Sleep Disorders

Restless legs syndrome & periodic limb movements during sleep

Restless legs syndrome (RLS)

A neurological disorder characterized by throbbing, pulling, creeping, or other unpleasant sensations in the legs, which is typically alleviated with movement.

Restless legs syndrome (RLS)

Periodic limb movement syndrome (PLMS)

A sleep disorder characterized by rhythmic movements of the limbs during sleep. The movements typically involve the legs, but upper extremity movements may also occur.

Periodic limb movement syndrome (PLMS)

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Restless legs syndrome (RLS)

Restless legs syndrome is a disorder related to sensation and movement. People with RLS have an unpleasant feeling or sensation in parts of their bodies when they lie down to sleep. Most people also have a very strong urge to move. And moving sometimes makes them feel better. But all this movement makes it hard or impossible to get enough sleep.

RLS usually affects the legs. But it can cause unpleasant feelings in the arms, torso, or even a phantom limb. A phantom limb is the part of a limb that has been amputated.

When you don't get enough sleep, you may start to have problems getting things done during the day because you're so tired. You may also be sleepy or have trouble concentrating. So it's important to see your doctor and get help to manage your symptoms.

The main symptom of RLS is a strong urge to move because of uncomfortable and sometimes painful sensations. The feelings usually affect the legs. But they can also affect the arms, torso, or a phantom limb (the part of a limb that has been amputated). Some people describe the sensations as aching, creeping, crawling, or prickling. Symptoms usually start about 15 minutes after you lie down to sleep or to relax. They can also occur when you haven't moved for long periods, such as when riding in a car or airplane. If you have symptoms a lot, it can lead to sleep loss and fatigue. And that can make it hard to do your daily activities.

After they are asleep, most people with RLS also have involuntary or jerking leg movements called periodic limb movements. These movements can interrupt your sleep, and make you more tired. Periodic limb movements may also occur during the day. But they're harder to notice then, and most people move around after their legs start to bother them.

RLS and periodic limb movements also often disturb the sleep of a bed partner. This can cause fatigue for both people and can strain the relationship.

Symptoms may start when you are infant or at any time during your life. At first, your symptoms may be mild and occur only once in awhile. But symptoms usually get worse with age. After age 50, many people have daily symptoms and suffer from significant sleep loss. Severe insomnia, fatigue, anxiety, depression, and lack of social activity can affect your quality of life.

RLS may start or become worse during pregnancy, especially after week 20.

Treatment for RLS is based on the type of symptoms you have and how bad they are. Getting regular exercise and enough sleep may be enough for mild symptoms. But if your symptoms get in the way of how well you can function, you may need medicines.

First treatments
Changing your daily routine is sometimes enough. It may help if you do things like stretch, walk, exercise regularly, get a massage, or take a hot or cold bath. Losing weight and avoiding smoking, alcohol, and caffeine can also help.

If your symptoms are caused by another medical problem like diabetes or iron deficiency anemia, you will be treated for that problem first. For example, you'll take iron supplements if you aren't getting enough iron.

If RLS starts during pregnancy, your doctor may just recommend exercise and stretching.

For children, regular exercise and sleep routines are usually tried first. If those don't work, the doctor may prescribe medicine.

Medicines
If your symptoms don't improve, you may try medicines. These include:

  • Dopamine agonists, such as ropinirole (for example, Requip).
  • Anticonvulsants, such as gabapentin (for example, Neurontin) or gabapentin enacarbil (for example, Horizant).

In some cases, your doctor may recommend an opioid pain medicine.

If your doctor recommends medicine, be sure to talk about the possible benefits and risks. Let your doctor know about all of the other medicines you take. Medicines for other conditions sometimes help cause RLS. For example, antidepressants may improve symptoms. Or they may make them worse.

Ongoing treatment
Over time, a dopamine medicine may not work as well.

You may also notice that your symptoms start earlier in the day. Or they may be more intense. Or they may spread to another part of your body.

If you're taking a dopamine medicine and your symptoms change, tell your doctor. Don't stop taking your medicine without talking to your doctor first. You can work with your doctor to find the best treatment for you.

If you make lifestyle changes, and you still have symptoms, you may need a doctor to reevaluate your symptoms. Many other health problems have similar symptoms. These include several vitamin and mineral deficiencies.

Your doctor may recommend different medicines. Or your doctor may recommend a combination of medicines. Follow up with your doctor if your symptoms don't improve.

Other treatment
Your doctor may have you try other treatments. These include:

  • A pneumatic compression device. This machine pumps air in and out of sleeves to make them tight and loose around your legs while you are resting.
  • Vibrating pads (Relaxis). The pads send vibrations to your legs. They may improve sleep for some people with RLS.

Periodic limb movement syndrome (PLMS)

Periodic limb movement disorder (PLMD) is a condition in which a person's legs, and sometimes arms, move repetitively and uncontrollably while he or she is asleep. These episodes of limb movement can disrupt the person's sleep, causing insomnia or daytime sleepiness. Periodic limb movement symptoms are only thought to be a disorder (PLMD) when insomnia or daytime sleepiness cannot be explained by any other problem, such as restless legs syndrome. Recently, it has been found that these movements are often linked to subtle breathing problems.

People who have periodic limb movement disorder (PLMD) have trouble falling or staying asleep (insomnia), or they feel sleepy during the day because the movements disrupt their sleep. These movements usually are in the legs and occur in some type of pattern. Although a person often is not fully awakened by these movements, they interfere with normal sleep cycles. A bed partner's sleep may also be disrupted.

Periodic limb movement disorder (PLMD) is diagnosed with a medical history, often including a sleep history from a bed partner, and a physical exam. A sleep study is usually required to detect the movements. A sleep study also can identify other conditions that may be causing symptoms, such as sleep apnea or other subtle breathing problems that may be causing movements.

Many questions remain about the nature of periodic leg movements and PLMD. Some researchers consider the movements to be normal. At least a few movements may occur during sleep in people who do not have restless legs syndrome, especially in the elderly.

A polysomnogram continuously records brain waves during sleep, as well as a number of nerve and muscle functions during nighttime sleep. The study is used to evaluate sleep disorders, such as sleep apnea, periodic limb movement disorder (PLMD), narcolepsy and hypersomnia.

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