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Restless Legs Syndrome and Periodic Limb Movements of Sleep

~ 3 min read

Your healthcare provider may suggest that you see a sleep specialist, and refer you to a sleep center in your area.People with restless legs syndrome, also called Willis-Ekbom Disease, experience throbbing, pulling, tingling, crawling, or other uncomfortable sensations in the legs, and a strong urge to move their legs when sitting still or lying down. Moving the legs or walking may provide only temporary relief.

These unpleasant sensations occur primarily at night, and may make it hard to fall asleep or stay asleep. Sitting in a chair for a long period of time such as on an airplane may prove difficult. These symptoms often follow a 24-hour pattern that includes a few symptom-free hours in early morning.

A neurological disorder, restless legs syndrome may cause fatigue, along with difficulty concentrating and completing daily tasks. It also may cause depression. An estimated 1 in 10 people in the United States has restless legs syndrome. It occurs in people of all ages, although it is more common in middle-aged and older adults. It affects women twice as often as men. Several other medical conditions can mimic some of the symptoms of restless legs syndrome such as the peripheral neuropathy from diabetes. A physician will be able to distinguish restless legs syndrome from these other conditions.

People sometimes attribute restless legs syndrome symptoms to stress, muscle cramps, arthritis, or aging. Assuming that little can be done to relieve their distress, many do not seek medical help. However, effective treatment is available.

The majority of people with restless legs syndrome also experience a disorder known as periodic limb movement of sleep. In this disorder, involuntary leg twitching or jerking movements occur roughly every 15 to 40 seconds in sleep. These movements may continue throughout the sleep period, sometimes causing sleepers to very briefly awaken. Although leg twtiching or jerking may be noticed by the affected person or their bedpartner, in most cases they only are detected on a sleep study performed in a sleep center. These awakenings usually go unremembered in the morning. In the absence of restless legs syndrome, periodic limb movements of sleep generally is not related to symptoms of poor sleep and requires no treatment. However, in a few individuals, it is associated with insomnia or unrefreshing sleep. In such cases, it is called periodic limb movement disorder.

Treatment for restless legs syndrome and periodic limb movement disorder

Individuals with very mild or intermittent symptoms may not require treatment. Some people have iron or vitamin D deficiency; correcting these problems may reduce symptoms. Others benefit from regular exercise. Taking a warm bath, or using a heating or vibrating pad or ice pack may also help.

There are several classes of medications that can be used as treatment for those with more severe or persistent symptoms.

  • Dopaminergic agents (examples: pramipexole (Mirapex®), ropinirole (Requip®)) designed to treat movement disorders such as Parkinson’s Disease, can be very effective
  • Alpha-2-delta calcium channel ligards (examples: gabapentin (Neurontin®), pregabalin (Lyrica®)) also are effective especially in persons who also have chronic pain
  • Benzodiazepine hypnotic medications (example: clonazepam (Klonopin®)) may prevent or reduce difficulty falling asleep or staying asleep, but do not reduce the frequency of periodic limb movements
  • Opioids (examples: methadone (Methadose®), oxycodone (Oxycontin®)) may be useful in persons who do not respond to other therapies, but have addiction potential

Consultation with a physician is essential if medications are being considered for treatment of restless legs syndrome or periodic limb movement disorder.