Health Column: Getting a 'leg-up' on a restful night's sleep

By Dr. Fredric M. Radoff
Blount Memorial Hospital

Sleep disorders fall into different categories. They can cause too much sleepiness, referred to as hypersomnia, or they can affect a person’s ability to fall asleep and/or stay asleep which is called insomnia. Hypersomnia and insomnia each have many causes, but the bottom line is, people who don’t sleep well are usually too sleepy the next day.

A common cause of inability to fall asleep is restless leg syndrome, or RLS. It’s said to affect up to 10 percent of the population, including children. In children, RLS has been called growing pains, or misdiagnosed as nervousness and anxiety disorders or attention deficit hyperactivity disorder.

There are four main criteria required to diagnose RLS. First, there’s a strong, and sometimes irresistible, urge to move the legs with an uncomfortable sensation. I have heard it described by patients as itching, creepy-crawly, pulling, antsy and painful.

Second, the RLS symptoms begin when a person rests, and the longer they are at rest, the worse the symptoms become.
Third, the RLS symptoms improve by moving the legs, only to return again at rest.

Fourth, the RLS symptoms are worse in the evening. RLS sufferers often have involuntary jerking limb movements while asleep and sometimes when awake.

RLS can be caused by anemia, iron deficiency, kidney failure, pregnancy, neuropathy or other causes. Finding and treating the underlying reason can reduce or eliminate the RLS symptoms. Since certain drugs can cause or worsen RLS, it is important to tell any health care provider about medications in use, including perchlorperazine, metaclopramide, phenytoin, haloperidol and phenothiazines, such as chlorpromazine.

Some antidepressant medications such as tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), and selective norepinephrine reuptake inhibitors (SRNIs) can cause RLS symptoms. Yet, some of these medications also improve the symptoms of RLS.

Often, as in the case of idiopathic and familial causes for RLS, other treatments or changes are needed. These can include changes in lifestyle and activities, as well as using certain medications. Also, alcohol consumption and tobacco use are best avoided. A healthy diet, including vitamins, is helpful, as is moderate exercise done regularly but not within six hours of trying to go to sleep.

Some people report that warm compresses on their legs are helpful. For some, relaxation techniques help. In addition, good sleep hygiene practices are recommended.

Numerous medications are available, and often are successful in stopping the RLS symptoms. Though included in the category of medications that can aggravate RLS, other anticonvulsant and antidepressant drugs, as well as opioids, benzodiazepines and medications that are used to treat Parkinson’s disease benefit most people with RLS.

Remember, all of these medications may have side effects or may interact with other medications already being taken. The patient’s health care provider can choose the treatment needed or refer the individual to a sleep disorders medicine specialist.

Dr. Fredric M. Radoff is a neurologist specializing in sleep disorders medicine at The Center for Sleep Medicine, a partnership of Blount Memorial Hospital and East Tennessee Medical Group.

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