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SLEEP DISORDERS CENTER
Frequently Asked
Questions about Restless Legs Syndrome & Periodic Limb Movement Disorder
How Common are RLS and PLMD?
Restless Legs Syndrome
Five to 10 of every 100 people experience the
discomfort of pain of RLS at some time in their lives. Severe cases of RLS,
although not common, often run in families. The disorder is more common in
older individuals but can occur at any age in both men and women. It is
more common during pregnancy, particularly during the last 6 months. Over
the course of the years, the problem may come and go without any obvious
reason.
Periodic Limb Movement
Disorder
PLMD is rare
in people under 30 years of age but becomes more common as people grow
older. PLMD affects 5% of people age 30 to 50; 29% of people age 50 to 65;
and 44% of people over age 65. Men and women are equally likely to be
affected by this disorder. PLMD contributes to the inability to sleep in
20% of the people who have been diagnosed with insomnia.
What Causes These Disorders?
Restless Legs Syndrome
Approximately 30% of cases of RLS have a hereditary
cause. This means that in 30 cases out of 100, the disorder has been passed
through the genes of either the father or mother to the child. The cases of
RLS that run in families often have more severe symptoms and are often more
difficult to treat.
The causes of the other 70% of RLS cases are not
clearly known. A number of situations seem to have a connection with or may
provoke the symptoms of RLS. These situations include poor blood
circulation in the legs, nerve problems, muscle disorders, kidney disease,
alcoholism and vitamin or mineral deficiencies. Other factors that may
trigger the syndrome are stopping or starting certain medications, caffeine
consumption, smoking, fatigue, a very warm environment, or prolonged
exposure to cold temperatures.
Periodic Limb
Movement Disorder
The cause of PLMD, like that of RLS, is unclear. The
same factors that are associated with RLS are also associated with PLMD.
Periodic limb movements are more common in people who
have kidney disease or narcolepsy. Some antidepressant medications may also
increase the frequency of limb movements.
How are These Disorders Diagnosed?
Restless Legs
Syndrome
Before prescribing a specific treatment, the clinician
must make a proper diagnosis. RLS has such unique symptoms that diagnosis
of this disorder can often be made on the basis of patients’ descriptions of
their symptoms. Some words used to describe these symptoms include “creepy,
crawly, pulling, and gnawing.” These feelings create an almost irresistible
need to move the affected limb.
Another sign that points to a diagnosis of RLS is that
movement of the affected limb relieves the painful or uncomfortable
feelings. However, healthcare providers need to obtain a careful medical
history and perform a physical examination to exclude other problems that
may be mistaken for RLS.
Periodic Limb
Movement Disorder
PLMD, on the
other hand, often requires more extensive studies to make a proper
diagnosis. People with PLMD are often unaware of their nighttime movements
and may instead complain only of restless sleep or excessive daytime
sleepiness. They may need to have their nighttime sleep observed and
studied in order to discover the cause of their problem.
How are These Disorders Treated?
The first step in treating RLS or PLMS is to determine
whether underlying causes (such as anemia, diabetes, arthritis, lung
disease, or the use of antidepressant medications) are contributing to the
unwanted movements. Sometimes proper diagnosis and treatment of these
underlying problems result in a lessening or disappearance of the symptoms
of RLS and PLMN. However, patients often find that their disturbing
movements continue even after they receive proper treatment of their
underlying conditions. When this occurs, a number of different treatments
may be tried.
Restless Legs
Syndrome
Home remedies are effective for some people with RLS.
These remedies include a hot bath, leg massages, a heating pad, ice packs,
aspirin or other pain relievers, regular exercise, and the elimination of
caffeine. Vitamin E and supplemental calcium have also helped some people,
although no studies have proven that these substances are effective.
At times, home remedies are not effective, and
clinicians must treat RLS with prescription medications. Several
medications can be helpful. Because a particular medication may help one
patient and not another, people with RLS may need to be patient as the
healthcare provider seeks the right type of drug. The effectiveness of a
particular drug will depend on the severity of the condition; the patient’s
other medical problems, and other medications that the patient is taking.
Periodic Limb
Movement Disorder
Many people with PLMD need no treatment because they
sleep through the limb movements and have no other symptoms such as
excessive daytime sleepiness. Others with PLMD who sleep lightly and are
easily disturbed by the movements may be able to reduce or eliminate their
sleep complaints by improving the soundness of their sleep. The following
sleep hygiene rules (behaviors that help improve sleep) can help a person
sleep more soundly.
Good Sleep Habits
These guidelines help most people sleep well:
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Get up about the same time every day.
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Go to bed only when sleepy.
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Establish relaxing pre-sleep rituals such as a warm
bath, light bedtime snack or 10 minutes of reading.
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Keep a regular schedule. Regular times for eating
meals, taking medications, performing chores and other activities help
keep our inner checks running smoothly
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Avoid caffeine within 6 hours of bedtime and don’t
drink alcohol, especially when you are sleepy. Even a small dose of
alcohol when your are tired can have a potent effect. Do not smoke before
bedtime.
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Try to nap at the same time every day. Mid
afternoon is best for most people.
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Use sleeping pills conservatively. Most doctors
seldom prescribe the use of sleeping pills for more than 3 weeks. Do not
take sleeping pills after drinking alcohol.
Good sleep hygiene and medication, both of which are
aimed at improving the soundness of a person’s sleep, may help the patient
but do nothing for the complaints of the bed partner because they do not
reduce the leg movements. An ideal treatment would eliminate these
bothersome leg movements entirely. Because we don’t clearly understand the
cause of the leg movements, eliminating them is difficult. Reports indicate
that several different drugs appear to reduce patients’ leg movements, but
many of these drugs have not been carefully studied in terms of their
effectiveness for treating PLMD.
One simple remedy for people who take antidepressant
medications may be to change their medication. Some antidepressant
medications make PLMD worse, so changing the medication to another
antidepressant may help reduce the limb movements.
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