Restless legs and the holiday season

Do you notice that you are not sleeping as well during the holiday season? There can be a number of possible reasons for that; one includes a disorder called restless leg syndrome, or RLS.

RLS is diagnosed by clinical symptoms. Four necessary features must be present: 1) an urge to move the legs, usually accompanied by an uncomfortable or unpleasant sensation in the legs; 2) the urge or unpleasant sensation begins or worsens during periods of rest or inactivity; 3) the urge or unpleasant sensation is improved by walking and other movements; and 4) symptoms are worse or may occur only in the evening.

It is estimated that as much as 10 percent of the general population may have some degree of RLS. In most people with RLS, symptoms are mild and do not require treatment. The cause of RLS is not entirely understood. But it seems related to dopamine (a neurochemical) and iron.

RLS can be a primary disorder not associated with another medical condition or secondary to an underlying disorder – most commonly iron deficiency, pregnancy, and severe kidney disease. Persons with Parkinson’s disease are about twice as likely to have RLS compared to the general population.

If present in childhood and especially if present in other family members, it is more likely to have a genetic cause. If symptoms start suddenly or worsen suddenly, it is best to seek medical attention, primarily to rule out iron deficiency. Other things such as caffeine, alcohol, and medications (antidepressants, antihistamines, and other psychiatric medications) can worsen symptoms. Increased alcohol consumption with holiday parties could be the culprit this time of year. Irregular sleep patterns, more common during the holiday season, can also exacerbate symptoms.

The first step in treatment is to work on lifestyle modification — avoiding caffeine, alcohol, and medications that can worsen symptoms and having a consistent sleep pattern. If iron is low (measured in the blood as iron and ferritin), it should be replaced with iron supplements. If iron is not low and symptoms are not controlled with lifestyle modifications, dopamine agonists — a class of drugs that mimic the actions of dopamine in the body — are generally started as first-line medications. The two drugs used most often are ropinirole and pramipexole. For more severe cases or if symptoms are not responsive to the dopamine agonists, a number of other medications can be tried.

Amie Peterson, M.D.
Assistant Professor of Neurology
OHSU Parkinson Center of Oregon
OHSU Brain Institute

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