Show 1419: Restless Legs, Muscle Cramps and Sleepless Nights

This week, Terry and Joe welcome Dr. Andrew Spector to the studio to share his expertise with listeners. Restless legs syndrome (RLS) is a relatively common problem that can really wreak havoc on a good night’s sleep. Have you experienced this problem? How do you manage it? We invite you to call and tell us about it. You can call 888-472-3366 between 7 and 8 am EST. Or email us: radio@PeoplesPharmacy.com.

What Is Restless Legs Syndrome?

This neurological condition is not new. The first description appeared late in the 17th century. However, it wasn’t until fairly recently that doctors started studying this problem so they could offer effective treatments. Usually RLS starts with an uncomfortable feeling in the legs that is relieved only by moving them. Sometimes people report a sensation similar to ants crawling on them. Others describe legs that throb or itch. Occasionally, the sensation will affect another body part, though legs pose the most common problem by far. The symptoms are noticeable when a person is resting, especially at the end of the day. However, sitting still for a long plane ride can also be very uncomfortable.

Do You Have Restless Legs Syndrome?

Dr. Spector will describe how he diagnoses RLS as well as other conditions that may sometimes make a diagnosis more confusing. Restless legs are not usually painful, so pain that keeps a person awake might be due to neuropathy. Another condition that often bothers a bed partner more than the patient is periodic limb movements of sleep. The name is descriptive, and because the person doesn’t wake up and isn’t troubled by unpleasant sensations, it is different from restless legs.

What Can You Do About RLS?

According to Dr. Spector, research points to low iron in the brain as a common contributor to RLS. Consequently, iron supplements could often be helpful. He’ll describe the testing that a doctor would use to determine the appropriate protocol for boosting iron.

Medications That Make RLS Worse:

If you have RLS, you may have considered taking an over-the-counter sleep aid containing diphenhydramine. Many listeners have told us that these medicines seem to make the RLS symptoms worse.

Can You Manage RLS Without Drugs?

We have heard from many people who have developed non-drug approaches that help them overcome their restless legs. They may avoid sugar or caffeine, which can sometimes trigger a bout of RLS. Avoiding nicotine and alcohol may also be useful. Magnesium or selenium supplements help certain individuals. Some listeners put a bar of soap under the bottom sheet near their legs and find that their symptoms are less troublesome. This home remedy is even more popular as a way to ward off nocturnal leg cramps. We have also heard from sufferers who have sought out acupuncture and found it effective. Maintaining a moderate level of exercise benefits many people with RLS.

Treating RLS:

In the past few decades, the FDA has approved several prescription drugs that can ease the symptoms of restless legs syndrome. It started with ropinirole (Requip), a drug that was originally developed to treat Parkinson disease. It is effective for RLS, although it has side effects that may limit its usefulness for some people. Other drugs in the same category are pramipexole (Mirapex) and rotigotine (Neupro). All of these medications work by increasing the availability of the neurotransmitter dopamine.

If a patient cannot tolerate one of these medicines, or if the doctor decides they are not appropriate, there are other options. Doctors may prescribe a medicine such as gabapentin enacarbil (Horizant). Other drugs in this category include gabapentin or pregabalin. Although the FDA has not approved them specifically for RLS, doctors sometimes find them helpful. They frequently cost less than Horizant. Opioids and benzodiazepines offer additional prescription options. If you have experience with any of these medicines, we’d love to hear about it.

This Week's Guest:

Andrew Spector, MD, is an Associate Professor in the Department of Neurology at the Duke University School of Medicine. Along with his clinical practice in sleep medicine, he serves as the Program Director of the Sleep Medicine Fellowship, the Duke Athletics Sleep Optimization Consultant, and the Vice Chair for Professionalism, Inclusion, Diversity, and Empowerment. Dr. Spector is the author of Navigating Life with Restless Legs Syndrome.  His website is http://www.andrewspectormd.com

[caption id="attachment_134148" align="alignnone" width="768"] Andrew Spector, MD, Duke University Department of Neurology[/caption]

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