Let’s continue talking about restless legs syndrome (RLS).
We reviewed some of the symptoms, causes, and adverse effects of restless legs syndrome in the past two blogs, now let’s talk about how RLS is diagnosed. Due to the unusual sensations that patients with RLS complain of, it is sometimes difficult for a healthcare provider to determine if these complaints are actually related to RLS. Contrary to popular belief, a sleep study is not needed to diagnose RLS and treatment decisions can be based on a sufferer’s response to 4 simple questions. If the answer to all 4 questions is yes, then a diagnosis of RLS is likely. These questions are:
· Do you feel an urge to move your legs, usually accompanied or caused by an uncomfortable and unpleasant sensation in your legs?
· Does this urge to move begin or worsen when you lie down, rest, or are inactive?
· Is the urge to move partially or totally relieved by walking or stretching, as long as the movement continues?
· Are your symptoms worse in the evening or night, or do they only occur during the evening or night?
Approximately 70-80% of patients with RLS also have periodic limb movements of sleep (PLMS). (But it should be noted that only about 20% of people with PLMS will have RLS.) PLMS are involuntary, repetitive movements of the legs that occur while the patient is asleep. These movements tend to increase as we age and are seen in the majority of patients who have sleep studies. Most often, PLMS do not require treatment, unless they occur with sleep disruption, insomnia, or excessive daytime sleepiness. When PLMS are seen on a sleep study in a patient who also describes RLS symptoms, they help support (but are not necessary for) a diagnosis of RLS.
When we think about treatment for RLS there are both medication based and non-medication based therapy. To start lets review the non-medication treatments. It should be noted that most of these methods have not been subjected to rigorous scientific studies, but as they are mostly harmless and may help they might be worth trying in someone who suffers with RLS.
As with many other sleep disorders, experts recommend good sleep hygiene, including a stable sleep and wake time. Avoidance of alcohol, caffeine, and nicotine may also improve symptoms. Some people respond to moderate exercise, stretching, hot baths, or massages. In addition, some studies have shown an improvement in nighttime symptoms, when people engaged in alerting activities, such as crossword puzzles or video games.
Now to the medications.
First off, many patients with RLS have decreased levels of ferritin, a protein that carries iron (necessary for blood cell production). The ferritin level in the blood may be checked by your doctor, and if low (usually <50), iron supplements may be recommended.