When you lay down on your bed at night, feeling the urge to move your body can ruin the whole experience and make it difficult for you to fall asleep. Moreover, if you don’t move, you start feeling a strange and growing sensation in your legs, and now your attention is not focused on relaxing your mind. Your body is interrupting everything, and it feels frustrating to keep trying.
That is how it feels every night for patients with restless leg syndrome — no wonder why they suffer from sleep disturbances and the various consequences of lack of sleep.
That’s why in this article, we are going to cover restless leg syndrome, also known as Willis-Ekbom disease. What is it exactly? How do you know your sleeping problems are caused by restless leg syndrome? And what can you and your doctor do to improve your symptoms?
Restless leg syndrome and Willis-Ekbom Disease
Restless leg syndrome, or Willis-Ekbom disease, is a neurological disorder associated with sleeping problems due to recurrent symptoms of twitching and tingling in your legs at night. They are uncomfortable sensations that make patients feel the urge to move around the legs over and over again as they try to fall asleep.
The symptoms of restless leg syndrome may appear when sitting or standing, but they are especially uncomfortable when the patient is lying down. They make falling asleep exceedingly difficult and cause insomnia and chronic sleep problems in patients.
Restless leg syndrome is often considered a puzzling disease that is difficult to understand and diagnose. It is also difficult to treat because most patients will still have symptoms after treatment. However, we can suspect this diagnose if we have recurrent twitching or tingling in the legs, when this awkward sensation is accompanied with the urge of moving the legs continuously, and when this situation affects our sleep at night.
According to recent research, these patients have altered brain chemistry with excessive levels of a neurotransmitter called glutamate. Patients with higher levels of glutamate usually report more severe, continuous or disruptive sensations. Another chemical involved in Willis-Ekbom disease is dopamine, which is often deficient or not enough, leading to involuntary muscle movement. Thus, to treat restless leg syndrome, we should have two different approaches we will cover in this article. One of them is a pharmacological approach destined to modulate brain chemistry while the other is based on lifestyle modifications to reduce the consequences and health impact of restless leg syndrome.
Available pharmacological options for Restless leg syndrome
There are several drugs to treat restless leg syndrome, and each one of them should be adopted for every patient depending on their individual needs. The most important medications are as follows:
- Levodopa: It is a dopamine precursor meant to increase levels of this neurotransmitter, which is deficient in the brain of patients with restless leg syndrome. It is effective, but long-term use may lead to augmentation (worsening) of the symptoms.
- Pramipexole: Instead of being a precursor of dopamine, this medication is an agonist. It is a substance that looks like and behaves like dopamine in the nervous system. It can be used along with levodopa in certain phases of the treatment.
- Ropinirole: It is another agonist of dopamine that improves the symptoms for up to 1 year in patients with restless leg syndrome. It is metabolized by the liver, and doctors need to consider the function of liver enzymes if they are prescribing other medications.
- Rotigotine: This medication works similar to pramipexole and ropinirole, but is usually administered in transdermal patches. Thus, it is very useful for patients with swallowing problems and daytime symptoms. It is also recommended before surgery.
- Gabapentin enacarbil and pregabalin: Pregabalin and gabapentin enacarbil (a slow-release version of gabapentin) are excellent in cases of moderate and severe restless leg syndrome. They are also useful to improve sleep measures in these patients.
- Oxycodone and naloxone: In some studies, the combination of oxycodone and naloxone in prolonged-release have improved the symptoms of these patients significantly. Improvements are not associated with augmentation, as it happens with tramadol.
- Iron (ferrous sulfate) and vitamin C: They may be included in the treatment of restless leg syndrome, and will be useful in patients with serum ferritin levels lower than 75 mcg/L. It is important to use ferrous sulfate and no other form of iron because other formulations are apparently not effective.
Lifestyle changes that may contribute to your treatment
According to a recent review and meta-analysis, lifestyle changes and modifications do not have sufficient evidence according to the available scientific data. However, that doesn’t mean they are not relevant.
Lifestyle changes may not completely cure the problem, and won’t be better than medications to calm down the symptoms, but they are definitely important to reduce the impact of restless leg syndrome in our general health.
We can summarise lifestyle changes for restless leg syndrome as follows:
- Changes in caffeine and alcohol intake: Caffeine and alcohol intake may directly or indirectly affect your sleep and brain chemistry. Thus, it is recommended to reduce the consumption of alcohol and caffeine close to sleeping time. In some cases, very high consumption of alcohol, nicotine or caffeine was a cause of restless leg syndrome, but results of quitting may be different from one person to another.
- Sleep hygiene improvements: Since patients with restless leg syndrome are prone to insomnia and other sleep alterations, sleep hygiene improvements are fundamental to reduce the impact of this disease in their lives. Sleeping at the same hour, creating a sleeping environment, and relaxing your mind and body before sleep may be fundamental in improving the consequences of restless leg syndrome in these patients.
- Aerobics, yoga, and other forms of physical activity: In many cases, physical exercise improves muscle function and stimulation by the nervous system in patients with restless leg syndrome. Physical activity would also reduce the cardiovascular risk associated with lack of sleep and has several advantages, and should not be ruled out in patients with restless leg syndrome.
References:
Anguelova, G. V., Vlak, M. H., Kurvers, A. G., & Rijsman, R. M. (2018). Pharmacologic and nonpharmacologic treatment of restless legs syndrome. Sleep medicine clinics, 13(2), 219-230.
Pamu, S., Thakkalapally, L., Badugu, V., & Pawar, D. Caffeine Induced Restless Legs Syndrome.
Aukerman, M. M., Aukerman, D., Bayard, M., Tudiver, F., Thorp, L., & Bailey, B. (2006). Exercise and restless legs syndrome: a randomized controlled trial. The Journal of the American Board of Family Medicine, 19(5), 487-493.
