Healthy Manhattan: Ants in Your Pants

Written by Dr. Cynthia Paulis on . Posted in Healthy Manhattan, Posts.

You’ve had a long, hard day and now it’s time to settle into the comfort of your bed and feel the cool sheets on your skin. You wait and wait, and still can’t get to sleep. Now your legs are doing the mambo. You may be suffering from a condition known as restless leg syndrome (RLS).

According to Dr. Michael Weinstein, the director of the Sleep Disorder Program at Winthrop University Hospital, "Restless leg syndrome is a discomfort associated with the compulsion to move your legs, which is exacerbated by immobility. The patients often have a hard time describing the feeling. I have heard expressions such as ‘heebie jeebies,’ ‘squirrely legs’ and ‘mad spiders’ to describe how their legs feel at night." The symptoms experienced when a patient is trying to sleep are often relieved by movement, and it is not unusual to see a patient getting up and pacing at night, earning them the nickname of "night walker."

RLS affects as much as 10 percent of the population. And it’s not just a problem for adults; more than a million children are also affected. It is often associated with attention deficit disorder, and women tend to suffer from it more than men. Many people who suffer from RLS will not seek medical attention because they believe that they will not be taken seriously, that their condition is too mild or that it is not treatable.

"One interesting thing about RLS is how long people will go before the diagnosis is made. It is not unusual for patients to have complaints 10 to 20 years before the diagnosis is made. The patient recognizes that this is a medical condition and many times the fault is on the doctor for not recognizing it as a serious problem—I still have colleagues questioning if it is a real thing. This is a real medical condition," says Weinstein.

Left untreated, RLS can cause exhaustion and daytime fatigue. The condition can affect jobs, personal relationships and daily activities because sufferers are sleep deprived. They have difficulty concentrating, impaired memory and often struggle to accomplish daily tasks.

More than 80 percent of people with RLS also experience another common condition known as periodic limb movement disorder, which is characterized by jerking movements during sleep that occur every 15 to 40 seconds throughout the night. The symptoms cause repeated awakening and severely disrupted sleep. A caveat here is that, while most people with RLS also develop periodic limb movement, those with only periodic limb movement disorder do not eventually experience RLS.

A classic feature of RLS is that the symptoms are worse at night, with a distinct symptom-free time, usually early in the morning, allowing for a more refreshing sleep at that time. Triggers for the syndrome are periods of inactivity such as long-distance flights, car rides, immobilization by a cast and sitting in a theater.

Although there is no known cause of RLS, there is evidence that low levels of iron have been present in many of the cases.

According to Weinstein, "Many patients with RLS turn out to have some occult iron deficiency. We do a test called a ferritin level; it’s a good test that reflects the body’s total store of iron.

Patients with low ferritin levels are iron deficient. You don’t have to be anemic and it doesn’t come to the attention of the primary care doctor. You can be iron deficient but not be anemic. Patients who have a ferritin level below 50 are started on supplemental iron."

Other conditions in which RLS is often seen are end stage renal disease, diabetes and pregnancy, especially in the last trimester. Certain medicines, including antinausea drugs, antipsychotics, antidepressants and antihistamines, have also been known to cause the condition.

RLS is a treatable condition. According to Weinstein, "The relief can be dramatic and it’s one of those potentially lifechanging interventions, especially when someone has had long-standing symptoms."

Certain lifestyle changes, such as limiting the use of caffeine and tobacco, correcting metabolic deficiencies and maintaining a regular sleep schedule, have also been known to help.

Dopamine drugs, once used to treat Parkinson’s disease, have been known to reduce the symptoms of RLS and periodic limb movement disorder. The drugs are well-tolerated, except for occasional dizziness and nausea, but chronic use of dopamine drugs can cause a problem known as "augmentation," where the person begins to experience symptoms earlier in the day until it is around the clock. Then it’s time to change the meds.

A very peculiar adverse affect of dopamine drugs that can occur is the development of impulsive gambling urges. Weinstein admits he had a patient who started taking trips to Atlantic City to play the slots after he started on the medicine, so they changed his meds.

So just a note of caution if you are being treated for RLS and find yourself in the middle of a Vegas casino in your pajamas: It might be time to give your doctor a call—unless, of course, you are winning.