Do your legs ever drive you crazy in the evening when you are sitting or lying down? Do you feel compelled to get up, stretch them, walk around?
Restless legs syndrome (RLS) is an apt name for a common disorder that is considered sleep-related, even though it occurs when you're awake, usually in the evening. In some cases, it is just annoying; in others, it is downright frustrating, interfering with evening activities and the ability to get a good night's sleep.
Sir Thomas Willis, a 17th-century English anatomist and physician, described something like restless legs: "Wherefore to some, when being abed they betake themselves to sleep, presently in the arms and legs, leapings and contractions of the tendons, and so great a restlessness and tossings of their members ensure, that the diseased are no more able to sleep, than if they were in a place of the greatest torture."
Some 300 years later, the Swedish physician Karl-Axel Ekbom also described in detail the disorder and applied the term "restless legs" in 1945. Today, RLS is sometimes called Willis-Ekbom disease, after these two physicians. As an oft-overlooked phenomenon that can disrupt quality of life, limit social activities and prevent sleep, some argue that its newer name better reflects its rightful place as a legitimate medical disorder. I'll stick with the older, more descriptive name here.
About 5 per cent to 15 per cent of Canadians have RLS. Usually only the legs are involved but arm restlessness is also possible. There are no laboratory tests to diagnose RLS. Rather, the diagnosis is based on five symptoms:
- An urge to move the legs, usually with an uncomfortable sensation in the legs;
- The urge begins or worsens during periods of inactivity, such as lying down or sitting;
- It is relieved or lessened by movement, such as walking or stretching;
- The urge only occurs, or is worse, in the evening or at night compared with the daytime;
- It is not caused by another condition (e.g., arthritis, leg cramps).
Not only is RLS uncomfortable , but at least 80 per cent of people with the syndrome have another problem they may not be aware of: periodic limb movements, repetitive, quick movements that occur usually at 20-40 second intervals during certain sleep stages. These movements are sometimes associated with arousals to lighter sleep and transient increases in blood pressure.
Although researchers are still grappling with the cause of RLS, we do know quite a bit about the risk factors. They include: having family members with RLS; increasing age; being a woman; pregnancy – especially the third trimester; having low levels of serum ferritin; kidney disease and some cancers.
What can you do if you think you might have RLS? You can learn more about this phenomenon from the Restless Legs Foundation (rls.org) or the Canadian Sleep Society (brochure on RLS at css-scs.ca). If you are bothered by symptoms that may be restless legs and especially if your sleep is affected, see your family physician.
There are pharmacologic and non-pharmacologic approaches to treatment.
The former fall into four types of medications, all with significant side effects. : those that activate receptors for the neurotransmitter dopamine in the brain or "dopamine agonists" such as ropinirole and pramipexole, certain anticonvulsants such as pregabalin, opioid medications such as oxycodone, and certain sleeping pills such as clonazepam. All these medications have significant side effects. For example, after a person uses dopamine agonists for 1-2 years, RLS symptoms can worsen, start earlier in the day and spread to more parts of the body, a phenomenon called "augmentation." Other side effects of RLS treatments can include drowsiness, dependence on the medication and increased risk of falling down. Medications for RLS are prescribed only after careful consideration of the potential benefits and risks.
The non-pharmacologic approaches, although recommended as the first step in managing RLS, have rarely been scientifically tested. These behavioural strategies are safer than using medication. People with restless legs discover their own methods that usually involve movement.
Experts in the field generally recommend staying active physically and mentally. They also recommend avoiding the following: sleep loss; alcohol; antihistamines (such as diphenhydramine – found in many over-the-counter cold and sleep remedies); caffeine; and intense exercise within two hours of bed.
During an episode, the following activities may help: walking; stretching, using various yoga or basic fitness stretches that involve the legs; massaging the leg muscles; taking a warm bath or shower (although some find cold is better).
If you are in a place where physical movement is limited, such as a plane or a bus, engage in a mentally engrossing activity, such as conversation, video games, reading a fascinating book or doing a crossword.
In general, being physically, emotionally or mentally stimulated and alert seems to keep the restlessness at bay.
Dr. Judith Davidson is a clinical psychologist and sleep researcher. She works with the Kingston Family Health Team and Queen's University in Kingston, Ont. She is the author of Sink into Sleep: A Step-by-Step Workbook for Reversing Insomnia. You can follow her on Facebook and on Twitter at @JudithRDavidson