Southeast Houston Sleep Medicine

RESTLESS LEGS SYNDROME

Restless legs syndrome (RLS) is a constellation of symptoms. 
Patients with RLS experience an urge to move their legs when
at rest, and failure to do so causes an unpleasant sensation.
Patients often kick and move their legs at night, which can disrupt sleep.  Daytime sleepiness and fatigue can result, often to the point where jobs, relationships and activities of daily living are affected.

Prior to initiating any therapy, physicians rule out underlying problems causing RLS.  One of the most common causes is iron deficiency.  Young women who lose iron on a monthly basis through their menstrual periods, or patients who have lost blood due to ulcers may become iron deficient.   If the iron is replaced, RLS symptoms improve.  End stage kidney disease, nerve damage from diabetes, and Parkinson’s disease can cause RLS as well. 

The majority of cases do not have an underlying cause and fall into the category of primary restless legs syndrome.  In these patients, there may be a family history of the disorder. They tend to be younger when symptoms start and have a slower progression of the condition. The same complaints are present as in other RLS patients, i.e., difficulty sitting still, feeling a constant urge to move their legs and problems sleeping. For these patients, treatment is directed toward relieving symptoms.

Physicians use a variety of different drugs to treat restless legs syndrome.  Often physicians will try using either Mirapex or ReQuip.  These medications mimic a chemical in the brain called dopamine.  By mimicking this chemical, Mirapex and ReQuip decrease the leg movements at night, alleviate sleeping problems, and minimize the urge to move the legs during the day.

If patients do not respond to Mirapex or ReQuip, physicians often try using a mild sedative called Klonopin, or a drug used in the treatment of Parkinson’s disease called Sinemet.  Another medication, Neurontin, decreases unpleasant sensations and pain related to problems with the nervous system.

A sleep study is not always necessary with RLS. In many cases, physicians make the diagnosis based solely on the symptoms described by the patient. The sleep study becomes important only when the leg movements are disrupting sleep by waking the patient frequently. Sleep specialists will look for leg movements that briefly wake the patient at a rate of at least 15 times an hour for adults, and at least 5 times an hour for children.