Sunday, December 3, 2006

Sleep Disorders and Restless Leg Movement

Fifteen years ago, I fractured my ankle. It required surgery, the insertion of one metal plate and four pins. My leg was placed in a cast and I was told to keep the leg suspended for at least 2 months. Despite the hospital noise and light, I was able to sleep.

But what I can never forget is that my dreams were filled with running episodes and restless leg movements --me running up and down hills, even falling on the uneven grassy surface. I could feel my foot jamming into a hole and the movement of the fall would wake me up. Then I would lie in bed feeling silly because the cast was so stiff that I could not even wriggle my toes.

I have since discovered that restless leg movements in sleep are common experiences. They are normal spasms that occur just before we fall asleep. However, there are other disruptive restless leg movements that are symptoms of sleep disorder syndromes. People with Periodic Limb Movement Disorder, for example, are wakened by involuntary rhythmic movements of the limbs during sleep.

Sometimes these take the form of twitching in toes and ankles; other times, they involve more flailing and exaggerated movements of the arms and legs. But the restless leg movements come in clusters, some lasting a few minutes, others more than an hour. In effect, the restless leg movements are jerky and persistent enough to disrupt sleep and cause sleep deprivation.

About 80% of people with periodic leg movement sleep disorder also experience the Restless Leg Syndrome, a condition that affects about 10% of the adult population in North America and Europe.

Unlike the periodic limb movement disorder, restless leg is most often experienced as "insects crawling inside the legs," a sensation which leads to an urge to stand up and move around. You can be in bed, trying to sleep, but your limbs become prickly or tingly and this sensation can only be relieved by physically getting up and moving around. Needless to say, sleeping when you have this syndrome is next to impossible.

Because our knowledge of these disorders is limited (the exact causes of these conditions are still unknown), treatment is often limited as well. Research, however is ongoing and much progress has been made in the last 5 years to define the nature and manifestations of these disorders. Here, for example, are some new expressions of these disorders uncovered by research.

1.Both restless leg syndrome and periodic leg movements are common in children with hyperactivity attention deficit disorder.

2.Both conditions seem to be more prevalent in the older adult female population.

3.Neurophysiological studies also indicate that restless leg syndrome is linked to irregularities in the spinal cord and brain.

4.Other studies have shown a correlation between the disorders and reduced iron concentrations in some brain regions.

5.Periodic Leg Movement Sleep Disorder seems to be linked to predisposing factors such as diabetes, use of anti-depressants, kidney disease, metabolic disorders, rheumatoid arthritis and circulatory problems.

6.A great deal of attention is also focused on the genetic component of both disorders. According to the National Sleep Foundation, restless leg syndrome occurs 3 to 5 times more frequently in first degree relatives of people with the same syndrome than in people without the syndrome. This finding definitely suggests a strong hereditary component to the sleep disorder.

If you do experience these restless leg movement symptoms that chronically deprive you of sleep, what can you do?

1.Some people experience mild cases of these disorders and seem to be able to function quite well without medical supervision. Consult your physician about your situation if it regularly deprives you of sleep and is causing inattentive or careless daytime responses that require medical attention. Your physician may be able to prescribe medication that can help you with the problems. A study sponsored by Eli Lilly suggests that a drug used to treat Parkinson's disease, may be effective in the treatment of restless leg syndrome and periodic leg movement disorder.

2. Use of electric nerve stimulation therapy applied to an area in the feet or legs seems to be helpful as well. This therapy is usually done 15-30 minutes before bedtime.

3.Make use of home treatments for relaxation--such as meditation, yoga or massage.

4.Avoid using alcohol, caffeine or anti-depressants as these may trigger episodes of restless leg movements.