Q: After years of struggling to fall asleep at night, my doctor finally diagnosed me with restless legs syndrome. What can you tell me about this condition?

A: Restless legs syndrome (RLS) is a disorder of nerves and muscles that causes an irresistible urge to move the legs, often accompanied by an uncomfortable "creepy-crawly" sensation.

As you've experienced, symptoms of RLS typically flare at night, just as you're settling down in bed. RLS not only causes discomfort and distress, but can also wreak havoc on sleep, causing daytime sleepiness and mood changes.

Fortunately, certain lifestyle strategies can help you manage milder forms of RLS, and several medications can provide relief for more serious symptoms.

There's a common mistaken belief that RLS refers to the jittery, leg-bouncing movements some people make when they're anxious or overstimulated. Partly because of this, the RLS Foundation, a nonprofit organization that provides information about the disorder, is lobbying to change its name. According to the foundation, the term "restless legs" trivializes a problem that can have a "severe and profound" impact on sleep and daily functioning.

People with RLS describe the discomfort as feelings of creeping, prickling, pulling, itching, tugging or stretching that typically occur below the knees and are felt deep within the legs. In severe cases, the arms are affected as well.

Movement provides immediate relief, so people with the condition often fidget, kick or massage their legs, or get up to pace the floor or perform deep knee bends.

Primary RLS, the most common form of the disorder, has no known cause. But more than 40 percent of people with primary RLS have a family history of the condition. This suggests an underlying genetic component. Researchers have found five gene variants that predict a greater likelihood of RLS.

One theory is that primary RLS arises from an imbalance of dopamine, a neurotransmitter with many roles in the body, including the regulation of muscle movement. Some of the medications used

to treat RLS work by mimicking the action of dopamine in the brain.

RLS can also develop as a byproduct of other medical problems. One of the chief culprits in this secondary form of the disorder is iron deficiency, which may explain why the condition is more common in women, who are more prone to low iron levels. This is mainly due to blood loss during menstruation. Pregnancy, childbirth and breastfeeding also deplete iron stores.

One small study found that older people with RLS had lower levels of ferritin (the main protein the body uses to store iron). The lower the ferritin level, the worse the symptoms.

Other research has shown lower ferritin levels in the spinal fluid of RLS sufferers and lower iron stores in their substantia nigra (one of the brain's centers for movement control).

People with kidney disease who receive dialysis (a process that filters waste and removes excess water from the blood) have an increased risk of developing RLS. It's also more common in people with diabetic neuropathy (nerve damage caused by diabetes). Multiple sclerosis, Parkinson's disease and certain rheumatic diseases (rheumatoid arthritis, lupus and Sjogren's syndrome) may also raise the risk, though the evidence isn't conclusive.

Caffeine, alcohol and nicotine can aggravate RLS symptoms. So can the antihistamine drug diphenhydramine (Benadryl), which is found in many over-the-counter cold, allergy and sleeping medications. Prescription antidepressants such as amitriptyline (Elavil), fluoxetine (Prozac) and escitalopram (Lexapro) can also make RLS worse. Lastly, anti-nausea medications, including metoclopramide (Reglan, others) and prochlorperazine (Compazine) have been shown to worsen symptoms.

Treatments include iron supplements, lifestyle changes and medications. If your blood ferritin is low (less than 50 ng/mL), you should be evaluated to find the cause.

Some people find that it helps to avoid caffeine and alcohol -- and as always, it's important to shun smoking. Others get relief by distraction -- reading or doing crossword puzzles, for example -- but mentally stimulating activities won't work so well when you're trying to get to sleep.

Moderate daytime exercise may reduce nighttime episodes of RLS. You may also get some relief around bedtime by rubbing or squeezing the leg muscles, applying cold or warm compresses (or taking a warm bath), and stretching the calf muscles.

Medications can help ease RLS symptoms, but finding the right one may require some trial and error. Also, some medications become less effective with time, so you may need to switch drugs periodically. The FDA has approved three drugs specifically for the treatment of RLS. Talk to your doctor about treatment approaches that might work best for you. By diagnosing RLS, you and your doctor have already taken the most important and difficult step toward restful and refreshing sleep.

LIFESTYLE CHANGES, MEDICATIONS EASE RESTLESS LEGS SYMPTOMS

By the faculty of: Harvard Medical School

Page 8A • The Tribune/Thursday, March 15, 2012

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