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Restless Legs Syndrome

Restless legs syndrome runs from my mother's father's generation and his siblings through the siblings in her generation and to me, my sister, and most of my maternal first cousins. (1) First, there appears to be a genetic predisposition. It is consdered to be primary RLS when no trigger causes are identified (that is, it appears to be idiopathic as to identification of any trigger). (2) The likelihood that a genetically predisposed person will begin to be bothered by RLS increases with his/her age plus the several hours prior to sleep at night and during the first hours of sleep. (3) Then there are triggers that set the syndrome off at times. When one or more triggers are identified, it is considered to be RLS secondary to that/those triggers. There is wide agreement that a trigger is low body stores of iron (tested for with the serum ferritin test); another is anything that reduces or impeeds the dopamine system effect in the brain (certain medications, melatonin suppliment, too much sugar, and caffeine). Wikipedia notes that RLS is often seen in people with ADHD (HERE); and Wikipedia lists triggers (causes), HERE. Oddly, caffeine appears to be a trigger in some cases AND a possible help in others. The RLS predisposition can be compounded when an individual person has multiple triggers involved in setting off RLS.

An example might be a patient with a strong maternal family history of RLS who has in previous decades had occassionally mildly bothersome RLS & is over 60 years old & is an excessive consumer of coffee with caffeine throughout adulthood. Patient has spinal surgery & is found to be iron deficient. RLS becomes severe prior to spinal surgery immediately after diagnostic inpatient work-up for a fainting spell. That patient also was mildly overweight, had life-long seasonal allergies (took antihistamines), has medication-controlled mild hypertension and loves sweets and snacking at night. Spinal surgery removes a risky defect pressing on the cervical spinal cord but does not get rid of periperal areas of numbness (nerve irritation vs. injury). The iron deficiency is corrected. Patient refuses RLS medications. Attention is turned to correct sleep hygiene (https://en.wikipedia.org/wiki/Sleep_hygiene) and adjustments are made. RLS is only mildly better. So, monthly calendars are kept to grade sleep each night using a personal grading scale of 1-5, 1 being a TERRIBLE night's sleep. Web searches are made as to any medications possibly being triggers, and such medications are then only taken in the morning. Then the old timey sleep starting remedy of drinking an alcohol-only "tottie" ("spirits of frumenti"...an old alcohol Prohibition days term for legally prescribed alcohol as a sleep aid) within the hour before bedtime is instituted and helps onset of sleep for the first hour. Attention to diet results in weight loss when sweets and evening high-calore & fairly high volume snacking are quit. RLS is minimally to mildly better but still a major frustration and sleep disturbance. Then...finally, attention is reluctantly turned to caffeine; and coffee is limited to before noon. FINALLY, the nightly sleep grade becomes a consistant 4 to 5.

RLS disturbance of sleep in those who do not wish long-term medication for RLS can be significantly improved (for practical purposes) by lifestyle changes (as in this example).

References:

  1. Johns Hopkins Medical about RLS (note roles of iron & dopamine): correcting low iron and stimulation of dopamine system in brain both reduce RLS: https://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/restless-legs-syndrome/what-is-rls/causes.html
  2. WebMD on RLS: https://www.webmd.com/brain/restless-legs-syndrome/rls-causes
  3. OTC sleep meds & melatonin make RLS worse: https://www.bcm.edu/healthcare/care-centers/parkinsons/conditions/restless-legs-syndrome
  4. An individual's website: http://aminotheory.com/rlsd/
  5. An individual's website: https://healthunlocked.com/rlsuk/posts/430334/medications-and-food-to-avoid-applies-to-most-of-us-who-has-rls.-this-is-taken-from-the-www.rlshelp.org-website.
  6. Cheese (also dairy) RLS-triggered, individual's website: https://healthunlocked.com/rlsuk/posts/130952204/rls-and-cheese

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(posted 17 December 2017; additions 1/23/2018)