Restless Legs Syndrome and Other Sleep-Related Leg Disorders

Description

Alternative Names

Complications

Restless legs syndrome rarely results in any serious consequences. But in some cases, severe and persistent symptoms can cause considerable mental distress, chronic insomnia, and daytime sleepiness.

Sleep deprivation, and the daytime sleepiness that follows, is increasingly recognized as a cause of mood disruption and contributor to industrial errors and motor vehicle crashes. Insomnia costs the US approximately $13.9 billion each year in direct medical costs and unknown billions from decreased productivity and consequences of accidents.

Increased Risk for Accidents. As many as 200,000 automobile accidents in the US and 1,500 deaths from such accidents are caused by sleepiness. Studies continue to report that drowsy driving is as risky as drunk driving. In a major 2003 survey, 60% of young adults reported driving while drowsy and 20% dosed off while driving. In the study 1% of adults who dozed off reported having an accident because of it. (One study strongly suggested that it was habitual sleepiness, however, and not just being sleepy at the time of an accident that places people at higher risk.)

Effect on Daily Performance and Activities. Studies suggest that sleeplessness worsens many waking behaviors including the following:

• Avoidance of passive activities. Since RLS is worse when resting, people with severe RLS may avoid activities that involve long periods of sitting, such as going to movies or traveling long distances.
• Reduced concentration. Some experts report that deep sleep deprivation impairs the brain's ability to process information.
• Impaired task performance. One study reported that missing only two to three hours of sleep every night for a week significantly impaired performance and mood. An Australian study reported that 17 hours of sleep deprivation causes impaired performance levels comparable to those found in people who have blood alcohol levels of 0.10%, a level that defines intoxication in many US states.
• Effect on learning. Whether sleeplessness significantly impairs learning is unclear. Some studies have reported problems in memorization, although others have found no differences in test scores between people with temporary sleep loss and those with full sleep.

Alcohol and Substance Abuse

Treatments for RLS. Medications used to treat RLS, such as the anti-anxiety agents (benzodiazepines) and opiates, can become habit forming and addictive.

Alcohol Abuse. A study found that people with insomnia were more likely to use alcohol for inducing sleep than people without insomnia. It should be noted, however, that a drink or two does no harm and may be helpful in people who are not at risk for alcoholism.

Psychiatric Effects

Some experts believe that many cases of RLS are due to underlying anxiety or depression. Studies in Swedish working-aged men and women reported that those with RLS were more apt to be socially isolated, to have frequent daytime headaches or depression, and to complain of reduced libido or problems related to sleepiness.

Furthermore, insomnia itself may increase the activity of the hormones and pathways in the brain that can produce emotional problems. Even modest alterations in waking and sleeping patterns can have significant effects on a person's mood. Persistent insomnia may even predict the future development of emotional disorders in some cases.

It is not clear if RLS is responsible for negative mood states or if anxiety or depression contributes to RLS. Certainly anxiety can cause agitation and leg restlessness that may even resemble RLS.

Emotional issues, however, are more likely to stem from RLS rather than the other way around.