Restless Leg Syndrome

Who is the worst sleeping partner? The answer to this question is simple if no options are given, i.e. a partner who snores loudly, however if you have to choose between a partner who snores and a partner who kicks while keeping, you would definitely pick the second option.
Restless leg syndrome and snoring are the leading causes of people being brought to sleep clinics and physicians by their partners. By definition, restless leg syndrome constitutes a multitude of symptoms that are associated with involuntary leg movements while sleeping.

Causes of Restless Leg Syndrome

The causes of Restless Leg Syndrome are not very well defined as it may be a part of any other syndrome or disease sequence or it may occurs independent of other diseases as an isolated sleep disorder. Whatsoever, Restless Leg Syndrome is seen more commonly in middle aged individuals associated with disorders like:

• Chronic kidney disease, the exact cause of Restless Leg Syndrome in chronic kidney disease is not known, but it is hypothesized that electrolyte disturbance affect the motor functioning that manifests itself as restless leg syndrome.
• Anemia due to iron deficiency: Exact etiology is not known but iron deficiency anemia has been seen in patients of restless leg syndrome.
• Diabetes Mellitus: Diabetes Mellitus causes restless sleep and in individuals with poor glycemic control, chances are very fair that they will develop neuropathies in long term resistant diabetes cases.
• Pregnancy: During pregnancy, natural rhythm among all the hormones is temporarily disturbed and this may be a cause of restless leg syndrome.
• Medications, especially true for anti-psychotics like lithium, calcium channel blockers, sedatives or any drug that affect normal cerebral environment and bring about any type of change in neurochemical environment or neurotransmitter levels.
• Sudden withdrawal from tranquilizers after chronic usage, which may disrupts normal sleep and disturbance in sleep and is manifested as frequent awakenings, recurrent bouts of insomnia and irritability. This is especially true for benzodiazepines and that’s why these have to be prescribed with caution and abrupt withdrawn from therapy should be avoided. Always taper off doses to avoid rebound insomnia.
• Genetics: Children may also have this sleep disorder and that’s why it is believed that Restless Leg Syndrome has genetically association too that causes symptoms to appear in early age without any known risk factor or disease status. Careful history from parents may point to diagnosis or cause.
• Neuropathies especially the ones that affect muscles and motility. This is especially true for autoimmune diseases that affect neuromuscular junctions.

Sign and Symptoms

Restless Leg Syndrome is a subjective or objective finding, as most people are in deep sleep, they might not have any recollection of their vigorous and disturbing physical activities at night, but history from sleeping partner is very helpful in this regard.

Abrupt and disordered bed sheets and feeling of tiredness after sufficient sleeping hours is another finding that may help in detection of Restless Leg Syndrome.

In Restless Leg Syndrome there is tingling ad disturbing sensation in ankles and foot that can only be relieved if legs are moved, this may happens during the day time also, especially after prolonged periods of low activity. This disturbing sensation may be crawling, creeping, aching or numbing.

Restless Leg Syndrome may or may not be associated with PLMD (Periodic Limb Movement Disorder), which is basically periodic and rhythmic limb movement while sleeping.

Complications

Restless Leg Syndrome is not a dangerous or life threatening illness and in most people is not even symptomatic. However, it is a fact that Restless Leg Syndrome disturbs normal sleeping pattern and affects the quality of sleep. It will definitely disturb the sleep of sleeping partner of the person having restless leg syndrome

Long standing Restless Leg Syndrome leads to anxiety, agitation, fatigue, insomnia and other issues that result from insomnia like confusion, impaired attention and concentration and hypertension in untreated cases. These symptoms have long-term implications and may remain hidden. Even if person is symptomatic it is taken as a trivial sleep complaint and consider normal by a vast majority of people and physicians as well.

Diagnosis

Restless Leg Syndrome is a subjective diagnosis and there is no test as such that can diagnose the condition. However, if it is secondary to any other systemic illness, blood tests can easily differentiate primary from secondary causes.

Careful history is sufficient to establish the diagnosis. People who suffer from restless leg syndrome have frequent episodes of awakenings at night. History from sleeping partner also poses light on diagnosis. Moreover disrupted bed sheets in the morning and wrinkled sleeping suit are also quite diagnostic. Another important complaint of people having restless leg syndrome is extreme feeling of tiredness and fatigue upon awakening and muscle aches without any physical activity or exercise.

Treatment

In case of Secondary Restless Leg Syndrome, as a result of any underlying disorder, treatment modalities involve treatment of underlying health issue. In case, no cause can be ascertained, treatment involves mostly behavioral therapy like massages, warm bath before going to bed and avoidance of brain stimulants or depressants before going to bed. This specially includes alcohol and caffeine. If symptoms of Restless Leg Syndrome are very severe and begin to affect day to day dealings and activities, consultation can be done with a physician to request muscle relaxants or tranquilizers (only if Restless Leg Syndrome begins to impair sleep quality and duration). In most cases, behavioral modification is sufficient and nothing else is required.