Up to 15 percent of the population are all too familiar with the irresistible urge to move their legs that keeps them awake at night. Interestingly, lifestyle changes--and drugs if needed--will help banish those sleepless nights and groggy, grumpy days.
You're in bed ready to go to sleep, but your legs have other ideas. They want to kick, stretch, do anything but rest. Restless legs syndrome (RLS), more colourfully described as 'the gotta-moves' or 'Elvis legs', usually affects the area between the ankles and knees. The feet, thighs, arms or trunk may also be involved. It's more noticeable if you're lying down or sitting for long periods, especially at night. In milder cases, there's a pulling, crawly feeling or pins and needles that goes away when you move. More serious RLS is painful, can last for hours and interrupts sleep repeatedly, leaving you exhausted. Contrary to what you might expect, RLS is a neurological, not a muscular disorder. The cause is most likely low levels of the brain chemical dopamine, which keeps nerve cells functioning smoothly. RLS tends to run in families and frequently develops during pregnancy.
LIKELY FIRST STEPS
Restless legs syndrome is no walk in the park but you have a number of options for treatment. For mild symptoms, simple lifestyle changes may do the trick. When such remedies don't work, you'll want to have your doctor rule out medical causes of RLS, such as kidney problems, diabetes or vitamin or mineral deficiencies, then
move on to medications that can help your legs give you a rest.
Lifestyle changes
When your legs are agitating, the best thing to do is just move them: walk around, stretch, do deep-knee bends. Massages or acupressure on the legs can further dissipate the creepy-crawly feeling. A heating pad or cold compresses may also relieve restlessness. Finally, consider some distraction--a good novel, late-night TV show or relaxation tape. You can also help prevent a future round of nighttime RLS by trying some of the following to see what works for you.
Treatment Options
MEDICATIONS
------------------------------------------------------------------------------------------------------------------------------------------
Dopaminergics Quieten leg restlessness.
------------------------------------------------------------------------------------------------------------------------------------------
Anticonvulsants Blunt leg pain.
-------------------------------------------------------------------------------------------------------------------------------------------
Benzodiazepines Help you sleep through any restlessness.
PROCEDURES
---------------------------------------------------------------------------------------------------------------------------------------------
TENS Electrical stimulation improves sleep.
LIFESTYLE CHANGES
---------------------------------------------------------------------------------------------------------------------------------------------
Moderate exercise Helps legs relax.
----------------------------------------------------------------------------------------------------------------------------------------------
Warm bath Take one 90 minutes before bed to calm nerves.
NATURAL METHODS
-----------------------------------------------------------------------------------------------------------------------------------------------
Supplements Iron or other supplements for deficiencies.
TAKING CONTROL
For some people, vitamin/mineral supplements can go a long way towards easing restless legs. Extra iron may remedy your symptoms if your iron levels are low, a common problem in RLS. The B-complex vitamins as well as magnesium, vitamin E and calcium may also be useful. Before trying these, ask your doctor for a blood test to find out if you're low in any key nutrient.
Medications
If these simple, natural methods fail, your doctor might try you on medications. As first-line therapy, try paracetamol or the anti-convulsant clonazepam (Rivotril). Sometimes you may be given a combination of these plus or minus the benzodiazepine, diazepam. This combination will be particularly helpful at night as it will help you sleep through the 'funny' RLS feelings.
Another option is a dopaminergtic agent such as levodopa (Sinemet). These drugs are usually used to quieten the tremors of Parkinson's disease but can quell restless legs too. (Don't worry, RLS doesn't lead to Parkinson's disease.)
Other drugs such as the anticonvulsant gabapentin (Neurontin), the analgesic codeine, the muscle relaxant baclofen and the beta-blocker propranolol (Inderal) may also be helpful.
Procedures
Apart from the lifestyle and medication alternatives, your doctor may also recommend transcutaneous electrical nerve stimulation (TENS). In this procedure, electrodes are attached to pads placed on the skin; the TENS machine then emits mild electrical impulses that feel like a massage, overriding pain or discomfort. Using it for 15 to 30 minutes before you turn in can substantially increase your chances of a restful night's sleep.
What is happening
You're in bed ready to go to sleep, but your legs have other ideas. They want to kick, stretch, do anything but rest. Restless legs syndrome (RLS), more colourfully described as 'the gotta-moves' or 'Elvis legs', usually affects the area between the ankles and knees. The feet, thighs, arms or trunk may also be involved. It's more noticeable if you're lying down or sitting for long periods, especially at night. In milder cases, there's a pulling, crawly feeling or pins and needles that goes away when you move. More serious RLS is painful, can last for hours and interrupts sleep repeatedly, leaving you exhausted. Contrary to what you might expect, RLS is a neurological, not a muscular disorder. The cause is most likely low levels of the brain chemical dopamine, which keeps nerve cells functioning smoothly. RLS tends to run in families and frequently develops during pregnancy.
- Massage, heat or cold to stop RLS symptoms.
- Regular exercise and warm baths to head off RLS.
- Iron or other supplements, if needed, to correct any deficiencies.
- Medications to relieve more severe cases.
QUESTIONS TO ASK
- Is my mild restlessness going to get worse?
- Is RLS a sign of other more serious medical problems?
- Will I have RLS for the rest of my life?
Treatments
Restless legs syndrome is no walk in the park but you have a number of options for treatment. For mild symptoms, simple lifestyle changes may do the trick. When such remedies don't work, you'll want to have your doctor rule out medical causes of RLS, such as kidney problems, diabetes or vitamin or mineral deficiencies, then
move on to medications that can help your legs give you a rest.
Lifestyle changes
When your legs are agitating, the best thing to do is just move them: walk around, stretch, do deep-knee bends. Massages or acupressure on the legs can further dissipate the creepy-crawly feeling. A heating pad or cold compresses may also relieve restlessness. Finally, consider some distraction--a good novel, late-night TV show or relaxation tape. You can also help prevent a future round of nighttime RLS by trying some of the following to see what works for you.
- Get moderate excercise. Some people find a stationary bike or treadmill workout before bed leads to a less restless night. Others sleep better if they stop exercising six hours before bedtime.
- Warm yourself up. Try a bath about 90 minutes before bedtime and keep your legs and feel warm in bed.
- Clean up your sleep habits. Keep your bedroom cool and go to bed and get up at the same time every day.
- Steer clear of common Irritants. Caffeine, alcohol and cigarttes can all provoke RLS or make it worse.
Treatment Options
MEDICATIONS
------------------------------------------------------------------------------------------------------------------------------------------
Dopaminergics Quieten leg restlessness.
------------------------------------------------------------------------------------------------------------------------------------------
Anticonvulsants Blunt leg pain.
-------------------------------------------------------------------------------------------------------------------------------------------
Benzodiazepines Help you sleep through any restlessness.
PROCEDURES
---------------------------------------------------------------------------------------------------------------------------------------------
TENS Electrical stimulation improves sleep.
LIFESTYLE CHANGES
---------------------------------------------------------------------------------------------------------------------------------------------
Moderate exercise Helps legs relax.
----------------------------------------------------------------------------------------------------------------------------------------------
Warm bath Take one 90 minutes before bed to calm nerves.
NATURAL METHODS
-----------------------------------------------------------------------------------------------------------------------------------------------
Supplements Iron or other supplements for deficiencies.
TAKING CONTROL
- Inventory the medications you take. A number of common medications can cause RLS, among them cold and allergy products, nausea drugs and calcium channel blockers. Even drugs you take for RLS (transquillers, anti-depressants and levodopa) can sometimes make it worse.
- Check out less likely treatments. If other therapies haven't worked for you, ask your doctor about the anti-hypertensive drug clonidine (Catapres) and SSRI (selective serotonin reuptake inhibitor) antidepressants such as fluoxetine (Prozac). They bring relief to only a few, but could prove to be your ticket to better sleep.
- Speak up if your medicine lets you down. If the medication you've been taking stops working, let your doctor know. This phenomenon is common in RLS and switching to a different prescription may bring you relief.
For some people, vitamin/mineral supplements can go a long way towards easing restless legs. Extra iron may remedy your symptoms if your iron levels are low, a common problem in RLS. The B-complex vitamins as well as magnesium, vitamin E and calcium may also be useful. Before trying these, ask your doctor for a blood test to find out if you're low in any key nutrient.
If these simple, natural methods fail, your doctor might try you on medications. As first-line therapy, try paracetamol or the anti-convulsant clonazepam (Rivotril). Sometimes you may be given a combination of these plus or minus the benzodiazepine, diazepam. This combination will be particularly helpful at night as it will help you sleep through the 'funny' RLS feelings.
Another option is a dopaminergtic agent such as levodopa (Sinemet). These drugs are usually used to quieten the tremors of Parkinson's disease but can quell restless legs too. (Don't worry, RLS doesn't lead to Parkinson's disease.)
Other drugs such as the anticonvulsant gabapentin (Neurontin), the analgesic codeine, the muscle relaxant baclofen and the beta-blocker propranolol (Inderal) may also be helpful.
Procedures
Apart from the lifestyle and medication alternatives, your doctor may also recommend transcutaneous electrical nerve stimulation (TENS). In this procedure, electrodes are attached to pads placed on the skin; the TENS machine then emits mild electrical impulses that feel like a massage, overriding pain or discomfort. Using it for 15 to 30 minutes before you turn in can substantially increase your chances of a restful night's sleep.
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