End Fatigue

Restless Legs Syndrome (RLS) and PLMS/PLMD

Do your legs kick around a lot at night? Are your sheets and blankets scattered around a lot when you wake up? Does your spouse note that they get kicked around a lot at night or that your legs jump? If so, you probably have PLMs (Periodic Leg Movements in sleep), which is present in about 80-90+ percent of those with restless legs syndrome (RLS) and may be contributing to your fatigue and pain. Although you may be asleep through the night, your legs are running a marathon and you wake up exhausted!

RLS/PLMs are very common in CFS and fibromyalgia, likely affecting over one third of those suffering with these syndromes. It is getting more media attention, now that there is an expensive new medication , called "Requip," that is being used to treat it. I never have prescribed Requip. I do not believe that it is as effective as other natural or even prescription therapies and I'm concerned about safety risks. It's mostly being prescribed because it is expensive and therefore being publicized.

RLS is characterized by very uncomfortable sensations in the legs while resting, especially at sleep onset. These sensations commonly interfere with sleep onset by encouraging voluntary movements such as attempts to walk them off. PLMs occur during light, non-REM sleep and involve rhythmic leg kicks that people are typically not aware of. This kicking can lead to arousals and awakenings, and in addition, brain arousal patterns usually precede the leg kicking. RLS is diagnosed by symptoms alone while sleep specialists do a sleep study to confirm PLMs and PLMD (Periodic Leg Movement Disorder). RLS and PLMD overlap but are viewed as 2 different conditions. True PLMD — the diagnosis of which requires periodic limb movements in sleep that disrupt sleep and are not accounted for by another primary sleep disorder, including RLS — is uncommon.

Although RLS causes a disagreeable leg sensation and sense of restlessness, it is not uncommon for only your bed partner to be aware that your legs are kicking much of the night or are constantly moving with PLMS. Although the causes of RLS and PLMS are not clear, they can be aggravated by iron and other nutritional deficiencies, hypothyroidism, and low blood sugars while sleeping. If you have daytime fatigue and your blankets are scattered around when you wake up or your bed partner notes that your legs move a lot during the night, PLMS may well be a problem for you. Although a sleep study can make the diagnosis, it usually runs approximately $2,000 and you may simply choose to videotape yourself for an hour or two while sleeping as a screening test, instead, to see if this is a problem.

Treatment

There are both natural and prescription approaches to treatment. Natural remedies focus on diet and nutritional supplementation. Avoiding caffeine is important. Because RLS/PLMS may be associated with hypoglycemia, eating a sugar-free, high-protein diet with a protein snack at night may be helpful. In addition, iron, vitamin C, tryptophan, and folic acid may also be helpful.

An estimated 25% of RLS patients have low serum iron levels. As noted above, if your serum ferritin score is under 50, your should take an iron supplement for both RLS and PLMs as well as PLMD. I recommend the prescription iron supplement Chromagen FA because it also contains folic acid and combines iron and vitamin C, which helps the iron to be absorbed. Take iron supplements on an empty stomach. Vitamin E can also be very helpful for RLS, although it takes six to ten weeks of treatment to help. Take 400 international units a day. If you have RLS in which pain, numbness, and lightning stabs of pain are relieved by movement or local massage, taking 5 milligrams of folic acid three times a day (available by prescription) may also be helpful, but does not help cases of RLS without these symptoms. A few case reports have suggested that taking the amino acid L-tryptophan may also be effective. I recommend using the related compound 5-HTP (consult your holistic health practitioner before adding 5-HTP to antidepressants, as a dangerously high serotonin level may rarely occur).

In addition, Ambien, Neurontin, and Klonopin are medications that are highly effective in the treatment of PLMS, although the Klonopin can be addictive. Medications such as anti-depressants and antihistamines may also worsen RLS/PLMS. I tell patients to adjust the dose of Neurontin to not only get adequate sleep, but to also keep the bedcovers in place and to avoid kicking their partners.