These statements may sound somewhat
exaggerated to someone who hasn't experienced restless legs syndrome (RLS), but
the feelings are very real to those afflicted with RLS. This disorder, which
often appears in otherwise healthy people, is not related to emotional or
psychiatric disorders. RLS affects primarily the legs, but can in fact be seen
in the arms as well.
People experience restless legs in different ways, but all describe very
unpleasant "creepy, crawly" sensations that occur in the legs when they are
sitting or lying still. For some, RLS can be very painful, yet the pain is
unlike that of a leg cramp. RLS is also different from the feeling of a limb
that has "fallen asleep" when the blood supply is cut off, and from the "pins
and needles" or "burning" sensation sometimes experienced by diabetics. The pain
and unpleasant feelings of RLS appear most often in the calves and can be
temporarily relieved by stretching, moving and or massaging the legs.
If you suffer from restless legs syndrome, you will find that it occurs
primarily when you are awake, but that it may also be present during your sleep.
The constant need to stretch or move the legs to get rid of the uncomfortable or
painful feeling often prevents a person with RLS from achieving and maintaining
sleep. Excessive fatigue during the day can be one result of the frequent
arousals caused by RLS. This increase in daytime fatigue may in turn cause you
to limit your activities during the day, including business meetings, travel and
social activities.
Periodic Limb Movement Disorder Another disorder that affects the limbs and a person's ability to
sleep at night, is periodic limb movement disorder (PLMD); also known as
nocturnal myoclonus. While the movements of RLS are a voluntary response to
uncomfortable feelings in the limbs when a person is awake, the movements of
PLMD only occur when a person is asleep and are involuntary.
Although some people may occasionally notice the involuntary movements of PLMD
at awakening, most not aware of these movements. Most people with RLS have
periodic limb movements, but those with PLMD often do not have RLS.
Periodic limb movements, like RLS usually occur in the legs but can also affect
the arms. The movements occur at periodic intervals, typically every 30 seconds.
They usually consist of a rhythmic extension of the toes, together with an
upward bending of the ankle, knee or hip. The movements usually do not occur
continuously throughout the night, but instead are more often seen in the first
half of the night.
*Most People with RLS have Periodic Limb Movements, but patients with PLMD often
do not have RLS
1.When is PLMD considered
a sleep disorder?
When leg movements occur five or more times during each hour of sleep,
they are considered periodic limb movement disorder. PLMD may cause various
complaints about sleep. While one person may have difficulty falling asleep,
another may have trouble maintaining asleep. Still, another patient may
experience excessive daytime fatigue. These problems result from the same cause,
but often involve a difference in timing and perception. For example, people
awakened by leg movements occurring immediately after sleep onset, they may wake
up before they realize they have fallen asleep. In this case the person may
complain of difficulty falling asleep.
A person who reports difficulty staying asleep may instead experience leg
movements throughout the night that are accompanied by very brief awakenings
that create the feeling of a poor night's sleep. Periodic limb movements can
cause several other problems, some of which affect the bedpartner as well. A
bedpartner may complain of being kicked at night or that the covers are twisted
and or knocked off the bed.
Approximately 5 to 10 out of every 100 people experience the discomfort or pain
of RLS at some point in their lives. Severe cases of RLS, although not common,
tend to run in families. This disorder is more common in older individuals, but
can occur at any age in both genders. It is more common during the last six
months of pregnancy. Over the course of several years, the problem may come and
go without any obvious cause.
PLMD
PLMD affects 5% of people age 30 to 50; 25% of people age 50 to 60; and 44% of
people over age 65. Men and women are equally at risk to be affected. PLMD
contributes to the inability to sleep in 20% of people who have been diagnosed
with insomnia. PLMD Is rare in people under 30 years of age, but becomes more
common with age.
Approximately 30% of RLS cases have hereditary causes. This means that in 30
cases out of 100, the disorder has been passed on by the genes of the parents.
The cases of RLS that run in families often have more severe symptoms and are
frequently more difficult to treat. For the other 70% of RLS cases, the causes
are not clearly defined . Some cases of RLS are the result of another underlying
medical condition. These include poor blood circulation in the legs, nerve
problems, muscle disorders, kidney disease, alcoholism and vitamin or mineral
deficiencies. Other factors that can trigger RLS are abuse of medications,
caffeine consumption , smoking, fatigue, a very warm environment and prolonged
exposure to cold temperatures.
PLMD
The cause of PLMD is also unclear. Some of the same factors associated with RLS
are involved with PLMD. Periodic limb movements are more common in people who
have kidney disease or narcolepsy.
Some antidepressant medications can also increase the frequency of limb
movements.
Your healthcare provider should be consulted to make a proper diagnosis. RLS
symptoms are so unique that diagnosis of this disorder can often be made on the
basis of patients' descriptions of their individual symptoms. Terms used
frequently to describe these symptoms include creepy, crawly, pulling, gnawing
and the irresistible feeling to jerk or move the legs.
PLMD
People with PLMD are usually unaware of their nighttime movements and may
instead only complain of restless sleep and or excessive daytime sleepiness. In
this case, an overnight sleep study may be needed to diagnose the cause of the
problem.
The first step in treating RLS or PLMD is to determine whether there are
underlying causes (such as anemia, diabetes, arthritis, lung disease or the use
of antidepressant medications) contributing to the movements. After a proper
diagnoses, prescription medications cab be used to treat both disorders. The
effectiveness of the medication will depend on the severity of the disorder,
other existing medical problems and other medications that the patient is
currently taking.
Home remedies may be effective for some cases of RLS. These remedies include: a
hot bath, leg massage, use of heating pad or ice packs, pain relievers, regular
exercise and elimination or reduction of caffeine intake.
