ROANOKE TIMES
Copyright (c) 1996, Roanoke Times
DATE: Tuesday, April 16, 1996 TAG: 9604160040
SECTION: EXTRA PAGE: 1 EDITION: METRO
SOURCE: JANE E. BRODY
It makes good sense to lie down when you need to rest your legs, but the legs of millions of Americans do not let them rest.
Before they can even fall asleep, many develop ``creepy crawly'' sensations in their legs, forcing them to get up and walk around for 10 or 20 minutes. Or once asleep, they may be partly aroused by involuntary kicks and jerks of their ``restless legs.''
Other people fall asleep uneventfully, but are often bolted from a sound slumber by a sudden, intensely painful leg cramp like the crippling charley horse that sometimes afflicts swimmers.
Whatever the exact nature of the problem, when legs are not happy in bed, the consequence is likely to be the same: insomnia or sleep deprivation accompanied by daytime fatigue, irritability, anxiety and depression. Although the problem of restless legs was first recognized centuries ago, sleep medicine is so young a discipline that many practicing doctors are unfamiliar with such sleep-disrupting disorders and the various treatments that can alleviate the distress.
Restless leg syndrome
This Floridian's story has a familiar ring to at least 5 percent of Americans: ``I had a terrible night this Monday. A few minutes after I turned off the bed light, it hit me. I thrashed my legs around trying to get relief; it felt like something was crawling on them. I rolled and tossed for what seemed like hours before I finally fell asleep.''
First described in 1685, restless leg syndrome attacks when a person is sitting or lying still (or trying to), for example, while driving, watching television, sitting in a theater or concert hall or, most commonly, when lying down in hope of going to sleep. Sensations deep inside the legs, usually restricted to the calves and variously described as creeping, crawling, aching, fidgety or jittery, often force those who are afflicted to get up and walk around for 10 minutes or more several times a night.
Even after falling asleep, more than 80 percent of people with the problem experience ``periodic movements of sleep,'' a condition that until recently was called nocturnal myoclonus. It involves jerking or kicking of the legs that may arouse the victim and nearly always disturbs the bed partner. Most people with the syndrome struggle to live with the problem for decades before it is correctly diagnosed.
Although more common in older people, the syndrome can afflict children and is often misdiagnosed as ``growing pains,'' which do not involve leg movements during sleep and commonly disappear by the early teen-age years. Dr. Daniel Picchietti of the Carle Sleep Clinic in Champaign-Urbana has evidence to suggest that restless leg syndrome may be responsible for a some cases of attention-deficit hyperactivity disorder in children.
The cause or causes of restless leg syndrome are not precisely known, but in one-quarter to one-half of patients who have no recognizable cause, the syndrome appears to result from an inherited imbalance of nervous system chemicals, especially the neurotransmitters dopamine and serotonin in the brain.
Nonhereditary cases are likely to be associated with other conditions, including iron deficiency, pregnancy, deficiency of folate or vitamin B-12, nerve damage from diabetes or uremic kidney disease, rheumatoid arthritis, excess consumption of caffeine or alcohol and a long list of medications, including lithium, beta-blockers, anticonvulsants and neuroleptics.
Treatment of an identifiable underlying problem, for example, taking iron supplements to correct deficiency or changing medications, will often relieve the leg symptoms.
But when symptoms are severe and not readily reversible, drug therapy may be necessary. Among medications that have been shown to be effective in many patients are Sinemet (a medication containing l-dopa, the drug used to treat Parkinson's disease), clonazepam (a tranquilizer related to Valium), clonidine, carbamazepine and opioids like Darvon. Still further remedies may soon be available. For instance, Dr. Bruce Ehrenberg at the Tufts University School of Medicine in Boston is studying the effectiveness of the antiseizure drug valproic acid.
Sometimes several medications must be tried before one is found that achieves an acceptable balance of symptom relief and side effects. Some patients report that they have been helped by supplements of vitamins E and C and magnesium, but these have not been studied scientifically. However, quinine, sometimes prescribed by poorly informed doctors, does not help restless leg syndrome or periodic movements of sleep.
Also helpful to thousands of patients is participation in a support group; there are now 150 of them around the country.
Night leg cramps
It is likely to be small comfort to those afflicted to know that night leg cramps are extremely common and become more so with age. These involuntary contractions of leg muscles, usually in the calf, during sleep are also common in pregnant women and more common in women generally than in men. They are believed to result when an already contracted muscle is then further contracted, locking it in that overly contracted position.
Although as with restless leg syndrome the exact cause or causes are not known, a reduced blood flow and oxygen supply to the leg muscles (conditions that might result, for example, from diabetes or overexertion during the day) are believed to be primary factors. Also as with restless leg, there is a hereditary form of the condition.
But the most common precipitating event is mechanical: sleeping (or trying to sleep) on one's back or stomach with toes fully extended. This greatly shortens the gastrocnemius and soleus muscles at the back of the calf and can cause them to knot.
The cramp, which typically lasts only a few seconds or minutes, can be relieved by massaging or stretching the affected calf or by walking around. Stretching the calf muscles is also an effective before-bed preventive: stand at least 2 feet from a wall and lean forward against it while keeping your knees straight and feet flat on the ground; this can also be done one leg at a time. Then repeat the stretch with your knees bent slightly.
People who sleep on their backs can be helped by the use of a foot board that keeps the feet bent or a frame that holds bedcovers off the feet. Those who sleep on their stomachs should hang their feet over the end of the bed.
Quinine, a muscle relaxant, taken at bedtime (300 milligrams) can reduce the frequency and severity of night leg cramps. But quinine occasionally has serious side effects and is no longer sold over the counter. When quinine is prescribed by a doctor, patients should be monitored for adverse effects on blood platelets.
Other possible preventatives include vitamin E (400 to 800 international units daily) and the drugs verapamil, carbamazepine, diphenhydramine (Benadryl) and phenytoin (Dilantin).
For further information:
RLS Foundation Inc. provides medical information, patient support services and referrals to doctors. Membership, which includes an annual medical information bulletin, costs $5 a year. For $25, the foundation provides the bulletin and four issues of its newsletter, along with access to support groups and regional listings of doctors who treat sleep disorders. The foundation can be reached by writing 304 Glenwood Ave., Raleigh, N.C. 27603, or calling (919) 834-0821.
The foundation also has a home page on the World Wide Web, http://www.rls.org
LENGTH: Long : 130 linesby CNB