Information kindly provided by Jacob Teitelbaum M.D.
People with restless legs syndrome (RLS) have the sensation that they need to continually move their legs while sleeping. Occasionally, RLS also occurs during the day. Limb movements tend to be repetitive and most frequently involve the legs. A person will often extend his or her big toe while flexing the ankle, the knee and sometimes even the hip. This can occur with the arms as well and sometimes even with the whole body.
Another pattern consists of a disagreeable leg sensation and sense of restlessness that is brought on by rest and often relieved by movement. It is not uncommon for your bed partner to be very aware that your legs are kicking much of the night or are constantly moving. You may or may not be aware of your own movements, however. Although the cause of RLS is not clear, experts suspect it comes from a deficiency of the neurotransmitter called dopamine. RLS can also be aggravated by iron deficiency (having blood ferritin levels less than 50, even though over 9 is considered normal), nerve injuries, vitamin B12 and folic acid deficiency, hypothyroidism, and other problems. In some people, RLS may be associated with hypoglycemia. Some medications (especially Elavil and perhaps lithium) can aggravate RLS.
If you tend to scatter your sheets and blankets, and especially if you tend to kick your bed partner or if you note that your legs tend to feel jumpy and uncomfortable at rest at night, you probably have RLS. You can also have a sleep study done to look for leg muscle contractions. If contractions occur every twenty to forty seconds and last for about one-half to five seconds each, you have RLS. The sleep study will determine if these leg movements are associated with waking from deep sleep into light sleep to a degree that would be expected to cause daytime fatigue. Leg movements are not considered significant unless one has associated daytime sleepiness.
There are both natural and prescription approaches to treating RLS. Following are summaries of those that have been found to be most successful.
Natural remedies for RLS focus on diet and nutritional supplementation. Avoiding caffeine is important. Because RLS may be associated with hypoglycemia, eating a sugar-free, high-protein diet with a protein snack at night may decrease episodes of cramping and RLS at night.
An estimated 25 percent of RLS patients have low serum iron levels. As noted above, if your serum ferritin score is under 50, I would take an iron supplement. I recommend the prescription iron supplement Chromagen FA because it also contains folic acid and combines iron and vitamin C, which helps the iron to be absorbed. Take iron supplements on an empty stomach. Vitamin E can also be very helpful, although it takes six to ten weeks of treatment to help. Take 400 international units a day. If you have RLS in which pain, numbness, and lightning stabs of pain are relieved by movement or local massage, taking 5 milligrams of folic acid three times a day (available by prescription) is helpful. However, folic acid does not help cases of RLS where there is no discomfort.
Finally, a few case reports have suggested that taking the amino acid L-tryptophan can be effective. I recommend using the related compound 5-HTP
Ambien, Neurontin, and Klonopin are the medications that are highly effective in the treatment of RLS. I tell patients to adjust the dose to not only get adequate sleep, but to also keep the bedcovers in place and to avoid kicking their partners. Opioids can also be effective, but carry a greater risk of addiction.
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