Overview

Restless legs syndrome (RLS) causes an irresistible urge to move the legs at rest, driven by dopamine and iron‑metabolism pathways. Symptoms peak at night and fragment sleep. RLS is part of a larger group of related problems collectively referred to as “Willis-Ekbom Disease” (WED).

In addition to RLS, a significant problem under the WED umbrella is “periodic limb movements of sleep” (PLMS), which are non-volitional flexion/extensions of the legs during sleep which can drive sleep disruption and breathing instability with a central sleep apnea pattern. Non-motor symptoms that occur within the WED spectrum include compulsive nocturnal behaviors like excessive eating and smoking.

RLS/WED tends to worsen with increasing drive of the sympathetic nervous system, which means that any source of sleep disruption or chronic sleep deprivation (a nonspecific stressor) can make RLS symptoms worse!

The management of RLS is complicated by the fact that drugs which have been prescribed to treat the symptoms—so-called “dopaminergic agonists” (e.g.: pramipexole, ropinirole)—tend to make the problem worse over time. This problem is called “augmentation.”

Health Consequences

Large cohort studies show RLS is associated with higher prevalence of hypertension and a greater incidence of cardiovascular events. Here in the mountains, sleep disruption associated with nocturnal leg movements is a common driver for central sleep apnea, complicating the discussion regarding treatment of sleep disordered breathing.

Rebis Treatment Approach

• Collaborative co-discovery for competing sources of sleep disruption, using the Five

  Finger Approach

• Consideration for iron replacement therapy

• Consideration for pharmacotherapy

• Consideration for physical treatment strategies

• Lifestyle coaching for evening movement and circadian alignment

• Managing the bi-directional relationship RLS has with Sleep Apnea

• Integrative medicine pathway: expanded nutritional testing and guidance

Benefits of Treatment

Effective treatment of RLS can reduce or eliminate the physically uncomfortable symptoms that are incompatible with sleep, allowing a better opportunity to rest.