Restless Leg Syndrome

A Catch-22 Condition

Vicky Arlidge of London, England, calls RLS the "Catch 22" of conditions. The more tired you are, the worse it gets. The worse it gets, the less you sleep. Now 35 weeks pregnant, Arlidge has suffered from restless legs since she was a teen. It was manageable until about her fifth month of pregnancy, and then it became unbearable.

"It now comes on every night when I go to bed and sometimes before then if I'm at rest, for example, if I'm riding in the car, watching [TV, etc.]," says Arlidge. "I can now only get rid of it by getting up and walking around/doing exercises until it has gone and then have to try and get to sleep quickly before it comes on again. On average, I am up three times in the night and am losing about three hours of sleep each night. I get it in the arms as well as the legs, which is apparently quite rare. Before pregnancy I only had it in the legs."

The Facts on RLS

The National Institutes of Health (NIH) defines RLS as a neurological disorder characterized by unpleasant sensations in the legs and an uncontrollable urge to move when at rest in an effort to relieve these feelings. RLS sensations are often described by people as burning, creeping, tugging, or like insects crawling inside the legs.

Dr. Philip Becker, medical director of the Sleep Medicine Institute at the Presbyterian Hospital of Dallas and a clinical professor in the department of psychiatry at Southwestern Medical Center at Dallas, says RLS is estimated to affect approximately 17 percent of pregnant women based on four criteria. Dr. Becker uses the acronym URGE to define these criteria:

• Urge to move
• Rest worsens symptoms
• Getting up relieves symptoms
• Evening worsening of symptoms

Although it disrupts sleep, Dr. Becker says RLS is not a sleep disorder. Rather, it is a movement disorder tied to the circadian cycle. It usually comes on between 4 PM and 4 AM and reaches its peak around bedtime. There are other factors, particularly in pregnancy, which may worsen the incidence of RLS.

"There's an anticipatory factor to this syndrome," says Dr. Becker. "You start looking for it and that intensifies it. Then you get emotionally involved and frustrated. At that point arousal is so high it's hard to settle and hard to relax. Then, if you do, the sensation intensifies and the movement comes out. In addition, the pregnant mother may be feeling a great deal of concern over how the lack of sleep is affecting her fetus, and that anxiety can worsen the incidence as well."

Dr. Becker is quick to note there is no evidence that lack of sleep does hurt the fetus and that pregnant women often have sleep disruptions from other causes besides RLS. However, RLS can still make a joyful time pretty miserable.