Sleep flies out the window when legs have a mind of their own
People describe it as the sensation of ants crawling under their skin, feathers tickling their legs, and soda water coursing through their veins. They call it “jumpy legs,” “the heebie jeebies” and “crazy legs,” yet there’s nothing either crazy or unusual about Restless Legs Syndrome.
“This is a serious affliction,” says Dr. Margaret Rajda, a sleep disorders specialist, fellow of the American Academy of Sleep Medicine, and associate professor with the department of psychiatry at Dalhousie University. “People really suffer.”
Dr. Rajda works in the QEII Health Sciences Centre Sleep Disorders Clinic, where she specializes in a wide variety of sleep disorders. A large number of her patients, and somewhere between five and 10 per cent of Canadians, suffer from Restless Legs Syndrome (RLS).
“It’s quite common,” she says, “and it becomes more common with age. It’s also more prevalent in pregnant women, and in individuals with disorders such as iron deficiency anemia, diabetes and kidney disease.”
Causes sleep loss
A disorder characterized by an unpleasant feeling in the legs, and less frequently in other parts of the body, RLS occurs when the body is at rest and usually worsens at bedtime. Those afflicted experience an overwhelming urge to move the legs.
“Movement will usually alleviate the uncomfortable sensation,” explains Dr. Rajda, “but only while you are moving. As soon as movement stops, the sensation comes back. RLS should not be confused with habitual shaking or jiggling of legs that some people do.”
Many RLS sufferers actually get out of bed and walk around. Some run on the spot and jump in place. Others have hot showers and massage their legs. It interferes with a good night’s sleep.
The problem, according to Dr. Gosia Phillips, a neurologist specializing in sleep medicine and assistant professor of medicine at Dalhousie University, is that moving around during the night can make it difficult to sleep. That, in turn, leads to sleep loss and a host of associated problems, such as fatigue, poor concentration, sleepiness, and difficulty completing tasks.
“It becomes very complicated,” says Dr. Phillips. “Sleep problems can cause social and occupational impairment and increase the risk of other conditions such as heart disease, stroke and mental health disorders.”
Like Dr. Rajda, Dr. Phillips is a sleep specialty physician at the QEII Sleep Disorders Clinic. All of the patients she sees there arrive with a referral—usually from their family doctors. Some come with a self-diagnosis of RLS, having consulted the Internet. Others know nothing about RLS, but arrive complaining of uncomfortable sensations in their legs—especially at nighttime—and tremendous difficulty falling asleep.
Diagnosis and treatment
In order to make a clinical diagnosis of RLS, specialists conduct a diagnostic interview to rule out other conditions that could cause similar sensations. They may also conduct a sleep study called a polysomnogram, attaching leads to the patient’s legs at shin level to look for periodic leg movements during sleep, a symptom associated with RLS.
Sometimes treating RLS is as simple as supplementing iron. In other instances, patients benefit from non-medicinal approaches such as maintaining a regular exercise regimen, ensuring a tranquil sleeping space, and avoiding alcohol, caffeine and tobacco.
When medication is warranted, sleep specialists may prescribe opiate-based drugs for severe cases. Typically, however, they suggest drugs that enhance dopamine transmission to the brain and dopamine replacement therapies used to treat Parkinson’s disease. “The doses used are minute in comparison to what would be taken by someone with Parkinson’s disease,” says Dr. Phillips.
Despite the small doses, there’s a concern that patients will develop a tolerance for dopaminergic drugs. Long-term monitoring will detect signs of a declining response over time, and in cases where symptoms get worse and begin earlier in the evening, doctors may recommend a drug holiday. “Even a brief time-out can reduce the amount of medication required to get the same therapeutic effect if dopaminergic agents are reinstituted,” explains Dr. Phillips.
In addition to treating RLS with dopamine, some practitioners are having success with anti-convulsants. “We don’t really understand how they work with RLS,” says Dr. Phillips, “but they offer a promising alternative to other medications because they have fewer side effects.”
Dr. Phillips and Dr. Rajda agree that there is much to learn about RLS. “Some of my patients tell me there are other “night-walkers” in their families,” says Dr. Rajda, “and we know there’s a genetic vulnerability. I look forward to the day when we will find a cure and be able to free people from this condition.”