Restless Legs Syndrome and Related Disorders - Diagnosis

Highlights	Complications	Resources
Introduction	Diagnosis	References
Causes	Treatment
Risk Factors	Medications

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Diagnosis

A diagnosis of restless legs syndrome or nocturnal leg cramps often relies solely on the patient's description of symptoms. In general, the recommended approach is first to take a sleep and personal history. The doctor may begin an interview that may include the following questions:

How would the sleep problem be described?
How long has the sleep problem been experienced?
How long does it take to fall asleep?
How many times a week does it occur?
How restful is sleep?
What are the leg problems like (cramps, twitching, crawling feelings)?
What is the sleep environment like? Noisy? Not dark enough?
What medications are being taken (including the use of antidepressants and self-medications for insomnia, such as herbs, alcohol, and over-the-counter or prescription drugs)?
Is the patient taking or withdrawing from stimulants, such as coffee or tobacco?
How much alcohol is consumed per day?
What stresses or emotional factors may be present?
Has the patient experienced any significant life changes?
Does the patient snore or gasp during sleep (an indication of sleep apnea, a condition in which breathing stops for short periods many times during the night and which may worsen symptoms of restless legs syndrome or insomnia)?
If there is a bed partner, is his or her behavior distressing or disturbing?
Is the patient a shift worker?

Keeping a Record of Sleep. To help answer these questions, the patient may need to keep a sleep diary. Every day for two weeks, the patient should record all sleep-related information, including responses to questions listed above described on a daily basis. Recording sleep behavior using an extended-play audio or videotape can be very helpful in diagnosing sleep apnea.

A bed partner can help by adding his or her observations of the patient's sleep behavior.

Sleep Disorders Centers

In some cases of an uncertain diagnosis, high-risk patients may need to consult a sleep specialist or go to a sleep disorders center. At most centers, patients undergo an in-depth analysis, usually supervised by a multi-disciplinary team of consultants who can provide both physical and psychiatric evaluations. Centers should be accredited by the American Academy of Sleep Medicine.

Among the signs that may indicate a need for a sleep disorders center are the following:

Insomnia due to psychological disorders.
Sleeping problems due to substance abuse.
Snoring and sudden awakening with gasping for breath (possible sleep apnea).
Severe restless legs syndrome.
Persistent daytime sleepiness.
Sudden episodes of falling asleep during the day (possible narcolepsy).
At most sleep disorders centers, patients undergo an in-depth analysis, usually supervised by a multidisciplinary team of consultants who can provide both physical and psychiatric evaluations.