Drugs & MedicationsNeurology


Do you have restless legs syndrome? I do, and it’s a bothersome, annoying problem! You may have it, too, and just don’t know it. I learned I had it after my first sleep study well over 15 years ago. The doctor told me that while I was asleep, my legs moved, or jerked, an unbelievable number of times—something over 50 times an hour! He called it “Periodic Limb Movement Parasomnia.” This problem was causing “chronic sleep deprivation” because 50 or more times each hour my leg movements were keeping me from reaching deeper levels of sleep. It’s like someone was standing near my bed and shaking my legs 50 times an hour….and I didn’t know it!  

When I learned of this, I became more aware of the strange sensations occurring in my legs while watching television in the evening. Quite often, an achey, wave-like feeling would come over my legs and force me to move them to make it stop. I felt the constant sense I needed to move my legs to get comfortable and make the wave feeling go away. Some days the sensation was worse than others; some days I had none. When I reported this to my sleep doctor it was obvious I had Restless Legs Syndrome. 

I was treated first with Sinemet (carbidopa-levodopa), a Parkinson’s Disease drug, but after a month or more it didn’t seem to be helping. I switched, then, to pramipexole (Mirapex), another Parkinson’s drug, and it helped. Over the next year, the dose was increased from .25 mg at bedtime to .5mg, and finally to 1.0 mg. I’ve been on that dose since. If I forget to take it, I don’t sleep. My legs ache and jump and I’m very restless. 

Restless Legs Syndrome is everything you’ve just read about in my story. It is classed as a sleep disorder, because it definitely affects one’s quality of sleep. The specific cause is unknown, but the type of drugs that treat it effectively, may give us a clue. It worsens with age. 

Diagnosing it clinically is possible if the patient is able to relate his symptoms clearly. Most cases, though, are discovered during a sleep study. Once you have it, the only recourse is to treat it. It cannot be prevented, at least as we know now. Cutting back or eliminating caffeine, alcohol, tobacco, and other stimulants helps. A hot bath, massage of leg muscles, heating pad, and mild exercise help, too. 

Drug therapy is most effective, however. Parkinson’s drugs (Sinemet, Mirapex) are first line treatment. It’s ok to try muscle relaxants, sleep aids, anti-inflammatories, or analgesics first, but  the most effective treatment is a drug that enhances dopamine (a chemical that increases the transmission of nerve impulses in the brain). Anti-seizure drugs like Neurontin (gabapentin) and Lyrica (pregabalin) have been used effectively, too. 

Dr. G’s Opinion: Restless Legs Syndrome (RLS) is more common than people realize. Many folks who can’t sleep or have jumpy, achey legs have it but don’t know it! They haven’t mentioned it to a doctor or had a test that might diagnose it. It is very annoying. It disrupts my concentration and prevents me from enjoying television programs or reading. If I am concentrating on a gripping movie or reading a “book I can’t put down,” I can ignore it—sometimes. But there are times it is so bothersome I have to take my medicine early. The medicine works well 95% of the time. If I forget to take it at bedtime, I know it within 15 minutes of lying down.

RLS is a disorder some people consider a part of aging and just live with it. Like me, it is sometimes diagnosed by accident when you’re looking for something else. Fortunately, it is treatable with drugs that have few side effects and can improve quality of sleep as a benefit. If you think you may have it, speak to your doctor, and get tested for confirmation.

References: Holder S, Narula NS. Common Sleep Disorders in Adults: Diagnosis and Management. Am Fam Phys 2022;105(4):397-405.


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