Posted on: Saturday, June 19, 2004
PRESCRIPTIONS
Medications can quell restless-leg sensations
By Landis Lum
Q. When trying to sleep, I get uncomfortable feelings in my legs which make me want to move them or get up in the middle of the night to walk. What can I do?
A. You may have restless- legs syndrome, common in both children and adults. There's a distressing desire to move your legs while just resting or sitting, especially at night. As Dr. Christopher Earley from Johns Hopkins said in the May 22, 2003, New England Journal of Medicine, there's often an uncomfortable feeling deep in the legs that may be described as a muscle ache or tension, or a feeling "like ants marching in my legs."
The more comfortable you are, the worse it is — you may even sleep on a hard floor than in a soft bed!
Common causes of restless- legs syndrome are iron deficiency, kidney dysfunction, diabetes, pregnancy and neuropathy, so take a fasting blood sugar and iron test.
Eighty percent of those with restless-legs syndrome (RLS) also have periodic leg movements during sleep (PLMS). However, PLMS also may be caused by other things besides RLS, such as sleep apnea and various antidepressant and anti-psychotic drugs.
If you need to sit a long time, keep your mind occupied by reading exciting books, doing intricate needlework, or playing video games.
Avoid alcohol, caffeine and smoking. If symptoms remain bothersome and occur nightly, Dr. Earley says so-called dopamine agonist drugs such as Mirapex and Requip, used to treat Parkinson's disease, work best with the least side-effects.
Start at a low dose two hours before symptoms usually occur and increase dose gradually to avoid nausea and dizziness (which people usually habituate to in 7 to 10 days).
If one drug in ineffective, try the other. If this fails, try an opiate such as oxycodone or propoxyphene, followed by the anticonvulsant gabapentin, and finally, a sedative such as clonazepam or triazolam. Doctors and patients can go to www.rls.org for more information.
If you have problems only once or twice a week, Dr. Earley recommends using the Parkinson's drug levodopa (Sinemet) as needed because it works within 20 minutes and causes less sedation than opiates. Using it more than two nights (or days) a week can actually worsen restless legs or make it occur during the daytime.
It lasts only a few hours, so you may have to take an extra dose in the middle of the night, but local neurologist Tom Drazen gets around this by combining the rapid- and long-acting Sinemet pills.
And if restless-legs syndrome occurs with pain, then gaba-pentin or opiates may be best.
The leg movements can cause insomnia, leading to daytime sleepiness, inattention, hyperactivity, decreased motivation and drive, or depression.
It is thus crucial that we take this underdiagnosed disease seriously and treat it aggressively.
Dr. Landis Lum is a family-practice physician for Kaiser Permanente and an associate clinical professor at the University of Hawai'i's John A. Burns School of Medicine. Send your questions to Prescriptions, Island Life, The Honolulu Advertiser, P.O. Box 3110, Honolulu, HI 96802; islandlife@honoluluadvertiser.com; or fax 535-8170. This column is not intended to provide medical advice.
