Restless Legs can Disturb Your Sleep

A beautiful place in Kananaskis to dream, relax, listen to music, dance and sleep. (Dr. Noorali Bharwani)
A beautiful place in Kananaskis to dream, relax, listen to music, dance and sleep. (Dr. Noorali Bharwani)

Before we talk about your legs and how they are connected to your sleep, let me tell you what others have to say about sleep. If you are a person who believes in meditation then you would agree with Dalai Lama, who said, “Sleep is the best meditation.” I believe in that.

If you are a George Bernard Shaw fan then you will agree with him, “Marriage is an alliance entered into by a man who cannot sleep with the window shut, and a woman who cannot sleep with the window open.” I won’t tell you where I stand on that.

If you tell your doctor you are constantly tired, have day time sleepiness, have difficulty falling asleep at night, have to move your legs at bedtime to find comfort then you probably have restless legs syndrome.

A syndrome is a group of symptoms that collectively indicate or characterize a disease, psychological disorder, or other abnormal condition.

According to an article in the Canadian Medical Association Journal (CMAJ November 19, 2013), restless legs syndrome is a neurologic movement disorder that may adversely affect sleep, and thereby result in daytime fatigue, somnolence and a reduced quality of life.

The article goes on to say, “This condition has also been associated with hypertension and cardiovascular disease. The pathophysiology of restless legs syndrome is incompletely understood.”

Restless legs syndrome is common, affecting five to 15 per cent of the population. Making a diagnosis is not easy. The National Institutes of Health state that four criteria are essential for diagnosis:

  • An urge to move the legs usually accompanied by, or caused by, uncomfortable and unpleasant sensations in the legs;
  • Unpleasant sensations that begin or worsen during periods of rest or inactivity;
  • Unpleasant sensations that are partially or totally relieved by movement;
  • And unpleasant sensations that are worse in the evening or at night compared with during the day or that only occur in the evening or at night.

There is no specific laboratory test or treatment to conclusively confirm the diagnosis or treat it. Management by a sleep specialist is required. Avoiding alcohol, caffeine and cigarette smoke may help.

According to the article, the American Academy of Sleep Medicine has recently published detailed management guidelines – available online.

If I remember correctly, Marilyn Monroe was said to have trouble sleeping. I wonder why. She said, “The nicest thing for me is sleep, then at least I can dream.”

That’s it for today. Think big, laugh a lot, sleep well and have sweet dreams.

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Restless Leg Syndrome Leads to Restless Sleep

After a night of restless sleep. (iStockphoto)
After a night of restless sleep. (iStockphoto)

Recently, one of my friends was diagnosed with restless leg syndrome (RLS). It is also known as Ekbom’s syndrome. It is a movement disorder. Important thing to remember is that it is not a psychological or emotional condition. It is thought to be a neurological disorder and it is believed that a brain chemical known as dopamine is involved.

About three to 15 per cent of the population is affected by RLS. It is more common in women than men. The prevalence increases with age. There may be a family history of the condition. Some medications can trigger RLS.

Individuals suffering from this disorder have a distressing need or urge to move the legs, usually accompanied by an uncomfortable, deep-seated sensation in the legs that is brought on by rest (sitting or lying down), relieved with moving or walking, or worse at night or in the evening.

RLS can be associated with involuntary limb movements while patient is awake and/or periodic limb movements (PLM) while patient is asleep. Studies show that more than 80 per cent of people with RLS also have PLMs. But the majority of people with PLMs do not have RLS.

The diagnosis of RLS is based on the clinical history. RLS may be a symptom of iron deficiency therefore the iron status should be assessed. Overnight sleep study may be helpful. There is no good medication to control the symptoms.

If you have unexplained leg pain then discuss your symptoms with your doctor and get proper investigations done at a sleep clinic.

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How much do you know about sleep?

Couple in bedroom. (iStockphoto)
Couple in bedroom. (iStockphoto)

This is a summary of an article written by Dr. Till Roenneberg, a professor of chronobiology and medical psychology at the Ludwig-Maximilians University in Munich, and published in the Washington Post on November 21 2012 titled, “Five myths about sleep.” Roenneberg is the author of “Internal Time: Chronotypes, Social Jet Lag, and Why You’re So Tired.”

Roenneberg says, “We spend between a quarter and a third of our lives asleep, but that doesn’t make us experts on how much is too much, how little is too little, or how many hours of rest the kids need to be sharp in school.”

First myth Roenneberg would like to debunk is – you need eight hours of sleep per night. He quotes Napoleon, who said, “Six hours for a man, seven for a woman and eight for a fool.” But this is not correct either. The truth is the ideal amount of sleep is different for everyone and depends on many factors, including age and genetic makeup.

Roenneberg’s research team has surveyed sleep behavior in more than 150,000 people. About 11 percent slept six hours or less, while only 27 percent clocked eight hours or more. The majority fell in between. Women tended to sleep longer than men, but only by 14 minutes.

When comparing various age groups – ten-year-olds needed about nine hours of sleep, while adults older than 30, including senior citizens, averaged about seven hours. Roenneberg’s team identified the first gene associated with sleep duration – if you have one variant of this gene, you need more sleep than if you have another.
Roenneberg says that we generally cannot oversleep. When we wake up unprompted, feeling refreshed, we have slept enough. In our industrial society we sleep about two hours less per night than 50 years ago and this significantly decreases our work performance and compromises our health and memory.

Second myth – early to bed and early to rise makes a man healthy, wealthy and wise. There was some truth in this when most of the work was done outdoors in natural light. The timing of sleep – earlier or later – is controlled by our internal clocks, which determine our optimal “sleep window.” With the widespread use of electric light, our body clocks have shifted later while the workday has essentially remained the same, says Roenneberg. This leaves us chronically sleep deprived.
Studies show that teenagers who sleep later and start school later exhibit improved academic performance, higher motivation, decreased absenteeism and better eating habits.

Third myth – exercise helps you sleep. Exercising may contribute to falling asleep earlier, and it certainly helps us sleep soundly through the night, says Roenneberg. But it’s exposure to light, not physical activity, that synchronizes our body clocks with daylight. Sleep is not only regulated by the body clock, but also by how long we were awake (also known as the buildup of “sleep pressure”).

Fourth myth – sleep is just a matter of discipline. Parents who think that putting their children early to bed will make it easier for them to wake up early in the morning will be disappointed. Roenneberg says early-to-bed teenagers will still have a hard time getting up at the crack of dawn. They go to school at their biological equivalent of midnight with profound consequences for learning and memory. Teenagers should sleep with daylight coming into their bedrooms and should refrain from using light-emitting devices after 10 p.m.

Fifth myth – most couples have very different sleep habits. Roenneberg says this is a matter of biology and genetics, not habits and personal preference. Women generally fall asleep earlier than men. Women, however, tend to control the sleep times in a partnership. Given how much time we spend in our beds, men and women don’t seem to give any consideration to sleep patterns when choosing a mate, concludes Roenneberg.

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Use of Melatonin in Prevention and Treatment of Jet Lag and Chronic Insomnia

A businessman trapped in his seat by a sleeping passenger. (Digital Vision)
A businessman trapped in his seat by a sleeping passenger. (Digital Vision)

I have discussed the use of melatonin In my previous articles on jet lag and sleep disturbance. Since I am interested in this subject, my attention was drawn to an article in November 20 edition of the Canadian Medical Association Journal (CMAJ) titled, “Five things you should know about melatonin” by Carter and Juurlink from the University of Toronto.

The small pineal gland in our brain secretes a hormone called melatonin. Its main functions are to regulate the circadian rhythm and initiate and maintain sleep. Circadian rhythms are physical, mental and behavioural changes in our body that follow a roughly 24-hour cycle. It responds to light and darkness in our environment. Exposure to light also regulates the levels of melatonin which peaks at two in the morning.

Studies have shown that melatonin is effective against jet lag. The benefit was greater when flying eastward and when crossing more time zones. The critical question is the dose and when to take it. Some studies suggest the timing of administration of melatonin needs to be precise and individualized.

One study has shown that melatonin was effective in helping people fall asleep at doses of 0.3 milligrams (mg). To treat the jet lag, the recommended dose of melatonin is 0.3-0.5 mg, to be taken the first day of travelling. If you take too much of it then it can cause sleepiness, lethargy, confusion, and decreased mental sharpness. People with epilepsy, and patients taking warfarin should avoid melatonin due some reports about possible interaction.

A 2002 Cochrane Database System Review titled “Melatonin for the prevention and treatment of jet lag” by Herxheimer and Petrie says, “Nine of the ten trials found that melatonin, taken close to the target bedtime at the destination (10pm to midnight), decreased jet-lag from flights crossing five or more time zones. Daily doses of melatonin between 0.5 and 5mg are similarly effective, except that people fall asleep faster and sleep better after 5mg than 0.5mg. Doses above 5mg appear to be no more effective.”

Can melatonin be used for chronic insomnia? Studies have shown melatonin increased total sleep time by 12.8 minutes, increased sleep efficiency by 2.2 per cent and decreased sleep latency by 4.0 minutes. It does not sound very impressive. There is no clinical consensus on the use of melatonin in cases of insomnia.

Melatonin is sold over the counter and it is synthetic. It is the only human hormone available in Canada without a prescription. Melatonin should be used with caution.

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