Restless legs syndrome: causes and symptoms
Jul 15, 2021
What is necessary to be able to fall asleep? A sine qua non condition is to maintain good sleep hygiene. Caring for routines in such a way that we promote drowsiness, avoid lights or physical exercise, a suitable temperature, all the silence we can obtain, and so on. We also need to feel relaxed and free of physical discomfort, something that people with restless leg syndrome do not.
These people, as soon as the body rests, they begin to feel a series of sensations from the trunk down that prevents them from sleeping and forces them to move their legs to try to alleviate the discomfort. The discomfort leaves to return at the moment in which the person is at rest again.
Symptoms of restless legs syndrome
Patients with restless leg syndrome, when feeling discomfort or tingling in their legs, have the urgent need to move them to end the itching that interferes with rest. The type of sensations that someone with restless legs can feel is wide, from itching, very minor pain, vibrating tactile sensations, small pinches that are moving, and so on.
On rare occasions it also occurs on the arms, chest or even on the face. In addition, the sensations are usually bilateral, that is, they can occur on both sides of the body without any criteria. Some patients describe a certain alternation, as if when the sensations on one side disappear they move to the other side of the body.
These sensations produce a lot of discomfort, and the longer the individual waits for them to leave, the more irritated he becomes.. For this reason, these people, whenever they are sitting or lying down, keep their legs moving. In this way the discomfort disappears during the time they are in motion. However, the symptoms return when one wants to rest completely, entering a circle that is difficult to break.
Course of the disorder
One of the characteristics of restless legs syndrome is that it fluctuates. The discomfort does not appear the same throughout the day, but often disappears in the morning to reappear in the afternoon and evening. This is why people without restless leg syndrome have many problems with both falling asleep and maintaining sleep.
They are also not present every day. In most cases, which are mild, they appear once or twice a week, which is already enough to disturb sleep and seek professional help. In the most severe cases there is talk of an occurrence of more than twice a week. Sometimes there are certain periods of remission in which the symptoms disappear completely over weeks or months. However this is a characteristic of the earliest stages of the disease; symptoms tend to get worse as time goes on.
The first link in the causal chain is usually unknown. Most cases have an uncertain origin, although there are instances of genetically transmitted restless leg syndrome. The current hypothesis considers the possibility that the circuits of dopamine basal ganglia are not working properly. Apparently those people who already have a dopaminergic alteration in this place, as in the case of Parkinson's disease, have a significantly higher risk of suffering from restless legs.
There are some medical factors that have been linked to the appearance of restless legs, but they do not explain all the cases. These factors include:
- Iron deficiency
- Certain medications such as antiemetics
- Use of alcohol, nicotine, or caffeine
- Being in the third trimester of pregnancy
Management of the disease is symptomatic, there is no definitive cure. However, symptomatic treatment is already very successful on its own. For most of the cases changes in the daily routine can already be very beneficial. Have a regular sleep schedule, exercise continuously in the morning, or bathe your legs in hot or very cold water at night can be enough to prevent the appearance of these annoying tingling
There are also effective drugs such as anticonvulsants, which are almost the first line of pharmacological treatment due to their effects dopaminergics, or the dopaminergic agents themselves that are administered in diseases where these circuits are dysfunctional as in disease Parkinson's. However, long-term use of this medication appears to make symptoms worse. This phenomenon stops as soon as the dopaminergic drug is withdrawn.
Other drugs such as opioids or benzodiazepines may be helpful as they help to reconcile the sleep, but they really have no effect on the presence of discomfort and tingling in the legs. In addition, the use of benzodiazepines is not recommended beyond the first two or three weeks, as they have great addictive potential. So perhaps they would only serve as a rescue in those days when despite following all the advice and taking the proper medication, the discomfort remains.