As early as 1685, ThomasWillis, an English physician, once described, “When these persons lie in bed ready for sleep, the tendons of the upper and lower limbs jump and jerk, and every part of the limbs tremble uneasily, as if they were in great pain.” We often encounter such a situation in real life, some middle-aged people have long-standing insomnia, tormenting them with indescribable discomfort in the deep muscles of the lower limbs, some are like a sense of insect crawling or itching, some are a kind of soreness or numbness, appearing at rest, especially at night when sitting or lying in bed, some people feel that the lower limbs do not know where to put to feel comfortable, always unable to find a suitable Some people feel that they don’t know where to put their lower limbs to feel comfortable, and they can’t find a suitable position, so they often turn around in bed and can’t sleep, and the deeper the liquid, the more obvious it is.
If you get out of bed and walk back and forth, the discomfort can be reduced. If you have severe symptoms, you may experience discomfort in both lower limbs during the day. If you have the above conditions, be alert to a disease called “restless legs syndrome”.
1. Is the onset of “restless legs” common? How is it diagnosed?
The prevalence of restless legs syndrome ranges from 2.5% to 15%, and the prevalence increases with age, with more women than men. The prevalence in adults is about 14%, mainly in middle-aged and elderly people, and about 25% in people over 65 years old. However, it can also be seen in children and adolescents. In the past, the pain and discomfort in children’s lower extremities at night was thought to be due to skeletal growth and so-called “developmental pain”, but in fact, many children may be suffering from this disease. Smokers and those who exercise less than 3 hours a month are also prone to the disease.
The diagnosis of restless legs syndrome is not difficult, as long as the following four characteristics are met.
(1) Abnormal sensations: Indescribable discomfort in the limbs, resulting in a strong desire to move the limbs, mainly the lower limbs. These abnormal sensations often occur deep in the limb rather than on the surface.
(2) Motor symptoms:The patient is unable to sleep and keeps moving the limbs to relieve the abnormal sensations. The main manifestations are walking back and forth, shaking or flexing and extending the lower limbs, or turning in bed.
(3) Symptoms are aggravated at rest and can be temporarily relieved by activity.
(4) The symptoms worsen at night and reach a peak late at night.
When the above symptoms occur, the patient should go to the hospital to see a doctor and undergo some necessary experience and laboratory tests. There are also many patients who cannot find out the cause, and that is primary restless leg syndrome. Its cause is not very clear, and some patients are related to heredity.
2. What are the possible causes of these abnormal manifestations?
Restless legs syndrome can be divided into primary and secondary forms. Many studies have shown that restless legs syndrome is associated with damage to dopaminergic neurons in the central nervous system. Recent studies have shown that iron deficiency has an important effect on restless legs syndrome, as iron is a cofactor of tyrosine oxidase, which controls tyrosine metabolism and thus affects dopamine synthesis, leading to a cluster of symptoms in restless legs syndrome.
The age of onset of primary restless legs syndrome is usually between 10 and 20 years, and after excluding any possible secondary causes, 25% to 50% have a family history of heredity.
It can be complicated in patients with many diseases, such as advanced renal disease, iron deficiency anemia, folic acid and/or vitamin B12 deficiency, peripheral neuropathy, lumbosacral radiculopathy, Parkinson’s disease, myelopathy, diabetes, rheumatoid arthritis, hypothyroidism, amyloidosis, desiccation syndrome, macroglobulinemia, chronic obstructive pulmonary disease, post partial gastrectomy, tumors, peripheral Microcongestion of blood vessels, as well as the use of some drugs such as tricyclic antidepressants, H2-blockers, coffee and alcohol consumption can also cause secondary restless legs syndrome. Pregnancy can also induce or worsen restless legs symptoms. Iron deficiency is particularly important, as about a quarter of patients with restless legs syndrome have iron deficiency, especially in the elderly.
3.If the primary cause is not found, should I treat it? What are the serious consequences of not treating it?
Patients complaining of severe motor symptoms and/or sleep disturbances or fatigue with RLS should be treated with appropriate medication to relieve the symptoms. Since the symptoms of RLS may resolve spontaneously, the physician may consider medication reduction or leave therapy when appropriate.
Patients with restless legs syndrome experience unbearable limb discomfort at night or at rest, often leading to sleep deprivation, discomfort and fatigue. Due to decreased sleep quality at night, manifested by difficulty falling asleep, easy to wake up or wake up early, patients often feel depressed and tired, sleepy during the day, and pain around the body.
4.How should the disease be treated?
If the patient is suffering from “restless legs syndrome” caused by the above-mentioned diseases, the first thing is to treat the original disease in time. With the improvement of the primary disease, the symptoms will disappear or be reduced. Caffeine can aggravate the symptoms and should be avoided, especially at night. Patients complaining of severe motor symptoms of RLS and/or sleep disturbances or fatigue should be treated with appropriate medication. In general, treatment is symptomatic and only provides temporary relief. Because symptoms of RLS may resolve spontaneously, physicians may consider medication tapering or leave therapy when appropriate. For the pharmacological treatment of primary RLS, dopaminergic medications are preferred. Levodopa is preferred when symptoms are mild to moderate.
If the patient’s symptoms progress to daytime or upper midnight, the amount of levodopa should not be increased and a switch to a dopamine agonist may be considered. For severe RLS, dopamine agonists such as pramipexole and cartegolines may be preferred to reduce symptoms in 70% to 90% of patients. If a patient has contraindications to dopaminergic medications, such as cardiac arrhythmias or psychiatric disorders, or if serious side effects develop, consider switching to an opioid. Anticonvulsants such as clonidine, carbamazepine, sodium valproate, or gabapentin are used as second-line medications when the above drugs are ineffective or the side effects are intolerable.
For secondary RLS, the first step is to treat the primary disease. As the cause of the disease is eliminated, the symptoms of RLS will disappear. For example, kidney transplantation for uremic patients, iron therapy for patients with iron deficiency anemia, folic acid supplementation for patients with folic acid deficiency, etc.
5.Is there anything that needs attention in daily life?
(1) In daily life, we should pay attention to behavioral interventions for sleep and establish good sleep hygiene habits.
(2) Find ways to promote sleep before going to bed, such as taking a hot bath, which can help relax the body and mind before going to bed.
(3) Form regular bedtime and waking habits, and do not go to bed only when you are extremely sleepy.
(4) Avoid having a full meal before going to bed; if you feel hungry, just have a small snack.
(5) Develop the habit of sleeping only in bed, do not use the bed as other places such as watching TV, reading and other activities.
(6) Do not drink caffeinated beverages 8h before going to bed, because drinking caffeinated beverages in the afternoon and evening will make it difficult to fall asleep.
(7) Do not drink alcoholic beverages 4h before going to bed. Although alcohol will make it easy to fall asleep, it will interrupt sleep at night and cause frequent awakenings and poor sleep quality.
(8) Do not exercise too late at night. Exercise will cause the body temperature to rise and maintain awakenings, which will affect sleep. Daytime exercise can improve sleep.
(9) Create a cool, quiet, dim sleep environment to reduce the effect of the environment on sleep.
Healthy diet: identify foods that make your symptoms worse, such as coffee, tea and alcohol, and try to avoid them; eat a balanced diet with more fruits, vegetables, proteins and starchy foods; maintain a healthy weight through a healthy diet.