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By: Kevin Asp on March 16th, 2016

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Treatment of Restless Legs Syndrome and Periodic Limb Movement Disorder

Sleep Disorders | Sleep Technologist Advice

Treatment of Restless Leg Syndrome and Periodic Limb Movement Disorders: What to Know

How do you effectively treat Restless Legs Syndrome and Periodic Limb Movement Disorder?

Restless Legs Syndrome (RLS) and Periodic Limb Movement Disorder (PLMD) are two disorders that are very similar in their signs and symptoms as well as their treatment. It is very likely, but not always true, that if you suffer from one, you may suffer with the other as well.  The primary difference is that RLS occurs while awake and PLMD occurs while sleeping. 

What is restless legs syndrome?

Restless Legs Syndrome (RLS) is a neurologic sensorimotor disorder that is characterized by an overwhelming urge to move the legs when they are at rest. The urge to move the legs is usually, but not always, accompanied by unpleasant sensations. These sensations keep many people from falling asleep since they constantly want to move their legs. More than 80 percent of people with RLS also suffer from a condition known as periodic limb movements in sleep (PLMS).

The most distinctive or unusual aspect of the condition is that lying down and trying to relax activates the symptoms. Most people with RLS have difficulty falling asleep and staying asleep. Left untreated, the condition causes exhaustion and daytime fatigue. In fact, a majority of patients with RLS report that their job, personal relations, and activities of daily living are strongly affected as a result of their sleep deprivation. They are often unable to concentrate, have impaired memory, or fail to accomplish daily tasks. It also can make traveling difficult and can cause depression.

What are the symptoms of RLS?

According to the National Institute of Neurological Disorders and Stroke, people with RLS feel uncomfortable sensations in their legs, especially when sitting or lying down, accompanied by an irresistible urge to move the affected limb.  These sensations less commonly affect the arms, trunk, or head.  Although the sensations can occur on just one side of the body, they most often affect both sides.

Because moving the legs (or other affected parts of the body) relieves the discomfort, people with RLS often keep their legs in motion to minimize or prevent the sensations. They may pace the floor, constantly move their legs while sitting, and toss and turn in bed.

A classic feature of RLS is that the symptoms are worse at night with a distinct symptom-free period in the early morning, allowing for more refreshing sleep at that time.  Other triggering situations are periods of inactivity such as long car trips, sitting in a movie theater, long-distance flights, immobilization in a cast, or relaxation exercises.  Many individuals also note a worsening of symptoms if their sleep is further reduced by events or activity.

RLS symptoms may vary from day to day and in severity and frequency from person to person. 

People who have both RLS and an associated medical condition tend to develop more severe symptoms rapidly.  In contrast, those who have RLS that is not related to any other condition and experience onset at an early age show a very slow progression of the disorder; many years may pass before symptoms occur regularly.

How is periodic limb movement disorder different from RLS?

Periodic limb movements in sleep are repetitive movements, most typically in the lower limbs, that occur about every 20-40 seconds. If you have PLMS, or sleep with someone who has PLMS (also referred to as PLMD, periodic limb movement disorder), you may recognize these movements as brief muscle twitches, jerking movements or an upward flexing of the feet. They cluster into episodes lasting anywhere from a few minutes to several hours.

In most people with PLMS, poor sleep and daytime sleepiness are the most bothersome symptoms. Many people do not link their sleep problem with leg movements. 

Since this happens during sleep, you have to look for other clues that you may suffer from PLMS. You can ask your bed partner if they feel or see you moving around throughout the night or look to see if your sheets are always a mess in the morning. Individuals with PLMS may also experience RLS, an irritation or uncomfortable sensation in the calves or thighs, as they attempt to fall asleep or when they awaken during the night. However, research also shows that many individuals have PLMS without experiencing any symptoms at all.
 

What's the cause of periodic limb movement disorder?

PLMD can occur at any age. Like many sleep disorders, PLMD is more common in middle-aged and older people. The exact cause of PLMD is still unknown. Scientists believe that the underlying mechanisms probably involve the nervous system, although studies have not revealed any consistent neurological abnormalities. PLMS are not considered medically serious. These movements can, however, be implicated as a contributing factor in chronic insomnia and/or daytime fatigue because they may cause awakenings during the night. Occasionally, PLMD may be an indicator of a serious medical condition such as kidney disease, diabetes or anemia.
 

What are the best treatment options available for both conditions?

The AAST has an in-depth Journal Club article that details the various effective diagnosis and treatment options for patients who are suspected of having RLS or PLMD. 

This learning module is available online at a reduced price for AAST members and is also availabe to non-members here.  This module offers 1 CEC upon completion.

Learn about treatment of restless legs syndrome and periodic limb movement disorder today!

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