Q. I think I may have restless leg syndrome. Not only is it bothering me but my restless legs appear to be affecting my partner’s sleep as well. Can you tell me more about it and what might be aggravating it?
A. Absolutely. You might be comforted somewhat in the fact that you are not alone with your restless legs. Approximately four -29% of North Americans and Western Europeans are known to be afflicted with restless leg syndrome (RLS) which is a neurological condition that can dramatically impact your sleep, your quality of life, and those of your bed mates.
Scientists have long sought answers for RLS but it continues to remain a mystery. It is thought to be connected to dopamine, a neurotransmitter in our brain, which our body uses to regulate our movements. Not surprisingly, some of the medications that are prescribed for RLS are dopamine agonists (ropinirole, pramiprexole). (**SPOILER ALERT – new study suggests these dopamine agonists should not be recommended for RLS any longer). It should also not be too surprising to learn that some (but not all) of the aggravating factors for RLS are directly associated with dopamine levels in our body.
RLS can affect anyone but it does tend to affect women slightly more often than men, and also affects people over 50 more than the younger generation. Symptoms can vary from mild to severely disruptive and it will typically worsen as we celebrate more birthdays. That is not comforting news for anyone who is already suffering from RLS.
Speaking of symptoms, the classic symptom that best characterizes RLS is the overwhelming urge to move the legs, typically accompanied by uncomfortable sensations like tingling, burning, or crawling feelings. These tend to worsen in the evening or at night and improve with movement such as getting up and walking. Many people also experience difficulty falling or staying asleep, making RLS a common cause of sleep disturbance (or clearly those of your partner).
Many of us undoubtedly may rush to get a cup or two of java in the morning to help offset the fatigue you are experiencing from the disrupted sleep. However, though caffeine may be helping you get rid of the morning cobwebs, it may be making your restless legs symptoms worse.
Let’s take a look at some aggravating (worsening) factors for RLS:
- Certain medications:
. Antidepressants
> Selective Serotonin Reuptake Inhibitors (SSRI’s) such as sertraline/Zoloft and fluoxetine/Prozac
> Serotonin-Norepinephrine Reuptake Inhibitors (SNRI’s) such as venlafaxine/Effexor
> Alpha 2 Agonist such as mirtazapine
. Antipsychotics such as quetiapine and aripiprazole are often taken along with antidepressants as mood stabilizer.
. Antihistamines
> Both sedating such as diphenhydramine/Benadryl and non-sedating such as cetirizine/Reactine antihistamines can exacerbate RLS, particularly when taken at night.
> Statins that are used to reduce cholesterol such as rosuvastatin/Crestor and atorvastatin/Lipitor
> Antinausea medications such as metoclopramide
- Lifestyle habits:
o Caffeine
o Alcohol
o Smoking - Certain health conditions are now recognized as common triggers or exacerbators of RLS such as:
- Iron deficiency: Low iron levels, especially low ferritin (even if hemoglobin is normal). Because of this, we often encourage patients to undergo bloodwork to check ferritin and iron levels if RLS symptoms are present or worsening.
- Brain iron deficiency is theorized to be a likely cause from:
– Pregnancy
– Diabetes
– Kidney disease
– Peripheral neuropathy
– Substance use disorder
– Stress/Insomnia
– Untreated sleep apnea
Do not stop taking your prescribed medication to see if it can alleviate your RLS symptoms. Just because they are on this list does not mean they are the cause and presumably they are treating another condition that is affecting you. If you suffer from RLS, consider booking an appointment with your pharmacist to review your current medications and lifestyle choices and they can make some recommendations.
Stay tuned for treatment options to consider which may help you live more comfortably with your RLS. The key point here is to “live more comfortably” as at this point there is no cure.
For more information on this or any other health topic, contact the pharmacists at Gordon Pharmasave, Your Health and Wellness Destination.
