lead to Periodic Limb Movement Disorder and Restless Legs, including the following –
Similar to RLS, several medications can cause PLMD.
Restless legs syndrome can worsen with age. It usually happens when the person does not seek medical assistance.Present day medical science and research recommends many physical therapies and medications that can levy the symptoms of the disorder.
Some patients experience long periods of remission. During these brief periods, the restlessness may disappear for days or weeks, but they eventually reappear. However, the presence of restless legs does not always indicate the presence of other neuropathologies.
Living with RLS or WED can be challenging due to the lack of sufficient rest and the extreme levels of fatigue. Here are a few things you can do to make it easier for yourself.
Tell others about your disorder. Speak to your spouse or significant other about your case of RLS. It is not pleasant for anyone to sleep with a “kicky” partner. Talk about your problem to your coworkers and your friends, so when they catch you pacing up and down the aisle they will understand your obligation.
Do not be lazy. We know how much a comfortable chair or a bed can entice a sleep-deprived soul, but you need to resist the temptation. Make it a habit of moving around and taking the stairs to your office every day. Working out on a regular basis can be impossible for any office-goer, so make the best of the time you have in hand.
Maintain a sleep journal. A sleep journal should contain each bit of information about your bedtime, waking time, alarm details, quality of sleep, dream quality and incidences of restless legs. If the symptoms of RLS occurred twice this month, you need to write down every detail about it including at what time it happened and how long it continued.
Ask for professional help. Several support groups put people with RLS in touch with each other and their families too. Participating in a group discussion or regular meetings can help you gain new insights on pain management, alleviation of restless symptoms and improvement of sleep quality.
Preparing for facing your RLS with the help of a professional.
During your first visit to a sleep specialist or a neurologist, you can expect a flurry of questions. It always pays off to prepare in advance. Find out the following information to help your doctor.
The RLS is a severe disorder that compromises the quality and extent of sleep in adults as well as children. It can take a hefty toll on regular productivity and daily functions. Seeking professional help can help you overcome the discomfort and embrace the pleasure of sleep once more.