Seniors, Sleep and Restless Leg Syndrome

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Restless legs syndrome (RLS) affects millions of people at one time or another. For some, it is manageable and transient, yet for others it is a miserable sleep disruptor that seriously affects their lives. The prevalence of this condition increases with age, and women are more commonly affected than men.

When one person experiences sleep difficulties, it often affects the entire household’s ability to rest and function. This is particularly true for caregivers whose loved ones struggle with RLS. Understanding how RLS affects the body and the best ways for managing symptoms can help the entire household get better rest.

What is RLS?

RLS (also known as Willis-Ekbom Disease) is a sleep-related movement disorder characterized by the need to move the legs (akathisia) or even the feeling that they are moving on their own. This sensation can vary from tingling, twitching or crawling, to painful aches and itching. Keith W. Roach, MD, Associate Professor of Clinical Medicine at Weill Cornell Medical College, explains that episodes usually occur around the time people are getting ready for bed or trying to fall asleep, but they can also happen during the day while a person is sitting or at rest.

“Restless leg syndrome isn’t a very good name for the problem,” Dr. Roach points out. “The neurological symptoms that most often appear in the lower legs can also appear in the upper leg, feet or even the arms. Furthermore, I think the name seems to trivialize an occurrence that ranges anywhere from annoying to severely life affecting.”

What Causes RLS?

Early onset of this condition (before or during teenage years) is believed to be hereditary, but there are a number of other causes that may play a part, especially in later onset. Dr. Roach shares that individuals with end-stage renal disease (ESRD) or peripheral neuropathy (caused by diabetes or other conditions) commonly suffer from secondary RLS.

Although no one knows for certain what causes RLS, Dr. Roach suggests that low iron levels can contribute to the problem. “If I have a patient who is experiencing RLS symptoms, I always check their iron levels with a blood test,” says Dr. Roach. Their levels don’t need to be so low that the person has anemia, however. “It has more to do with small changes in how iron moves into the cells that regulate dopamine levels in the brain.”

Iron deficiency can seem like a straightforward fix for RLS, but some doctors may not be aware of the correlation. “I did not learn about this in medical school,” Dr. Roach admits. “I had to go back and do some additional research when I was trying to help one of my patients. By doing so, I discovered that this was an effective approach.” Dr. Roach stresses that iron deficiency can be a serious problem for seniors that must be carefully tracked and managed, whether or not it is contributing to bothersome RLS symptoms.

Drug-Free Treatments for RLS

While there are prescription medications that can help alleviate RLS symptoms and improve sleep, Dr. Roach encourages people to try non-drug remedies first. “This is especially important for elderly individuals who are typically already taking a number of prescriptions,” he explains.

Dr. Roach provides the following alternative ideas for managing RLS:

  • Sleep hygiene is a good place to start. Limit your exposure to bright lights for about an hour before bed (this includes the television), and try to wind down enough to feel tired.
  • If you experience symptoms after you get into bed, then get up. You don’t want to have a negative feeling associated with going to sleep. It is better to get up and move around or do something distracting before you try to go to sleep again. Mentally challenging activities like crossword puzzles and reading are effective because they distracting without interfering with one’s ability to fall asleep.
  • Chamomile tea is a wonderful remedy for many people. It is very relaxing and helps to induce sleep, so it is worth a try. There are lots of other caffeine-free tea varieties on the market that could have therapeutic effects.
  • A warm bath or shower can help relax the muscles in the legs and other affected areas.
  • Massage is beneficial, especially for those who are unable to get up and move around. Products containing counterirritants, like menthol, capsaicin and wintergreen oil, can be used in massaging the affected areas to increase blood flow and help distract from RLS movements and pain.
  • A hot water bottle can provide relief for some people. This is a good approach for elderly individuals. Many bandages and heating devices like heating pads should not be used in conjunction with muscle rubs and liniments, though, so be sure to read the directions on the product.
  • While warmth may help some individuals, cold may be more useful for others. Applying an ice pack or taking a cold shower can help minimize RLS symptoms.
  • For those who are able, low-impact exercise is a good option for treating RLS and improving overall health. Some time spent on a stationary bicycle or in the swimming pool can do wonders to help tire out the legs. Just be mindful of the timing. Working out too late in the day can keep you up at night, but if you are unable to sleep, try whatever works best for your schedule.

Prescription Medications for RLS

If addressing iron levels and the use of non-pharmacological methods is not effective, prescription medications may be a next step. “The drugs I would probably try are pramipexole (Mirapex) or ropinirole (Requip),” Dr. Roach suggests. “Rotigotine (Neupro), dopaminergic agents like Sinemet, benzodiazepines, anticonvulsants and opiates may also be used to help patients manage their symptoms, minimize pain and promote sleep.”

It is worth noting that a number of drugs used to treat Parkinson’s disease (PD) can be useful in treating RLS, but RLS does not progress to PD. “While there are some similarities between these two conditions, there are substantial differences regarding their symptoms and progression,” assures Dr. Roach.

All drugs have side effects, though. Pramipexole and ropinirole both list light-headedness and nausea as possible side effects. “Dizziness and drowsiness can be particularly dangerous for the elderly, since they are already prone to falls,” Dr. Roach adds. Hallucinations are much less common side effects of these prescriptions, but older individuals may face an increased risk. It is important to work with your doctor to weigh these potential hazards with the benefits of each treatment option.

RLS Triggers to Avoid

A few common factors can trigger symptoms, including caffeine (especially later in the day), nicotine, alcohol and some prescription and over-the-counter drugs. Certain kinds of antidepressants and antipsychotics, beta blockers, some older types of antihistamines (like Benadryl), and dopamine blockers used to treat nausea are the most likely to worsen RLS symptoms.

Sleep deprivation is another trigger that can cause a damaging snowball effect. “Patients who are having trouble sleeping due to RLS frequently turn to over-the-counter sleep aids (including melatonin), but these may exacerbate their symptoms,” notes Dr. Roach. He suggests sticking to a set bedtime routine and reducing stress and anxiety through healthy outlets like gardening, exercise and breathing techniques. “Staying active by doing things you enjoy can play a significant role in symptom management as well as physical and mental health,” he advises.

Carol Bradley Bursack

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Over the span of two decades, author, columnist, consultant and speaker Carol Bradley Bursack cared for a neighbor and six elderly family members. Her experiences inspired her to pen, "Minding Our Elders: Caregivers Share Their Personal Stories," a portable support group book for caregivers.

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2 Comments

RLS has been my night time buddy for several years. Everyday I was exhausted and needed to sleep in the afternoon--not a nap, but sleep. The popular opinion was sleep apnea. Some thought I should get a CPAP machine or a mouth guard. So my internist wrote a scrip for a sleep test at a local hospital.
I was wired up with electrodes all over my body or it seemed by the sleep lab technician. A few hours in the sleep lab revealed that I had RLS--much to the surprise of my armchair diagnosticians. My internist prescribed a generic drug, ropinirole. I take this cheap generic about two hours before bedtime. When I am exhausted, my legs twitch in the afternoon A low dose quiets my legs.
I have not experience any side effects from taking this drug. But the moral of my story is to find out if you have RLS in the first place. If I had not taken the sleep test, I would not of known the underlying cause of my tiredness.

I am so glad you wrote about the nonpharmaceutical approaches.They are so worth trying until you figure out which ones work for you. I cut back on coffee and soda. I now turn off my computer and iphone much earlier. Be sure to get enough sleep if you have this condition. Too little sleep will make RLS worse. I also sleep in a cold room all year around.
You explained RLS very well. Thank you