"Dr. McConnell is very thorough. He spends a good bit of time with each patient and is a great resource for referrals for specialty consults as needed."
Have you ever thought or said anything like this?
“Worms crawl under my skin if I don’t keep moving my legs.”
“My legs decide they want to run, and I have to follow.”
“After I get in bed, a gremlin grabs my legs and leads me around like a puppet.”
These statements may sound bizarre or unbelievable to someone who hasn’t experienced Restless Legs Syndrome (RLS), but the feelings are all too real if you have restless legs.
What Is Restless Leg Syndrome?
Restless Leg Syndrome (RLS) occurs in people who are otherwise healthy. It can reduce sleep quality, daytime functioning, and overall quality of life. Although it affects mostly the legs, as the name suggests, it can also affect the arms, trunk, or multiple body parts at the same time.
People experience restless legs in many different ways. Everyone describes unpleasant “creepy, crawly” sensations in the legs wile they are sitting or lying still, especially at bedtime. If you have RLS you know it is not the same as the pain experienced from a leg cramp, or the numbness someone feels if a leg “falls asleep.” RLS sensations are also different from the “pins and needles” or the burning feeling a person with diabetic neuropathy may experience. The uncomfortable feelings happen most often in the calves and are eased for a while by stretching or moving the legs.
In some cases, RLS can be painful, or disturbing enough to cause insomnia. The constant need to rub or move the legs to get rid of the painful sensations often prevents a person with RLS from falling asleep. As a result, the person may be extremely tired during the day and unable to perform well at work or take part in social activities.
Sleepiness is not the only daytime problem you might experience if you have RLS. During the day, RLS can reduce your ability to travel by car, airplane, or any other kind of transportation requiring you to sit still for long periods of time.
RLS may disturb your ability to sit still in class, at lectures, movies, concerts, and in business meetings. As a result, RLS symptoms can often lead to anxiety and depression.
What Is Periodic Limb Movement Disorder?
Periodic Limb Movement Disorder (PLMD) is similar to RLS in many ways. It is associated with night-time limb movement complaints, reduced sleep quality and problems with daytime functioning. Unlike RLS patients, people with PLMD do not complain about the ”creepy-crawly” feelings or the “overwhelming urge to move” Instead, individuals with PLMD have uncontrolled leg kicks that are reported by their bed partner or recorded on a sleep study. When the leg kicks are seen on a sleep study they are called Periodic Limb Movements of Sleep (PLMS).
PLMS usually occur in the legs but may also affect the arms. As the name implies, the movements are periodic. They occur over and over, usually every 30 seconds. They typically consist of a movement of the big toe, together with an upward bending of the ankle, knee, or hip. The movements are often called jerking or kicking.
They usually do not occur throughout the entire night. Most PLMS occur in the first half of the night.
If your sleep study shows periodic leg movements five or more times during each hour of your sleep, they may be serious enough to prevent you from sleeping. You may wake up often during the night due to your leg movements, but not realize it is from the leg movements. When this happens, you may complain of difficulty falling and/or staying asleep.
PLMS may cause very brief awakenings many times during the night. Some people may not be aware of these awakenings. This often leads to a feeling of poor sleep quality. Patients with PLMS may fall asleep during the day while reading, watching TV, working, or driving.
PLMS may cause several other problems, some of which may affect your bed partner and some of which affect you. Your bed partner may complain of being kicked at night, of the bed covers being twisted or knocked off the bed, or that limb movements shake the bed. You may notice that the frequent leg movements are wearing hair off your legs.
Your doctor may want to confirm a diagnosis of Periodic Limb Movement Disorder (PLMD). This requires PLMS on a sleep study and complaints of daytime effects. Although patients with RLS often have PLMS, PLMS are not required to have the diagnosis of RLS. Thus, you can only have PLMD if you do not have RLS or another disorder that causes leg movements at night (such as sleep apnea).
How Common Is RLS & PLMD?
Restless Legs Syndrome
Seven to ten of every 100 people experience the discomfort of RLS at some time in their lives. Approximately 2 to 5 out of every 100 people have symptoms severe enough to require medical attention. The disorder is more common in women and older individuals, but can occur at any age in both men and women. RLS can also be severe during pregnancy, especially during the last 6 months. Over the years, RLS may come and go without any reason.
Periodic Limb Movements of Sleep & Periodic Limb Movement Disorder
PLMS becomes more common with age. PLMS is rarely seen in people younger than 30 years of age. PLMS affects a small percentage of people age 30 to 50, one-third of people age 50 to 65, and almost half of people over age 65.
Men and women are equally likely to be affected. However, most people have PLMS only. Experts agree that PLMD is quite rare.
What Causes These Disorders?
Although we don’t know the actual cause of RLS, PLMS, or PLMD, there are some related conditions and hereditary signs to consider.
About 30% of RLS cases have a hereditary cause. This means that in 3 cases out of 10, the disorder has been passed through the genes of either the father or mother to the child. The causes of the other 70% of RLS cases are not clearly known. When RLS appears to run in families, the symptoms are more likely to begin early in life (before the age of 45) and to be associated with anemia or iron deficiency.
RLS is linked to a variety of other problems. These include: iron deficiency anemia, nerve problems, muscle disorders, kidney disorders, alcoholism, rheumatologic disorders and vitamin or mineral deficiencies. Other things that may trigger RLS are stopping or starting certain medications, smoking, fatigue, and sleep deprivation.
PLMS are often seen when older patients have overnight sleep studies. PLMS are associated with several common medical conditions including neuropathy, spinal cord diseases, kidney disease, rheumatologic disorders, narcolepsy, obstructive sleep apnea, and REM sleep behavior disorder.
Some antidepressant medications can also increase the frequency of PLMS. Studies have suggested that some of the same factors associated with RLS, such as heredity and iron deficiency, may also be associated with the development of PLMS as well as PLMD.
How Are These Disorders Diagnosed?
Restless Legs Syndrome:
Before treating, your healthcare professional needs to be certain you have RLS.
You may need to see a sleep specialist. RLS is a diagnosis made based on the presence of a unique set of symptoms.
The diagnosis must be made carefully so as not to be confused with other common conditions. Some words used to describe these symptoms include creepy, crawly, pulling and gnawing. These feelings create an almost irresistible need to move the legs.
RLS gets better, briefly, when the leg is moved. The feelings are worse in the evenings than in the daytime.
Your doctor will carefully review your medical history and perform a physical examination to be sure that you don’t have other problems that may be mistaken for RLS.
Periodic Limb Movements Or Sleep & Periodic Limb Movement Disorder:
An overnight sleep study is needed to make the diagnosis of PLMD. Small electrodes will be taped to your legs and/ or arms to record movements at night. The overnight study also helps to rule out any other sleep disorders including sleep apnea.
How Are These Disorders Treated?
The first step in treatment is to find out whether you have one of the problems linked to RLS or PLMD. Sometimes proper diagnosis and treatment of these problems may help RLS or PLMD. For example, if you have iron deficiency anemia, treatment with iron replacement may help your RLS symptoms. Still, many patients find that their disturbing movements continue even after they receive proper treatment of other conditions.
Restless Legs Syndrome
Home remedies may help some people with RLS. These remedies include: hot baths, leg massage, heat, ice packs, aspirin or other pain relievers, regular exercise, and avoiding caffeine.
When home remedies do not work, RLS can be treated with prescription medications. A medication may help one RLS sufferer and not another. You may need to try several over a period of time. How well a drug works will depend on the severity of the condition, the patient’s other medical problems, and other medications that the patient is taking.
Sleep Hygiene Rules For PLMS & PLMD
Good sleep hygiene and medication are aimed at improving the soundness of a person’s sleep. They may not necessarily reduce PLMS and therefore you could continue to be disruptive to your bed partner. If this happens, you should discuss further treatment options with your healthcare provider or sleep specialist.
Some antidepressants and other medications can make RLS and PLMD worse. Changing to another medication may help reduce your symptoms and limb movements. Fortunately, the same drugs that help RLS can also relieve PLMD. See your healthcare professional before making any changes in medication.