Another sleepless night; another round with Restless Legs Syndrome (RLS) is keeping you awake. RLS is often associated with menopause, but in fact, the two are not interconnected. This first of a two-part series looks at RLS and its causes.

Restless Legs Syndrome (RLS) defined
Dr. John W. Winkelman of Brigham & Women’s Hospital in Boston recently discussed RLS at the 21st Annual Meeting of the North American Menopause Society (NAMS). His focus is to draw greater attention to RLS as a largely misunderstood sleep disturbance.

Winkelman lists the four main criteria, known as URGE, in this neurological disorder:
*Urge to move limbs especially the legs
*Rest or inactivity worsens symptoms
*Getting up and/or moving around improves the sensations
*Evening and night time bring on worsening symptoms

RLS patients complain of uncomfortable sensations in the legs or limbs described as throbbing, pulling, creeping or crawling when sitting or lying down. Smaller numbers of patients may experience RLS in their arms, heads or torsos. These sensations can occur in one or both sides of the body. RLS sufferers have anywhere from 100 to 300 movements during the night.

RLS vs. PLMS
Restless Leg Syndrome should not be confused with Periodic Leg Movement Syndrome (PLMS). PLMS is a similar disorder that affects up to 80% of RLS sufferers; but not all PLMS patients will have RLS. PLMS is the involuntary twitching of legs during sleep, usually every 15 to 40 seconds, which causes sufferers to wake up. The main difference between the two is that RLS occurs when a patient is awake, preventing one from falling and staying asleep, while PLMS occurs during sleep and causes one to wake up repeatedly during the night.

Causes of RLS:
RLS strikes at night or during prolonged periods of sitting or inactivity. Patients find that walking around or moving the legs while sitting or in bed helps to alleviate those unpleasant feelings. Generally, there is no real known cause, but these are the most common traits in RLS patients:

*Genetics: RLS tends to run in families

*Low iron levels in the brain: serum Ferritin levels lower than 40 may indicate an iron deficiency or the brain’s inability to transmit iron though the cells

*Dopamine abnormalities: dopamine is a chemical found in the brain and controls muscle activity; dopamine keeps muscle movements smooth versus jerky; any disruptions in dopamine transmission patterns may increase the risk of developing RLS. For example, those with Parkinson’s disease have abnormal dopamine function in brain and often develop RLS. However, this does not mean that RLS sufferers are more prone to developing Parkinson’s disease itself.

*Some chronic diseases such as kidney failure (End Stage Renal Failure) and diabetes

*Certain medications: antinausea drugs (prochlorperzine, metoclopramide), antipsychotic drugs (haloperidol, pehnothiazine derivatives), antidepressants that increase serotonin levels and some cold and allergy medications that contain sedating antihistamines

*Pregnancy: particularly in the last trimester; usually RLS symptoms should disappear within 4 weeks after birth

RLS and menopause: is there a connection?
Winkelman points out around 5% of Americans experience some degree of RLS “at a clinically significant rate of occurrence.” Moreover, the National Institute of Neurological Disorders and Stroke (NINDS) supports these statistics, reporting that as many as 10% of Americans have RLS. Around two or three percent of those patients have moderate to severe symptoms while five percent have mild symptoms. This means roughly five million adults and one million children suffer from RLS. So is there a connection to menopause?

Women tend to associate RLS with menopause and perimenopause since RLS may strike around age 40. But neither perimenopause nor menopause and fluctuating hormone levels are to blame or as Winkelman says, “menopause and RLS are not interconnected. Indeed RLS does affect more men than women – almost double – for reasons that are not always clear. He continues by pointing out that women have a greater chance of developing RLS in their 70s, long after menopause, than in their 40s.

Why is this important?
Winkelman notes, “Some doctors who are unfamiliar with sleep disturbances may miss a proper diagnosis because they are not asking the right questions.” This often leads to doctors and patients associating RLS to menopause, nervousness, insomnia, stress, arthritis, muscle cramps, and simple aging.

Winkelman suggests that RLS should “be the tip of the iceberg to find the underlying cause for proper treatment options and patient relief. In the past, RLS was often mistaken for leg cramps but the two conditions are not related and each requires a different course of treatment.”

In part two, learn more about why RLS is a concern and the treatment options available.

“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