Restless Leg Syndrome

The sleep doctors of Sleep Medicine Associates of Texas have helped scores of patients who suffer from restless leg syndrome (RLS). Restless leg syndrome is a neurosensorimotor disorder that significantly impacts sleep in the first half of the night. People often must stretch, move or walk to provide relief, resulting in significant disruption to sleep quality. People usually report to the physician that their legs make it difficult to settle so they feel the urge to move their legs which may include an abnormal sensation in the affected limb(s) (sometimes referring to this as a creepy-crawly feeling), the urge is present when still or at rest, movement of the affected limb(s) provides some temporary relief, and the most active symptoms are present in the evening or during the night.

Diagnosing Restless Leg Syndrome

To assist in the 4 core criteria of diagnosing RLS, the acronym URGE has been used: U = Urge to move, R = Rest worsens the urge, G = Gyration (movement) relieves the urge, E = Evening or night worsening of the urge. Under most circumstances the diagnosis of RLS does not require sleep laboratory testing at a sleep study center. RLS can typically be diagnosed by interviewing the patient.

Falling under the same medical umbrella is periodic leg movements of sleep (PLMS). Periodic leg movements of sleep is a rhythmic movement of the lower extremity that is measured during sleep and may or may not have clinical relevance. Periodic movements can also be present during sleep in the arms as well. PLMS predominately occurs during the first half of the night and tends to increase in frequency over each decade of life, with children under ten years of age rarely having PLMS and many adults sixty or older having more than fifteen leg movements per hour of sleep. Although two separate disorders, people with RLS usually have PLMS too and it is quite common, affecting up to 10% of adults. Ongoing research is finding PLMS has cardiovascular consequences, including higher rates of hypertension. There is a monitoring technique which sleep specialists can conduct as part of a sleep study. It is termed the Suggested Immobilization Test (SIT), and it measures periodic leg movements of wake (PLMW) in the one hour before beginning a polysomnogram.

Restless Leg Syndrome Treatment

Many different treatments have been proposed for RLS and PLMS. Guidelines from the American Academy of Sleep Medicine and the Medical Advisory Board of the RLS Foundation support the use of medication therapy first in most people. The most common medications used for the treatment of RLS include ropinirole (Requip) and pramipexole (Mirapex) as well as the recently approved gabapentin enacarbil (Horizant). Although clonazepam (Klonopin) and opiate/narcotic agents have been used for many years, it is recommended that these potentially addicting agents be closely monitored. This medication therapy occasionally creates side effects. One such long-term risk is a worsening of RLS symptoms. Being under the care of an experienced board certified sleep doctor at Sleep Medicine Associates of Texas you can help assure that such side effects are caught early and treated effectively.

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