Sometimes, legs ache, tingle and develop shooting pins and needles in the night. These uncomfortable sensations cause a person to wake up. If he or she gets up and moves around, or massages the leg, the sensations disappears. Only to reappear when the leg is at rest again.
Sleep is very important. Lack of or disturbed, non-refreshing sleep can occur due to these feelings in one or both legs. The person is then unable to get up in the morning or cope with the day. It also results in fatigue, forgetfulness, depression and irritability. Work, efficiency and academic performance suffer.
This “restless leg syndrome” (RLS), also called Willis-Ekbom Disease, affects almost eight per cent of the population. It is commoner in children and middle-aged adults. More women than men are affected.
It is more common in people with diabetes, peripheral neuritis from any cause, kidney disease and anaemia. It tends to run in families. Some specific gene variants have been associated with RLS. One theory is that the basal ganglia in the brain — responsible for the production of a chemical called dopamine that controls smooth, purposeful muscle activity — do not function efficiently. Low levels of iron in the blood have an adverse effect on the production of dopamine.
RLS can be pecipitated in some people by certain medications, such as antipsychotics, antidepressants, antihistamines and those used to combat nausea and vomiting. In these cases, the RLS is temporary. Stopping the medication relieves the symptoms. RLS sometimes appears during pregnancy and spontaneously disappears around a month after childbirth. Use of alcohol, tobacco in any form (cigarettes, beedis, snuff and chewing tobacco) and caffeine (coffee, tea and cola) aggravate RLS.
Simple measures such as controlling diabetes, correcting electrolyte and mineral imbalances, treating kidney disease and taking iron supplements help. Megavitamin supplements, however, are not beneficial.
Sleeping for seven to nine hours a night as well as waking up and going to bed at fixed times is often beneficial. Symptoms are usually less in the early morning, so getting up later may help with sleep. Taking a bath in hot water at bedtime helps relax the muscles as does gentle stretching exercises. Exercise also releases chemicals from calf muscles which reduce the symptoms. Remember, however, to keep a gap of at least an hour between working out and going to bed so that the body has time to cool down.
RLS can also occur during long flights or if you just sit still for a long time, say binge watching television. If you sit reading on the other hand, symptoms can decrease even if there is no active movement of the legs. A hot water bottle or heating pad helps relieve the pain in some people while ice packs help in others. Sleeping with the legs elevated also relieves symptoms.
If these simple measures do not help, medication may be required. Iron supplements can cause gastric irritation and constipation so take them on a full stomach. Combining iron pills with citrus juices (rich in Vitamin C) increases the absorption. Pain relieving medication is helpful but can be habituating (codine) or addiction (benzodiazepines). Some anti-seizure medications such as gabapentin and pregabalin also work. Treatment has to be individualised.
The good news is that in some people RLS spontaneously disappears, especially if they have implemented beneficial lifestyle changes. The bad news is we still don’t know why RLS occurs.
The writer is a paediatrician with a family practice at Vellore and author of Staying Healthy in Modern India.
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