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Health Questions & Answers #70 ~ [Issue 1105-4]  Wellness Weekly
 Nov 25, 2005 13:51 PST 

Q & A #1:
What is restless legs syndrome?

Restless legs syndrome or RLS is a sleep disorder in which a person
has unpleasant feelings or sensations in the legs. These feelings are
described as creeping, crawling, tingling, pulling, or painful. While
these sensations happen most often in the calf or lower leg area,
they can be felt anywhere from the ankle to the upper thigh. RLS
symptoms can occur in one or both legs and can also be felt in the
arms. These symptoms occur most often when lying down, but can also
occur when sitting for long periods of time, such as at a desk,
riding in a car, or watching a movie. People with RLS talk about
having an irresistible urge to move the legs. Moving the legs,
walking, rubbing or massaging the legs, or doing knee bends can bring
relief, at least for a short time.

Unlike other conditions, RLS symptoms get worse when relaxing or
lessening activity, particularly during the evening and nighttime
sleeping hours. Many people with RLS have trouble falling asleep and
staying asleep. If not treated, RLS can cause extreme tiredness and
daytime fatigue. A person's job, personal life and daily activities
can be strongly affected due to exhaustion. A person can lose their
ability to focus and have memory loss.

Many people with RLS also have a related sleep disorder called
periodic limb movements in sleep (PLMS). With PLMS, a person jerks or
bends their legs unintentionally during sleep. These movements can
happen every 10 to 60 seconds, or hundreds of times, during the
night. They can wake a person, disturb sleep, and wake bed partners.
People who have both RLS and PLMS have trouble falling and staying
asleep and can have extreme sleepiness during the day.

Q & A #2:
How common is RLS?

RLS affects about 2 to 15 percent of Americans. But, it may actually
affect more people. Some people with RLS do not seek treatment
because they fear they will not be taken seriously, their symptoms
are too mild, or that the condition cannot be treated. Health care
providers sometimes think the symptoms of RLS are caused by something
else, like nervousness, insomnia (not being able to sleep), stress,
arthritis, muscle cramps, or aging.

RLS is thought to affect women more often than men. It can start at
any age, even in young children, but most people with RLS are
middle-aged or older. And, older people with RLS have symptoms more
often and for longer periods of time. Young people who have RLS are
sometimes thought to have "growing pains" or may be considered
"hyperactive" because they cannot sit still in school.

Q & A #3:
What are the symptoms of RLS?

RLS symptoms are not the same for every person. They range from
uncomfortable to painful and can vary in frequency. A person can have
periods when RLS does not cause problems, but the symptoms usually
return. Another person can have severe symptoms every day.

Common symptoms of RLS include:

Unpleasant or uncomfortable feelings or sensations in the legs often
described as creeping, crawling, tingling, pulling or painful, often
producing an irresistible urge to move the legs. These feelings most
often occur deep inside the leg, between the knee and ankle. While
rare, they can also occur in the feet, thighs, arms, and hands. Most
of these feelings involve both sides of the body, although they can
happen on just one side of the body.

Leg discomfort that occurs and gets worse when lying down or sitting
for long periods of time. Long car trips, sitting in the movies,
long-distance flights, and having a cast on can trigger RLS.

Symptoms that happen and are worse later in the day, evening, and
during the night.

The need for constant movement of the legs (or other affected body
parts) to lessen discomfort. People may pace the floor, move their
legs when sitting, and toss and turn in bed.

Having leg and sometimes arm movements when sleeping that you cannot
control.

Trouble falling asleep or staying asleep.

Sleepiness or tiredness during the day.

Certain medications, such as drugs for nausea, seizures, and
psychosis, as well as some cold and allergy medicines, may make
symptoms worse. Talk with your health care provider if you are taking
any prescription or over-the-counter medicines.

Q & A #4:
What causes Restless Legs Syndrome (RLS)?

In most cases, the cause of RLS is not known. For about half of all
RLS cases, there is a family history of the condition. People who
have RLS in the family tend to be younger when symptoms start and
develop symptoms slowly.

RLS is thought to be related to the following factors or conditions:

Some women get RLS during pregnancy, especially in the last 3 months.
But the symptoms usually go away about 4 weeks after having the baby.

People with anemia (low iron levels) may be more likely to get RLS.
Once low iron levels or anemia is corrected, symptoms can lessen.

Chronic diseases such as kidney failure, diabetes, Parkinson's
disease, and peripheral neuropathy (loss of feeling or numbness in
the hands and feet) may be linked to RLS.

Q & A #5:
How is RLS diagnosed?

There are no tests for RLS. It can be hard to diagnose and is easily
confused with other conditions. When someone with RLS goes to see a
doctor, there is often nothing wrong that the doctor can see or
detect with a physical exam. Diagnosis therefore depends on what a
person describes to the doctor. To help make a diagnosis, the doctor
may ask about all current and past medical problems, family history,
and current medications. A complete physical and neurological exam
may help identify other conditions that may be linked with RLS, such
as nerve damage (neuropathy or a pinched nerve) or abnormalities in
the blood vessels. Basic lab tests may be done to assess overall
health and to rule out anemia.

Q & A #6:
How is RLS treated?

There is no cure for RLS. Sometimes RLS can be controlled by
diagnosing and treating an underlying condition, such as peripheral
neuropathy or diabetes. Treating the underlying disease can relieve
many of the symptoms of RLS.

For people who have RLS with no diagnosed cause (like an underlying
disease), treatment is focused on symptom relief. For those with mild
to moderate symptoms, lifestyle changes are often suggested including:

a. reducing or stopping use of caffeine, alcohol, and tobacco products;

b. taking supplements to increase iron, folate, and magnesium in the
body;

c. developing and keeping a regular sleep schedule;

d. getting moderate exercise;

e. taking hot or cold baths, rubbing or massaging the legs or other
affected body parts, or using a heating pad or ice pack.

Health care providers may prescribe medicine for symptom relief.
Three types of drugs are most often prescribed:

1. Benzodiazepines - these drugs depress the central nervous system
and allow people to sleep more, despite the RLS symptoms. They should
not be used by people with sleep apnea (a person stops breathing on
and off during the night).

2. Dopaminergic agents - are drugs used to treat Parkinson's disease.
They have been shown to reduce RLS symptoms and nighttime leg movements.

3. Opiods - are painkillers and relaxing drugs that can sometimes
help people with severe RLS symptoms.
	
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