For the Legs That Do Not Sleep Well at Night

Shobha came to visit my clinic with a complaint that for her was quite funny to narrate. She felt that though she gets good sleep at night, the legs do not. She had an unpleasant tingling sensation in the legs, especially in the calf muscles, which made her to move around or apply bandage tightly. She felt better by stretching the leg out, but still the uncomfortable pain did persist for some time. The intensity of the pain also prevented her to fall asleep or getting continuous refreshing sleep.

Shobha was suffering with nothing but 'restless legs syndrome (RLS)'. In this condition, one or both legs can get affected. Though the name suggests it being a disease of the lower limbs, some patients also complain of similar symptoms in the arms as well. Apart from the sleep, the symptoms can get precipitated while being in a prolonged position like sitting at a desk, driving a car, watching a movie. The symptoms appear abruptly and can have a pulse-wave pattern of recurrence, making it more troublesome.

The prevalence of this disease increases with the age and it is believed that almost 10-15 per cent of the population is affected by RLS. It has been reported to be one of the leading causes of sleep-loss or insomnia in elderly population. It is seen more often in women than men. Though rare, children too can get affected with it, but the diagnosis is made difficult and can lead to various hyperactivity disorders or growing pains.

It is believed that RLS runs in the family; and is triggered or aggravated by epochs like Pregnancy, or systemic illnesses like kidney failure, and anemia related to iron or vitamin deficiency. The insufficient iron, which is a common manifestation of the above conditions, can be the reason to have the basic lack of dopamine. The brain uses dopamine to control limb movements. The diagnosis is usually made according to the symptomatology and clinical presentation. There is an opinion to check the levels of iron in the blood, although many people who have RLS can have perfectly normal levels of iron but abnormal levels of iron in the cerebro-spinal fluid that bathes their brain.

The treatment primarily includes dopamine-like drugs, sedatives along with behavioral strategies that include stretching, taking a hot bath, or massaging the legs before bedtime. The patients of RLS are often asked to avoid caffeinated beverages to reduce symptoms. If required and documented by the blood level tests, one can be given iron, vitamin B12, or folate supplements. Some patients may even require mild doses of anti-convulsive therapy, while some do feel relieved with analgesics.

Homeopathic medications have found more effective in relieving the symptoms of RLS without causing any unwanted side effects that are seen with any of the above treatments. A constitutional medicine approach along with the acute remedial prescription based on the symptom-similarity is the best approach to deal with this ailment.