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Brain and Nervous System
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Sleep and Sleep Problems

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Movement Disorders in Sleep

Sleepers typically shift position every 15–30 minutes, and it’s normal for muscles to jerk at the onset of sleep. For some people, however, uncontrollable movements make it impossible to obtain a restful night’s sleep.

Restless Leg Syndrome (RLS)

An estimated 1%–5% of adults have restless legs syndrome (RLS), a neurological disorder characterized by strange aching, crawling, or painful sensations in the lower legs that can be temporarily relieved by moving the legs.

Sleep deprivation is a major problem for people with RLS, as the symptoms are most prominent at night. People develop a variety of coping strategies, such as pacing, doing knee bends, rocking, or stretching the leg muscles. Symptoms are worse when sitting still, and the irresistible urge to move can make it difficult for people with RLS to take car or plane trips, enjoy a movie, or even hold a desk job. At night, RLS symptoms may compel the person to get in and out of bed many times.

Daytime symptoms sometimes abate for a few hours, days, or even years. Some people get temporary relief by rubbing or squeezing their leg muscles, wrapping their legs in bandages, or applying cold or warm compresses.

Because the symptoms sound bizarre or vague, and the need to be constantly mobile seems like nervousness, people with RLS are frequently thought to have psychiatric problems. In the past, they were often misdiagnosed as having hypochondria, manic-depressive illness, or a stress-related disorder. Children who have RLS are often diagnosed as having attention-deficit disorder. In adolescents, RLS may be mistaken for growing pains or back trouble. RLS usually worsens with age. Women may find that symptoms flare up during menstruation, pregnancy, or menopause. At least 1 in 4 pregnant women experiences restless legs.

As many as half of people with RLS note that other members of their family have similar symptoms. In at least a third of cases, genetic studies indicate that the disorder results from a single aberrant gene, with each child of an affected person having a 50% chance of inheriting the condition.

Restless legs can be a complication of alcoholism, iron deficiency anemia, diabetes, heart failure, or kidney failure. In some people, caffeine, stress, nicotine, fatigue, or prolonged exposure to a cold or very warm environment can worsen the symptoms. Certain medications — including antihistamines, antidepressants, or lithium — can exacerbate RLS.

Periodic Limb Movement Disorder (PLMD)

This neurological condition is similar to RLS, except that it occurs during sleep. During the night, the leg muscles involuntarily contract every 15–45 seconds, which causes jerking movements that at least partially rouse the person from sleep. The same movement (involving the hip, knee, or ankle) may be repeated hundreds of times a night. Unless a bed partner complains, the affected person will likely remain oblivious to the movements and baffled at feeling tired after what he or she believes was a full night’s rest. Up to 50% of the elderly may experience such leg movements during sleep. Nearly everyone with RLS will also have PLMD.

Treatments for Movement Disorders

Drugs that ease the tremors of Parkinson’s disease also reduce the number of leg movements and thus improve quality of life for people with RLS and PLMD. Levodopa-carbidopa (Sinemet), pergolide (Permax), and pramipexole (Mirapex) are first-line treatments for these disorders.

People with mild movement disorders may be prescribed diazepam (Valium), clonazepam (Klonopin), or temazepam (Restoril), which may improve sleep by reducing the number of awakenings due to leg movements. Most people who take these medications for insomnia develop a tolerance to them after a few weeks, but this doesn’t seem to happen when such drugs are taken for RLS.

Because of the potential for addiction, most physicians are reluctant to treat sleep disturbances with opiates (opium-containing drugs) such as propoxyphene and oxycodone. However, these drugs often help people with severe RLS symptoms that resist other treatments. The opiates decrease the discomfort of RLS and, for some patients, dramatically reduce leg movements at night. When properly used, they may provide long-term benefit with little risk of addiction.

February 2003 Update

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