According to the National Institutes of Health, as many as 10 percent of the U.S. population may have RLS (Restless Leg Syndrome). Several studies have shown that moderate to severe RLS affects approximately two to three percent of adults (more than five million individuals).
RLS is a neurological disorder characterized by throbbing, pulling, creeping, or other unpleasant sensations in the legs and an uncontrollable and overwhelming urge to move them. The most distinctive or unusual aspect of the condition is that lying down and trying to relax activates the symptoms.
Listen in as Tim Lieske, MD discusses the importance of talking to your doctor if you think you may have restless leg syndrome.
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Restless Leg Syndrome: Symptoms, Triggers and Treatments
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Learn more about Timothy R. Lieske, MD
Timothy Lieske, MD, Lincoln Pulmonary & Critical Care
Dr. Timothy Lieske is a pulmonologist with Lincoln Pulmonary & Critical Care.Learn more about Timothy R. Lieske, MD
Transcription:
Restless Leg Syndrome: Symptoms, Triggers and Treatments
Melanie Cole (Host): According to the National Institute of Health, as many as 10 percent of the US population may have restless leg syndrome. My guest today is Dr. Tim Lieske with Lincoln Pulmonary and Critical Care. Welcome to the show, Dr. Lieske. What is restless leg syndrome and what does it feel like?
Dr. Tim Lieske (Guest): Well, restless leg syndrome is actually--there's kind of a continuum of disorders that we include in restless leg syndrome, or at least some people say there's some overlap to some disorders that occur at night when we sleep called “periodic limb movement” or “periodic limb movement syndrome”. However, restless legs is a disorder that occurs almost exclusively during the day. It usually occurs in adults. It occurs usually later in life, although there are some instances where it occurs very early in life and it has a lot of, shall we say, reasons for it to occur, but there's also a very large percentage of patients who we don't know what causes it. And, it is a syndrome where your legs, it's usually your legs, although on rare occasions, it can occur in the arms, but your legs just feel uncomfortable and there are probably at least 20 or 25 different ways this has been described. It’s been described as "creepy", "uncomfortable", sometimes "pins and needles". Sometimes just a vague discomfort. Some people say it's "creepy-crawly", "I just can't my legs comfortable." Some people even will describe it as it seems like there's something crawling underneath their skin. And, it can occur during the early part of the day. Most of the time, it occurs during the evening, seems to get worse as we get closer and closer to bed, and other than . . . and the most important part about this is it often makes it very difficult to get to sleep and so we see insomnia associated with this.
Melanie: So, who is at risk for restless leg syndrome and does it run in families? Is there a genetic component to it?
Dr. Lieske: Well, it seems to occur a little bit more in females than males; again, a little bit older population, and it seems like it can run in families. There have been studies that show that as many as 40-60 percent of a family may have restless leg syndrome; however, there has been no genetic marker found for it. There's ongoing research there but we've not found a specific marker on any gene or anything like this that says "Oh, if you have this gene, you're going to have restless legs." The other thing about restless legs besides the insomnia is, sometimes it can be so severe during the day that it makes it difficult for people to even sit, say, in a meeting or you know, concerts, movies, those kinds--anytime where you're supposed to sit still, it seems to get worse.
Melanie: Are there certain triggers, such as fatigue or stress that can bring it on?
Dr. Lieske: We know that the more tired and more fatigued someone is, it tends to make it worse. Stress probably just associated with the anxiety that can occur with stress, can oftentimes aggravate this to the point where anytime you're in a stressful situation, you feel so uncomfortable you can't even sit down. You have to be up moving and so forth.
Melanie: So, how would someone know that they have restless legs and who would they go see to have it checked out if they do have this uncomfortable condition?
Dr. Lieske: Okay, well, restless legs is almost exclusively what we call a “clinical diagnosis”. It's a diagnosis where the physician or mid-level will take a history and ask the specific symptoms. You know, there's been one sentence that seems to occur a lot in a history taking, and then that sentence kind of goes somewhat like this: "Do you have situations where you're supposed to be in a quiet situation or trying to lay down at night to go to bed, where you have this uncontrollable urge to have to either move or your legs are very, very uncomfortable?" That seems to be the most important question to ask people and that can almost make the diagnosis. There is no test that we have at the present time that can diagnose restless leg syndrome.
Melanie: So, if you do figure out that somebody has this, how can it be treated and is there a cure for it?
Dr. Lieske: Well, there is no cure for it but one of the most important things that we can do, we often find restless leg syndrome associated with iron deficiency. If the clinical diagnosis is made of restless leg syndrome, then studies to determine if your iron stores are low and the iron stores we're talking about are in the central nervous system, such as in the brain. The particular test that we use is the ferritin level and if it's below a certain level, it would indicate that your iron stores in your brain may not be high enough. Now, you may have normal iron, if you do just an iron level, but it may indicate that your brain iron is not normal. That probably occurs in about 40 percent of the cases, so then, we certainly would suggest that you treat these patients with iron, but that should be done under careful supervision of a physician because there are certainly some risks involved with taking iron and not really having these levels and this monitored. So, it needs to be done under very careful supervision. Plus, if the iron stores are low, we have to also be concerned, is there some reason for the iron to be low? Is there some sort of a GI issue? Are you losing blood somewhere? That kind of thing. So, that needs to be evaluated, too. But then, iron treatment is one therapy. There are therapies that involve non-medication like sometimes getting up and walking, if that . . . and sometimes, that's all it takes to settle it down so you can get to sleep. Sometimes, warm baths--those kinds of things. There's one that I always very interesting. A lot of people know, "Well, let's just put a bar of soap at the foot of the bed." There's no reason why it should work. Some people swear by it. You know, I think that's kind of an anecdotal, cute little idea, but it kind of falls into some of the non-medical treatments. There are medical treatments that can be used; drugs such as Ropinirole and Pramipexole. Those are drugs that we use for movement disorders. Those need also to be used and there are certain dosages and so forth, and those also need to be used under very careful, careful supervision of a physician because there are some side effects of those drugs.
Melanie: When do you determine that somebody might need medicational intervention?
Dr. Lieske: If you determine, first of all, that the iron is either normal, or low and you've replaced the iron, and then I would probably move to non-medical treatment, but if none of that works and the patient is having a great deal of difficulty just being comfortable--and it should be pointed out, most of the time, they don't complain of pain, it's just discomfort--then I would move to the other medications. There are other medications besides Pramipexole and Ropinirole, such as Gabapentin, which is . . . and another one, there's Neurontin and Lyrica, and those kinds of things, but, again, also should be used under the supervision of a physician.
Melanie: Is there any way to prevent it if you knew that your mother had it or you're worried that you're going to get it? Is there anything they do lifestyle-wise? Would exercise or any of these things help to stave it off, as it were?
Dr. Lieske: Well, like I said earlier, there is no cure. There have been small studies that have been done that if it seems like there is a family history, lifestyle certainly. Maintaining an ideal body weight, getting adequate exercise, making sure your diet is complete, and so forth. Those are just good healthy living things and sometimes it makes a difference. We also know that there are other things that can be associated with it and some of these things are, say, a traumatic brain injury, other issues with neurologic disorders, like sometimes we see neuropathies associated with diabetes and sometimes there's overlap into what seems like a restless leg syndrome. So, anything that we can maintain a healthy lifestyle and those kinds of things certainly are not going to hurt. Again, no cure and you may not be able to prevent it, but certainly those things are certainly recommended.
Melanie: And, in just the last few minutes, Dr. Lieske, give your best advice for people that suffer with restless leg syndrome--what you really want them to know; what you tell them every day.
Dr. Lieske: Well, first of all, there does not appear to be any association with this disorder with anything else such as some people worry about Parkinson's Disease, dementia and those kinds of things. There does not appear to be any association with restless legs and these disorders. Again, most importantly, I think, is making sure your iron stores and your iron has been checked. Certainly, what you don't want to do is say, miss a colon cancer because the iron is low, so you need to make sure that whole aspect of care: iron, bleeding, and that kind of thing are well-taken care of and then, if we do have to go to medications, make sure you take your medications because it's very important. There does seem to be sometimes, especially in severe cases, you have to maintain and make sure you take your medications, because if you kind of start and stop them, in severe cases, that is, it sometimes makes it more difficult to control.
Melanie: Thank you so much for being with us today. Talk to your doctor if you think you might have restless leg syndrome. For more information, you can go to bryanhealth.org/restlessleg. That's bryanhealth.org/restlessleg. You're listening to Bryan Health Radio. This is Melanie Cole. Thanks so much for listening.
Restless Leg Syndrome: Symptoms, Triggers and Treatments
Melanie Cole (Host): According to the National Institute of Health, as many as 10 percent of the US population may have restless leg syndrome. My guest today is Dr. Tim Lieske with Lincoln Pulmonary and Critical Care. Welcome to the show, Dr. Lieske. What is restless leg syndrome and what does it feel like?
Dr. Tim Lieske (Guest): Well, restless leg syndrome is actually--there's kind of a continuum of disorders that we include in restless leg syndrome, or at least some people say there's some overlap to some disorders that occur at night when we sleep called “periodic limb movement” or “periodic limb movement syndrome”. However, restless legs is a disorder that occurs almost exclusively during the day. It usually occurs in adults. It occurs usually later in life, although there are some instances where it occurs very early in life and it has a lot of, shall we say, reasons for it to occur, but there's also a very large percentage of patients who we don't know what causes it. And, it is a syndrome where your legs, it's usually your legs, although on rare occasions, it can occur in the arms, but your legs just feel uncomfortable and there are probably at least 20 or 25 different ways this has been described. It’s been described as "creepy", "uncomfortable", sometimes "pins and needles". Sometimes just a vague discomfort. Some people say it's "creepy-crawly", "I just can't my legs comfortable." Some people even will describe it as it seems like there's something crawling underneath their skin. And, it can occur during the early part of the day. Most of the time, it occurs during the evening, seems to get worse as we get closer and closer to bed, and other than . . . and the most important part about this is it often makes it very difficult to get to sleep and so we see insomnia associated with this.
Melanie: So, who is at risk for restless leg syndrome and does it run in families? Is there a genetic component to it?
Dr. Lieske: Well, it seems to occur a little bit more in females than males; again, a little bit older population, and it seems like it can run in families. There have been studies that show that as many as 40-60 percent of a family may have restless leg syndrome; however, there has been no genetic marker found for it. There's ongoing research there but we've not found a specific marker on any gene or anything like this that says "Oh, if you have this gene, you're going to have restless legs." The other thing about restless legs besides the insomnia is, sometimes it can be so severe during the day that it makes it difficult for people to even sit, say, in a meeting or you know, concerts, movies, those kinds--anytime where you're supposed to sit still, it seems to get worse.
Melanie: Are there certain triggers, such as fatigue or stress that can bring it on?
Dr. Lieske: We know that the more tired and more fatigued someone is, it tends to make it worse. Stress probably just associated with the anxiety that can occur with stress, can oftentimes aggravate this to the point where anytime you're in a stressful situation, you feel so uncomfortable you can't even sit down. You have to be up moving and so forth.
Melanie: So, how would someone know that they have restless legs and who would they go see to have it checked out if they do have this uncomfortable condition?
Dr. Lieske: Okay, well, restless legs is almost exclusively what we call a “clinical diagnosis”. It's a diagnosis where the physician or mid-level will take a history and ask the specific symptoms. You know, there's been one sentence that seems to occur a lot in a history taking, and then that sentence kind of goes somewhat like this: "Do you have situations where you're supposed to be in a quiet situation or trying to lay down at night to go to bed, where you have this uncontrollable urge to have to either move or your legs are very, very uncomfortable?" That seems to be the most important question to ask people and that can almost make the diagnosis. There is no test that we have at the present time that can diagnose restless leg syndrome.
Melanie: So, if you do figure out that somebody has this, how can it be treated and is there a cure for it?
Dr. Lieske: Well, there is no cure for it but one of the most important things that we can do, we often find restless leg syndrome associated with iron deficiency. If the clinical diagnosis is made of restless leg syndrome, then studies to determine if your iron stores are low and the iron stores we're talking about are in the central nervous system, such as in the brain. The particular test that we use is the ferritin level and if it's below a certain level, it would indicate that your iron stores in your brain may not be high enough. Now, you may have normal iron, if you do just an iron level, but it may indicate that your brain iron is not normal. That probably occurs in about 40 percent of the cases, so then, we certainly would suggest that you treat these patients with iron, but that should be done under careful supervision of a physician because there are certainly some risks involved with taking iron and not really having these levels and this monitored. So, it needs to be done under very careful supervision. Plus, if the iron stores are low, we have to also be concerned, is there some reason for the iron to be low? Is there some sort of a GI issue? Are you losing blood somewhere? That kind of thing. So, that needs to be evaluated, too. But then, iron treatment is one therapy. There are therapies that involve non-medication like sometimes getting up and walking, if that . . . and sometimes, that's all it takes to settle it down so you can get to sleep. Sometimes, warm baths--those kinds of things. There's one that I always very interesting. A lot of people know, "Well, let's just put a bar of soap at the foot of the bed." There's no reason why it should work. Some people swear by it. You know, I think that's kind of an anecdotal, cute little idea, but it kind of falls into some of the non-medical treatments. There are medical treatments that can be used; drugs such as Ropinirole and Pramipexole. Those are drugs that we use for movement disorders. Those need also to be used and there are certain dosages and so forth, and those also need to be used under very careful, careful supervision of a physician because there are some side effects of those drugs.
Melanie: When do you determine that somebody might need medicational intervention?
Dr. Lieske: If you determine, first of all, that the iron is either normal, or low and you've replaced the iron, and then I would probably move to non-medical treatment, but if none of that works and the patient is having a great deal of difficulty just being comfortable--and it should be pointed out, most of the time, they don't complain of pain, it's just discomfort--then I would move to the other medications. There are other medications besides Pramipexole and Ropinirole, such as Gabapentin, which is . . . and another one, there's Neurontin and Lyrica, and those kinds of things, but, again, also should be used under the supervision of a physician.
Melanie: Is there any way to prevent it if you knew that your mother had it or you're worried that you're going to get it? Is there anything they do lifestyle-wise? Would exercise or any of these things help to stave it off, as it were?
Dr. Lieske: Well, like I said earlier, there is no cure. There have been small studies that have been done that if it seems like there is a family history, lifestyle certainly. Maintaining an ideal body weight, getting adequate exercise, making sure your diet is complete, and so forth. Those are just good healthy living things and sometimes it makes a difference. We also know that there are other things that can be associated with it and some of these things are, say, a traumatic brain injury, other issues with neurologic disorders, like sometimes we see neuropathies associated with diabetes and sometimes there's overlap into what seems like a restless leg syndrome. So, anything that we can maintain a healthy lifestyle and those kinds of things certainly are not going to hurt. Again, no cure and you may not be able to prevent it, but certainly those things are certainly recommended.
Melanie: And, in just the last few minutes, Dr. Lieske, give your best advice for people that suffer with restless leg syndrome--what you really want them to know; what you tell them every day.
Dr. Lieske: Well, first of all, there does not appear to be any association with this disorder with anything else such as some people worry about Parkinson's Disease, dementia and those kinds of things. There does not appear to be any association with restless legs and these disorders. Again, most importantly, I think, is making sure your iron stores and your iron has been checked. Certainly, what you don't want to do is say, miss a colon cancer because the iron is low, so you need to make sure that whole aspect of care: iron, bleeding, and that kind of thing are well-taken care of and then, if we do have to go to medications, make sure you take your medications because it's very important. There does seem to be sometimes, especially in severe cases, you have to maintain and make sure you take your medications, because if you kind of start and stop them, in severe cases, that is, it sometimes makes it more difficult to control.
Melanie: Thank you so much for being with us today. Talk to your doctor if you think you might have restless leg syndrome. For more information, you can go to bryanhealth.org/restlessleg. That's bryanhealth.org/restlessleg. You're listening to Bryan Health Radio. This is Melanie Cole. Thanks so much for listening.