Almost every parent will tell you sleepless nights are part of the job description, but sleep disorders are not. Sleep disorders are medical or behavioral conditions that prevent you from getting a good night’s sleep, and these common, chronic conditions can also keep you from being the best parent you can be.
Kevin Smith, PhD, a clinical psychologist board certified in behavioral sleep medicine, and David Ingram, MD, a board-certified sleep medicine physician, both with the Children’s Mercy Sleep Disorders Center, discuss one of the most common sleep disorders that may be keeping you up at night, and what you can do about it—restless legs syndrome.
The details on Restless Legs Syndrome
Dr. Smith asked Dr. Ingram a series of questions. Below is their conversation.
Dr. Smith: With all that is going on in the world, I’ve found more people than ever are having problems sleeping, so I thought it would be useful to start a blog series to review the symptoms, causes and treatments for several of the most common sleep disorders, and today I have board certified sleep physician Dr. David Ingram joining me to talk about one of the most common sleep disorders, restless legs syndrome. Thanks for joining me today.
Dr. Ingram: My pleasure.
Can you give us a general overview of what restless legs syndrome is?
Dr. Ingram: The first thing about restless legs syndrome, or RLS, is it goes by different names such as Willis-Ekbom disease. This emphasizes the fact that it’s a disease.
Dr. Smith: Yes, I think the name “restless legs syndrome” contributes to some of the confusion. I’ve heard people ask, “Is RLS a real disorder?”
Dr. Ingram: Putting the label “disease” on it was meant to emphasize that it’s very real, and it’s important for people to get treated. Restless legs, or Willis-Ekbom, basically is a sleep disorder where you get these weird, bothersome sensations in your legs at night. You may feel like you have to move your legs. It’s an uncomfortable “having to move” sensation. That’s the most common symptom people report or experience.
I don’t hear people mention significant pain with restless legs. Would you agree that if you have restless legs syndrome, it probably will present as annoying and uncomfortable, but not painful?
Dr. Ingram: Yes, patients often describe restless legs syndrome as a creepy, crawling feeling in their legs, or itching. It’s usually a deeper kind of feeling in both legs rather than one, and it’s usually not a feeling on the surface of the skin. It’s usually deeper and below the knees.
Is this a common syndrome?
Dr. Ingram: Yes. In adults, maybe 5 to 10% struggle with restless legs. In kids, maybe 2 to 3%.
Dr. Smith: And I think there is a lot of confusion between RLS, and the movements that happen while we’re asleep. With RLS, you’re really talking about the feelings and movements of your legs before you actually go to sleep.
Dr. Ingram: Exactly. Restless legs is a diagnosis based on what people tell us about what they’re feeling before they fall asleep. But we also have movements that happen when we sleep. Someone may wake up and not feel like they slept at all. Sometimes these movements disrupt sleep quality, and result in the daytime symptom of sleepiness. The way we look at that is by doing a sleep study.
What causes restless legs syndrome?
Dr. Ingram: Many times it runs in families, so we think there is maybe some genetic component to it. Other times it just seems to be out of the blue. Sometimes it can be related to other medical problems the person has such as kidney problems, diabetes and other neurological problems. One thing we usually check for is iron deficiency. Iron is important for the production of dopamine in the brain, and dopamine is involved in moving and sensation. It’s really common in pregnancy and can be challenging to treat.
What type of therapy do you recommend if iron levels are low?
Dr. Ingram: If they’re low, I’ll start off with oral iron. Iron can be given by mouth or by IV. There are some side effects to iron, like constipation, but overall, it’s well tolerated.
Dr. Smith: And for some patients I have seen, behavioral-based treatments, such as massage, heat, cold compresses, and relaxation/distraction strategies can really help.
Dr. Ingram: Yes, with some people, their symptoms are so infrequent or so mild, that some of those measures can help. Regular, moderate exercise can be very helpful. We also check to see if there are things the person is taking or doing that could be making their restless legs worse and are those things that we can change? For example, the person might be taking an over-the-counter sleep aid, thinking it will help, but it may make their restless legs worse. Antidepressants also can make restless legs worse. Other common substances that might disrupt sleep are caffeine, alcohol and smoking.
There are prescription medications that we can use for restless legs. These also can have side effects, so be sure to work closely with your doctor on those.
Could you talk about a few of the more popular adjunct treatments related to restless legs, ones that you think could be helpful, and ones that you think need to be debunked?
Dr. Ingram: Some low-risk strategies I think that are reasonable and safe are yoga and acupuncture. The evidence isn’t really strong that those are effective, but they can have other health benefits. There’s also a new vibrating device that has received FDA approval. It works through natural sensation and the nervous system. I also get asked about supplements, like magnesium and vitamin D. In most cases, we don’t know if they work or if they are safe.
Dr. Smith: And people should talk to their doctor before trying any of these treatments, even if they are available over the counter.
Dr. Ingram: Yes. So, for vitamin D for example, if your provider thinks this might be an issue, they should check your vitamin D level first. If it’s low, you might consider a supplement. Just because you can buy something over the counter, doesn’t mean that it’s a good idea.
Again, if you think you have the symptoms of restless legs, talk with your doctor about it. You may feel a lot better and have a better quality of life if you deal with it, rather than letting it linger.
Most parents would agree that it’s easier to parent when you are getting good sleep, so prioritizing good sleep can have a positive effect on the entire family.
Associate Program Director, Sleep Medicine Fellowship; Associate Professor of Pediatrics, University of Missouri-Kansas City School of Medicine; Education Associate Professor of Pediatrics, University of Kansas School of Medicine