Canyon Ranch (Massachusetts)

Restless Legs Syndrome is finally getting some respect, thanks to marketing campaigns by drug manufacturers. And that's good news for a lot of tired people, according to sleep experts.

It may seem like Restless Legs Syndrome came out of nowhere, but it's a startlingly common cause of poor sleep. One study found that 10 percent of the adults surveyed had it to some degree. And it can be debilitating. Doctors who treat it have seen people suicidal with sleep-deprivation due to RLS.

While Restless Leg Syndrome may sound like something from a Monty Python skit, the name is perfectly descriptive. People who suffer from it have unpleasant sensations in their legs that are only relieved by movement. The sensations usually aren't painful, but the urge to move is irresistible. It tends to be worse at night, when it interferes with sleep, and can also be a misery on plane flights - and even when sufferers just want to sit still and watch a movie or TV show.

It's a very real type of twitch disorder that runs in families - about two-thirds of RLS sufferers have relatives who also have it. Its now quite well-understood, and, fortunately, quite treatable.

RLS may manifest in the legs, but it originates in the brain.

It's a neurological syndrome caused by low dopamine levels in the brain. Dopamine is a chemical that, among other things, suppresses twitching. People who have Parkinson's disease, for example, twitch and shake because the cells in the brain that make dopamine are damaged. In people who have primary RLS, those cells are alive but can't take up iron, and iron is necessary to make dopamine. Work is going on right now to identify the exact location of the gene that causes it.

Because iron plays a central role in dopamine production, people who are anemic can develop secondary RLS, a highly treatable condition that goes away when their bodies once again have adequate stores of iron. The strong connection between iron and RLS accounts for the fact that pregnant women often develop the syndrome: Many women become anemic during pregnancy. Other populations at risk for RLS include people with kidney disease, diabetes and certain spinal disorders, and, since dopamine production tends to decline with age, the elderly.

Restless, not Ridiculous
Awareness of the syndrome has soared in the last few years, as drug manufacturers have filled the airways with advertising campaigns.

Pharmaceutical ads are serving a genuine public good, in this case. The ads for drugs to treat the syndrome are educating patients, and the patients are educating their doctors by, essentially, diagnosing themselves and then going in and asking for treatment. Doctors are taught virtually nothing about sleep in medical school.

There's also been a great deal of skepticism about the reality of RLS, in part because it's so unlikely sounding - patients on the Restless Legs Syndrome Foundation's website report their families referring to it as "Ridiculous Legs Syndrome" - and in part because many people are suspicious of drug companies. There's a tendency to say, 'Oh, they've made up this silly-sounding disorder just to sell more pills.' In fact, the drugs used to treat the disorder are highly effective for many people.

In addition, people can't understand how a condition could be so common but so invisible for so long. This is a syndrome that's more prevalent than asthma, and yet physicians simply were not diagnosing it until the drug companies started their campaigns.

One reason for this is that people tend to "normalize" sleep disorders: People who've always slept badly assume that their experience, however miserable, is normal and can't be changed. People also often identify their sensations as "fidgetiness" or "nervousness" - as simply aspects of who they are as people.

In children, people often call RLS "growing pains," and in fact there is a connection with growth, because children in a growth spurt often deplete their iron stores.

Experts have found that many children with identified sleep problems have RLS, and the syndrome underlies perhaps half of all childhood ADHD cases. Many children are hyperactive in response to chronic sleepiness.

Sleep, Beautiful Sleep
Fortunately, about 80 percent of people with moderate to severe RLS respond to the drugs the pharmaceutical companies are flogging - another reason they're advertised so enthusiastically.

Before prescribing one of them, however, physicians should first check patients for anemia - if their RLS is caused by low iron stores in the body, treatment may be as simple as supplementation with iron and perhaps B12. (Supplementation with calcium, magnesium and potassium may help people who have trouble with leg cramps - which, however, have nothing to do with true RLS.)

For people with primary RLS for whom these drugs work, relief is often dramatic. Many patients sleep through the night after taking their first dose.

Restless Legs Syndrome Facts
RLS is a neurological movement disorder characterized by an irresistible urge to move the legs accompanied by uncomfortable sensations that occur most prominently in the evening or when at rest. Movement provides transient relief. RLS is not muscle cramps, referred back pain or neuropathy

Doctors diagnose Restless Legs Syndrome by asking patients who complain of poor sleep a few simple questions: "Are your legs ever uncomfortable when you're lying in bed or sitting still? Do you feel a need to move them?"

For more information, visit the RLS Foundation's website.

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