Restless Leg Syndrome

What is Restless Leg Syndrome?

Restless legs syndrome (RLS) is a disorder of the part of the nervous system that affects movements of the legs. Because it usually interferes with sleep, it also is considered a sleep disorder.

What causes Restless Leg Syndrome?

RLS patients have been shown to have low iron storage in the brain. We know iron is necessary for the proper synthesis and functioning of Dopamine which is an important neurotransmitter.

Symptoms of Restless Legs Syndrome

People with RLS have strange sensations in their legs (and sometimes arms) and an irresistible urge to move their legs to relieve the sensations. The sensations are difficult to describe: they are usually not painful, but are reported to be uncomfortable, “itchy,” “pins and needles,” or “creepy crawly” feeling deep in the legs. The sensations are usually worse at rest, especially when lying in bed. Symptoms usually occur only in the evening. The sensations lead to discomfort, sleep deprivation, and stress.

The severity of RLS symptoms ranges from mild to intolerable. Symptoms get gradually worse over time in about two thirds of people with the condition and may be severe enough to be disabling. Most people have these symptoms only intermittently but in severe cases, they can occur nightly. The symptoms are generally worse in the evening and night and less severe in the morning. While the symptoms are usually quite mild in young adults, by age 50 the symptoms may cause severe nightly sleep disruption that can significantly impair a person’s quality of life.

Who is affected by Restless Legs Syndrome?

RLS affects about 10% of the U.S. population to some degree. Only a small percentage has severe RLS. It affects both men and women and may begin at any age, even in infants and young children. It is common in pregnancy affecting on average 20% of pregnant women. Most people who are affected severely are middle-aged or older. Other medical conditions such as anemia or kidney disease can put you at greater risk for RLS.

RLS is often unrecognized or misdiagnosed. In many people, the condition is not diagnosed until 10-20 years after symptoms begin.

How is RLS diagnosed?

RLS is a clinical diagnosis which means it is not based on any given test, but on your symptoms, medical history and physical exam.

How is RLS treated?

Once correctly diagnosed, RLS can often be treated successfully with medications. Sometimes people with RLS have low iron, therefore, iron supplements can help relieve the symptoms. Before a treatment plan is decided on, your sleep specialist should do a blood test to look at iron levels in your blood, in particular, Ferritin, which is a marker of iron storage levels. If Ferritin is low and symptoms are mild or intermittent then most sleep specialists will try iron replacement first. If iron is not the problem or iron therapy is not effective or symptoms are causing great sleep disruption, then there are 4 classes of medication that are used:

  1. Dopamine agonists, e.g. pramipexole (Mirapex), ropinirole (Requip)\
  2. Anti-epileptics, e.g. gabapentin (Neurontin)
  3. Benzodiazepines, e.g. clonazepam (Klonopin)
  4. Opioids, e.g. Methadone
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