Count your blessings if your legs are comfortable when you are resting or sleeping. More than a few older adults are troubled with either restless legs or nocturnal leg cramps, and with the resulting sleep disturbance.
Restless leg syndrome is a disorder of the nervous system with a prevalence of 5 to 10 percent in the older population. The main symptom is a distressing and almost irresistible need to move the legs, with a coexisting uncomfortable (though not usually painful) sensation deep within the legs. The sensation may be described as a muscle ache, a tension or a crawling. Some describe a feeling like ants moving in the legs or bubbles popping in the leg veins. The trouble may extend beyond the legs to involve the arms and trunk. Symptoms characteristically are brought on with rest. In fact, the more comfortable a person becomes, the more likely that the problem develops. Movement of the legs brings relief, and avoidance of movement may promote involuntary jerks of the legs. Most often the trouble comes at night in bed, but some have symptoms when resting during the day.
Although the cause of restless leg syndrome is unknown, most experts believe it is a disorder of the nervous system’s control of the muscles rather than a problem with the muscle themselves. Treatment is directed at calming the overactive nervous system. Medications such as levodopa, pergolide, clonazepam, and gabapentin are often effective, but potential side effects demand careful monitoring by the prescribing physician. Massage, warm baths, exercise and learned relaxation techniques also help. Iron deficiency is common among those with restless leg syndrome, and diagnosis and treatment of the deficiency by a physician may improve or resolve symptoms.
Leg cramps, another common cause of nocturnal distress, are easily distinguished from restless legs. A cramp is a sustained pain caused by involuntary contraction of a muscle, usually in the calf but sometimes in the foot. The problem occurs more often in pregnant women and older adults, but almost everyone has experienced a cramp at some time. About 40 percent of older adults experience at least occasional nocturnal leg cramps, but 5 percent have distress on a nightly basis. A leg cramp is understandable if it occurs after overuse of a muscle, but the cause of recurring nocturnal leg cramps in unabused muscles is unknown. Most experts believe they are due to abnormal processing of essential body salts and minerals by the muscles. Occasionally a prescribed medication is the cause. Cramps tend to be resistant to treatment with medications, but quinine, vitamin B12 or gabapentin may provide at least partial relief. Although physicians commonly prescribe quinine to treat leg cramps, many authorities discourage its regular use because of potentially serious side effects. Warm baths, massage and stretching exercises may help prevent nocturnal cramps if performed before retiring to bed.
The disruption of sleep caused by restless leg syndrome or nocturnal leg cramps can lead to daytime fatigue or sleepiness, alteration in mood and even confusion. Proper diagnosis and treatment by a physician is essential if symptoms are frequent or severe.
Dr. Michael Spilane (†) practiced at HealthPartners Specialty Center in St. Paul. Dr. Spilane passed away in May of 2019. This article first appeared in the December 2012 issue of Minnesota Good Age