Thomas Pearson, M.D. Board Certified in Sleep Medicine JC Blair Sleep Care Center
Not sleeping well? Restless Leg Syndrome is often a reason for insomnia
Insomnia is a major contributor to an unhealthy lifestyle, impacting a person’s physical, mental, and social health. Although insomnia has many underlying causes, it is often a result of a medical condition termed restless leg syndrome (RLS) affecting 12 million Americans every year. People with RLS tend to have uncomfortable sensations in their legs or limbs when sitting or lying down, described as “itchy, pins and needles, or creepy crawly” feelings deep in the legs. These feelings create an urge to move the legs to remove the sensations, which also leads to walking discomfort and stress. Symptoms may begin at any age, with RLS being more prevalent in older populations and women.
RLS is hereditary in 25-75% of cases. Generally, we consider that there are two types of RLS, primary and secondary. Primary RLS may be genetic or familial. Secondary RLS is often due to a separate medical condition.
RLS symptoms may appear temporarily in pregnant women or in a person taking certain medications. Other medical conditions associated with RLS are vitamin B-12 deficiency, Lymes disease, Rheumatoid arthritis, or damage to the spinal nerves. It is also linked to other conditions such as Parkinson’s disease and varicose veins.
Frequently misdiagnosed and unrecognized for years, RLS was initially thought to be due to a disease affecting the leg’s blood vessels or nerves, but currently, there is no evidence to support these findings. On the other hand, recent studies have shown that the two most common medical conditions inducing RLS are iron-deficiency anemia and peripheral neuropathy. Iron deficiency anemia is a result of a deficiency in hemoglobin, an iron-rich protein able to bind and carry oxygen in blood vessels. Peripheral neuropathy, or damage to arm and leg nerves, induces numbness, pain, and loss of sensation in affected areas, and is commonly caused by diabetes.
RLS is a clinical diagnosis. There is no test for RLS. Certain tests such as polysomnography or sleep testing may be necessary to find out if someone has periodic limb movement disorder (PLMD). RLS is what a patient will often tell a doctor he or she has, but PLMD is what the doctor may find in a sleep study.
There is no cure for RLS but there are medications that may lessen the symptoms. Additional treatments including physical therapy may help. Underlying conditions such as anemia or diabetes are treated first. Some of the self-care treatments are relatively simple and include getting some form of daily exercise, limiting alcohol and caffeine intake, avoiding day time naps and heavy meals before bed, and trying to not use bed time as a worry time.
If a doctor determines that a person has RLS or has symptoms of RLS at least three nights a week, daily medication treatment is recommended. Widely prescribed medicines used to treat RLS are in a class called dopamine agonists which stimulate dopamine receptors within the brain helping to reduce the involuntary muscle movement in RLS.
Healthy daily life choices that emphasize regular sleep habits can lessen the symptoms and occurrences of RLS. Daytime sleepiness or persistent insomnia may be a result of some other medical condition or aging, so it is advisable to contact a medical professional for their opinion and proper diagnosis.
Overall, RLS is treatable and symptoms will decrease with the right treatment, which will reduce insomnia and lead to a more balanced well-being.
Thomas Pearson, M.D., is board certified in Sleep Medicine and Neurology and practices at J.C. Blair Memorial Hospital in Huntingdon. For more information about restless leg syndrome and other sleep disorders call the J.C. Blair Sleep Care Center at 814-643-8478, visit www.jcblair.org/services/sleepstudy.php or ask your family healthcare provider for a referral to the J.C. Blair Sleep Care Center.