Sleep Deprivation  Article Reprint

Original Article: http://www.sleep-deprivation.com/articles/types-of-sleep-disorder/disrupted-sleep/rls-and-plmd.php

 

RLS and PLMD: Restless Legs Can Lead to Interrupted Sleep

Restless legs syndrome, or RLS, is a common condition that can affect the lower limbs at any time of day. In its primary state (with no identifiable trigger), it is identified as a neurological disorder. Uncomfortable sensations in the legs force individuals to stand and move about for relief. Along with periodic limb movement disorder (PLMD), it can also cause excessive daytime sleepiness and interrupted nighttime rest.

RLS and PLMD are two separate sleep disorders with very similar symptoms and treatments. The distinct difference between the two is that PLMD sufferers experience involuntary leg movements while they're sleeping.

RLS Overview

Restless legs syndrome is identified as either primary or secondary. No cure currently exists for the primary state, which may be hereditary. The underlying causes of secondary RLS are generally traced to other health conditions. An iron deficiency, for instance, might instigate secondary RLS as can antidepressants. Once the initial condition is treated, this form of the disorder will usually resolve itself. A third instance, referred to as "idiopathic," means there is no connection between genetics or other conditions.

RLS may be merely annoying, similar to leg cramps, for some people, while others find the condition restrictive. Sitting for long periods is impossible, especially while flying or in social settings such as theaters or weddings. Minor interruptions occur once or twice a week. In severe cases, RLS can involve other parts of the body. In most instances, however, the area between the ankles and knees on one or both legs are affected.

Symptoms of RLS and PLMD

Many sufferers find it difficult to describe RLS symptoms. Irritating sensations include tingling, aching and burning deep inside the legs. The urge to move the legs becomes irresistible and it becomes difficult for a person to remain immobile. RLS generally becomes progressively worse throughout the day. When individuals are at rest or especially when prone, sleep becomes difficult and sporadic.

Restless leg syndrome can affect anyone, even children. Women, more than men, in higher age brackets seem to be most commonly affected. A great percentage of those who are diagnosed with RLS also suffer from periodic limb movement disorder. Once primary RLS occurs, it may grow progressively worse as a person grows older. Researchers state that those who develop RLS in later years experience a rapid progression from mild to severe.

PLMD can occur throughout the night. Events lasting less than one second may be present as often as every five seconds. More involved spasms last as long as 10 seconds. Leg movement is mild to severe with wild thrashing that becomes a constant sleep interrupter. Toe twitching can be seen and sometimes even blocked nasal passages contribute to known PLMD sleep interruption. Arm involvement sometimes adds to the disruption of sleep.

Those who experience PLMD are not typically afflicted with RLS. In addition, they may not be aware of loss of sleep from these events.

Related Factors and Causes of RLS

To date, there is no known cause of primary RLS, other than a familial connection. However, experts suggest several commonalities that could influence the onset of RLS:
  • Anemia: When an individual's system returns to normal levels, symptoms lessen or disappear.
  • Chronic diseases: These include diabetes and Parkinson's disease. Patients suffering kidney failure frequently report restless legs syndrome.
  • Medications: This includes over-the-counter and prescription. Simple cold medications, as well as some anti-nausea drugs and most antidepressants, can cause RLS to develop or worsen.
  • Nerve damage: Also known as peripheral neuropathy, which involves feet or hands.
  • Pregnancy: When RLS does occur, it is generally in later stages and will resolve itself within a few weeks after giving birth.
  • Stimulants: This includes alcohol, caffeine and tobacco, which are potential triggers if RLS is already present.

Diagnosis and Treatment

Clinically, RLS is often misdiagnosed. Physicians will generally look for an underlying cause first. Sleep studies may provide insight into brain wave and muscle activity. It is the patient who must provide the details of symptoms, which are varied; thus leading to a lengthy round of tests and conclusions.

The International Restless Legs Syndrome Study Group suggests standard criteria:
  • activity aids in relief from the discomforts brought on by lack of movement
  • fidgety or nervous feelings, known as "motor" restlessness
  • limb movement for relief becomes urgent
  • symptoms worsen at night.

The above determinations, paired with general to specific patient questions, provide guidance in reaching a diagnosis.

Professionals often suggest lifestyle changes for those who experience milder symptoms of restless leg syndrome. Additional vitamin intake and the removal of stimulants from the diet are common suggested preventatives. Relief is sometimes found in massages combined with cold or heat treatments.

More severe cases may benefit from drugs that have historically been beneficial in the treatment of Parkinson's disease. Evidence suggests, however, that there is no particular medication that will treat everyone. Those available today may alleviate symptoms in one person and cause them to worsen in another.

If you suspect you suffer from RLS or PLMD, a daytime and sleep diary can help pinpoint specific issues. These should include dietary and medication changes as well as daily routine fluctuations and emotional influences.

Resources

Emedicinehealth.com (2003-2007). Restless Legs Syndrome Overview. Retrieved January 24, 2007, from the Emedicine Web site: http://www.emedicinehealth.com/restless_legs_syndrome/
article_em.htm.

Nhlbi.hih.gov (n.d.). What Causes Restless Leg Syndrome? Retrieved January 24, 2007, from the National Heart, Lung, and Blood Institute Web site: http://www.nhlbi.nih.gov/.

Ninds.hih.gov (n.d.). Restless Legs Syndrome Fact Sheet. Retrieved January 24, 2007, from the National Institute of Neurological Disorders and Stroke Web site: http://www.ninds.nih.gov/disorders/restless_legs/detail_restless
_legs.htm.