Sleep and Sleep Problems
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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
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
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
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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