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Chapter 028. Sleep Disorders (Part 9)

Restless Legs Syndrome (RLS) Patients with this sensory-motor disorder report an irresistible urge to move the legs, or sometimes the upper extremities, that is often associated with a creepycrawling or aching dysesthesias deep within the affected limbs. For most patients with RLS, the dysesthesias and restlessness are much worse in the evening or night compared to the daytime and frequently interfere with the ability to fall asleep. The symptoms appear with inactivity and are temporarily relieved by movement. In contrast, paresthesias secondary to peripheral neuropathy persist with activity. The severity of this chronic disorder may wax and wane over time. | Chapter 028. Sleep Disorders Part 9 Restless Legs Syndrome RLS Patients with this sensory-motor disorder report an irresistible urge to move the legs or sometimes the upper extremities that is often associated with a creepy-crawling or aching dysesthesias deep within the affected limbs. For most patients with RLS the dysesthesias and restlessness are much worse in the evening or night compared to the daytime and frequently interfere with the ability to fall asleep. The symptoms appear with inactivity and are temporarily relieved by movement. In contrast paresthesias secondary to peripheral neuropathy persist with activity. The severity of this chronic disorder may wax and wane over time and can be exacerbated by sleep deprivation caffeine alcohol serotonergic antidepressants and pregnancy. The prevalence is 1-5 of young to middle-age adults and 10-20 of those 60 years. There appear to be important differences in RLS prevalence among racial groups with higher prevalence in those of Northern European ancestry. Roughly one-third of patients particularly those with an early age of onset will have multiple affected family members. At least three separate chromosomal loci have been identified in familial RLS though no gene has been identified to date. Iron deficiency and renal failure may cause RLS which is then considered secondary RLS. The symptoms of RLS are exquisitely sensitive to dopaminergic drugs e.g. pramipexole 0.25-0.5 mg q8PM or ropinirole 0.5-4.0 mg q8PM which are the treatments of choice. Opiods benzodiazepines and gabapentin may also be of therapeutic value. Most patients with restless legs also experience periodic limb movements of sleep although the reverse is not the case. Periodic Limb Movement Disorder PLMD Periodic limb movements of sleep PLMS previously known as nocturnal myoclonus consists of stereotyped 0.5- to 5.0-s extensions of the great toe and dorsiflexion of the foot which recur every 20-40 s during NREM sleep in episodes lasting from .