Restless Leg Syndrome (RLS) affects up to 5 million American adults, keeping them up at night and interfering with their lives. This article, the second of a two-part series, looks at why RLS is a real concern and the various treatment options available.

All advice is for general information purposes. Consult your healthcare provider for a proper diagnosis.

Many women think menopause is to blame for RLS. In reality, menopause is not a cause of RLS even though this condition tends to appear around age 40 in some women. The risk of developing RLS actually increases for women in their 70s. Why RLS affects more women than men is largely unknown. What is knows is that the uncomfortable sensations and leg agitations have huge impacts on patients’ lives.

RLS health issues:
*Sleep disturbances including problems falling and staying asleep
*Daytime fatigue and discomfort from lack of adequate rest
*Interference with mobility due to sensations and lack of rest
*Reduced overall quality of health and life, exhaustion and lethargy
*Difficulty performing daily tasks
*Difficulty concentrating and remembering
*Irritability from lack of restorative rest
*Dreading evening and nightfall knowing the sensations will return
*Increased rates of anxiety and depression
*Increased rates of cardiovascular disease

RLS and End Stage Renal Failure
This last problem is particularly important for patients with End Stage Renal Failure, which is a chronic kidney disease characterized by complete or near complete kidney function failure. Dr. Winkelman of Brigham & Women’s Hospital in Boston explains the serious impact RLS has on End Stage Renal Failure sufferers. “Up to one third of End Stage Renal Failure Patients have RLS, putting them at a greater risk for developing cardiovascular disease. Moreover, these individuals tend to have a worse three year mortality rate compared to End Stage Renal Failure patients without RLS.”

Diagnosing RLS
Winkelman notes doctors need to ask the right questions to understand the underlying causes of a patient’s RLS. He refers to the URGE criteria: Urge to move, Rest worsens sensations, Getting up and moving helps, and Evening is the worst time; are to separate RLS from other medical conditions.

Other tools that can assist healthcare providers are:
*A neurological and physical exam
*Patient sleep history
*List of all current patient medications
*Blood test to measure iron levels in the brain; readings of iron serum Ferritin below 40 may indicate RLS
*Sleep lab studies such as a polysomnography test to measure brain waves, heartbeats, breathing patterns, and leg movements

Treating RLS
Doctors may recommend one or more treatment options depending on the underlying causes for RLS.

Medication to combat symptoms:

*Dopaminergic agents that increase dopamine levels in the brain that help regulate smooth muscle movements in the body.
Common side effects are nausea and dizziness. There is a risk of ‘augmentation’ or worsening of RLS until patient experiences RLS almost all day long, usually because patients have taken their medication for a long time.

*Benzodiazepines treat anxiety, muscle spasms and insomnia for those with mild RLS, to help patients get a better night’s sleep.
Side effects include daytime drowsiness. There is a risk of aggravated sleep apnea for individuals who have this pre-existing condition.

*Opioids include medications such as codeine, oxycodone, and propoxyphene. These are used to treat pain in those with more severe RLS symptoms.
Side effects may include dizziness, nausea, worsening sleep apnea, as well as possible addiction in some and constipation brought on by codeine.

*Anticonvulsants (gabapentin, pregabalin) help sufferers deal with the unpleasant creeping and crawling sensations as well as nerve pain.
Side effects are dizziness and fatigue.

*Treating underlying conditions like diabetes and End Stage Renal (kidney function) Failure to help alleviate or possibly eliminate RLS

*Improve health and lifestyle habits including decreasing alcohol and caffeine consumptions, quitting smoking, establishing a regular sleep pattern, moderate exercise, and possible folate and magnesium supplements

*Iron supplements

Patients should keep track of any RLS symptoms and any new sleep disturbance developments. Communication with your doctor is the most important doctor is crucial to understanding what is causing RLS and keeping you up at night. Menopause and perimenopause are not to blame for RLS keeping you awake at night. With the right information, you and your doctor can work together to put RLS to bed...and you.

“Restless Legs Syndrome in Women at the Menopause” as presented by John. W. Winkelman, MD, PhD, Brigham & Women’s Hospital, Boston, MA at the NAMS 21st Annual Meeting www.menopause.org

National Institute of Neurological Disorders and Stroke www.ninds.nih.gov

Menopause, Your Doctor, and You