Sleep Related Movement Disorders
The Insomnia and Sleep Institute of Arizona treats a variety of sleep disorders including restless legs syndrome and periodic limb movement disorder. Learn more about both of these conditions, symptoms, and treatment options that work for our patients.
Restless Legs Syndrome (RLS)
Restless legs syndrome (Willis-Ekbom Syndrome) is a neurological sleep disorder that makes it feel like you cannot help but move your legs. This makes it very difficult to achieve the comfort necessary to fall and stay asleep. Symptoms of restless legs syndrome tend to get worse at night, but exact symptoms vary from person to person. Some patients describe it as feeling like there is an itching or burning sensation inside the legs, and symptoms may get better when legs are moved or if a patient kicks their legs, gets up, and walks around. Understandably, these symptoms and short-term fixes are not conducive to a full, sound night’s sleep.
Restless legs syndrome does not only occur at night. The condition can also make it tough to sit still for extended periods, making air travel or long car rides challenging. Unfortunately, many people do not seek treatment because they do not see restless legs syndrome as serious. Furthermore, restless legs syndrome may in fact affect other skeletal muscle groups such as the arms.
Restless legs syndrome often gets more severe over time, in some cases leading to getting less than five hours of sleep per night. Such accumulated sleep loss can lead to daytime dysfunctions, including difficulty concentrating, irritability, and decreased quality in personal and professional relationships. Those suffering from restless legs syndrome are likelier to have anxiety and/or depression, too.
The good news is that restless legs syndrome is manageable. The Insomnia and Sleep Institute of Arizona is the leading comprehensive sleep center in the Phoenix Valley and known for receiving countless referrals for second opinions regarding sleep disorders like restless legs syndrome. Whether you are looking for an initial diagnosis or are unsatisfied with a previous diagnosis or treatment plan, we set the standard for sleep medicine in Arizona. So much more than a sleep lab, our physician-owned comprehensive sleep center prioritizes the patient, and you will always consult with a sleep specialist during your very first appointment.
RLS and Your Health
Most patients develop restless legs syndrome when they are 45+ and women are more than twice as likely to struggle with this disorder. There is a genetic component to restless legs syndrome, too. Over 50 percent of patients report that someone else in their family also has it. If you have someone diagnosed with restless legs syndrome in your family, your odds of developing it are 3 – 6 times higher.
The exact cause of restless legs syndrome varies. It may be caused by low iron levels, which leads to a miscommunication between neurons. Diabetes, which causes damage to the blood vessels and nerves that control lower limb muscles, is another possible cause of restless legs syndrome. Pregnancy can cause it as well, and in these situations, it is often temporary. Certain medications are also linked to restless legs syndrome, such as allergy drugs, antidepressants, antihistamines, and some over the counter sleep aids.
How restless legs syndrome “feels” is often described differently on a patient to patient basis. If you have an uncomfortable sensation in your legs that is tough to describe, but feels different than numbness or common cramping, you might have restless legs syndrome. It might feel itchy, throbbing, burning, or like a crawling or creeping sensation. Most patients need to move their legs to get rid of the sensation, or you might feel a tightening and flexing of the muscles while the legs are not moving. In severe situations, there can also be periodic limb movements.
Periodic Limb Movement Disorder (PLMD)
A periodic limb movement occurs when you experience repetitive muscle movements that are uncontrollable. It usually does not keep someone from falling asleep but does disturb sleep throughout the night. This, of course, causes fatigue and a host of other symptoms during the day like irritability and lack of energy and concentration. There are two times periodic limb movement can occur: periodic limb movement in sleep (PLMS) and periodic limb movements during wakefulness (PLMW). PLMS is the most common and most patients are unaware that it is happening. One of the most common movement is an extension of the big toe coupled with a bend of the lower limb joints. When the PLMS occur at a frequent rate during sleep and trigger excess arousals from sleep this is then known as periodic limb movement disorder.
In rare circumstances, PLM can even happen in the upper arms. All types of PLMS tends to happen during non-REM (rapid eye movement) sleep. Episodes of periodic limb movement range from minutes to a full hour, typically every 20 – 40 seconds. One or both legs may be affected. Periodic limb movement disorder might be a factor in other issues such as depression, short attention span, poor memory, fatigue, and/or difficulty tolerating CPAP or demonstrating symptomatic improvement with CPAP therapy.
Treating Restless Legs Syndrome and Periodic Limb Movement Disorder
Treatment for these two conditions are the same and begins with an assessment of the serum ferritin and vitamin D levels. Studies have indicated that a low ferritin level (<75 ng/ml) can reduce dopamine synthesis, and in turn cause restless legs syndrome and/or periodic limb movement disorder. Studies have also suggested that maintaining a vitamin D level between 50 and 75 ng/ml is necessary to ensure optimal dopamine synthesis.
Ensuring any underlying sleep disorders, such as underlying sleep apnea, are well treated is critical. Up to 70 percent of patients with moderate to severe restless legs syndrome have underlying obstructive sleep apnea (OSA). Not treating these disorders greatly aggravates both restless leg syndrome and/or periodic limb movement disorder.
Gabapentin and Horizant may be prescribed for moderate to severe restless legs syndrome. Dopamine agonists such as pramipexole, ropinirole, carbidopa-levodopa, and/or a Neupro patch can also be helpful. In patients with drug-refractory restless legs syndrome, meaning the medications were not effective, then opioid medications may be considered such as codeine, hydrocodone, and methadone. However, the use of opioid medications will require any underlying sleep disorders, like sleep apnea, to be effectively treated. Other pain medication such as tramadol may also be considered for patients with restless legs syndrome.
RLS and Periodic Movement Disorder Videos
Both restless legs syndrome and/or periodic limb movement disorder have treatment options available. The Insomnia and Sleep Institute of Arizona is more than the gold standard in the region—this sleep center sets the standard. Physician-owned and staffed, we are so much more than a sleep lab. Dr. Ruchir P. Patel founded The Insomnia and Sleep Institute of Arizona in 2013 as an outcome-driven sleep clinic committed to properly evaluating the patient’s sleep complaints to determine the next best steps from testing to therapeutic care.
Restless Leg Syndrome and Periodic Limb Movement Disorder
Yes. The avoidance of aggravating factors often helps reduce instances of restless legs syndrome and/or periodic limb movement disorder. This may include reducing caffeine, alcohol, or nicotine intake, increase mental activities like crossword puzzles when bored, daily leg massage, and regular exercise to name just a few.
If these problems don’t wake patients up, how do they realize they need help from a sleep specialist?
A lot of the time a sleep partner, such as a spouse, tells someone about their constant jerking or movement of the legs. Other times patients seek out a sleep specialist because they feel groggy or “out of it” even though they seem to be getting enough sleep.
Legally, yes, as iron supplements abound but this is not the best course of action. It is important to exclusively work with a sleep specialist to properly and safely treat any sleep disorder or disturbance. Diagnosing and following low iron levels is important to a patient’s health, as iron poisoning is a possibility. The quality of iron supplementation also varies. Determining low iron levels followed by an individualized supplementation either orally or intravenously is key to a safe and effective outcome.
Every drug treatment is personalized to the patient. The most common classes include dopaminergic agents, alpha-2-delta calcium channel ligands, benzodiazepines, and opioids.