Hi Verity,

 > It also more commonly occurs after a heavy night. I would
 > appreciate any suggestions,

From Modern Maturity
September-October 1994

NIGHT WALKERS
Do your legs seem to have a life of their own?
Your torment has a name
by Robert Yoakum

Those who have restless legs syndrome take it very seriously, but they have an
awful time putting their symptoms into words.  That's one reason the condition
is so often shrugged off by doctors.  One cannot describe the sensation in
conventional terms.  Some typical efforts:  "It's a creepy-crawly sensation
like a thousand tiny worms working their way through my leg muscles"; "it feels
like bugs crawling up and down my leg"; "it's like my legs have a life of their
own."  Scientists call all such sensations paresthesia.  Symptoms of
paresthesia also include "numbness, tingling, or a 'pins and needles' feeling,"
according to The Mosby Medical Encyclopedia.

To relieve these symptoms RLS sufferers feel they must walk, no matter how
tired they are.  Like the inhabitants of a nocturnal hell, they are doomed to
move while the rest of the world sleeps.  The most seriously afflicted may have
to walk all night, so when they say they haven't slept, they mean it -
literally.

RLS affects nearly 5 percent of the population, according to the Restless Legs
Syndrome Foundation, and the majority of those are middle-aged or older.  Most
of its victims have only mild cases, but more than a million suffer from a
severe form.

A recent short item about the condition in the Harvard Health Letter brought
what one editor called "a ton of mail."  Sufferers were relieved to learn they
were not alone and that their torment had a name.  They were equally glad to
find relief exists, although there is no known cure for the condition at this
time.

Astonishingly, many doctors and nurses have never heard of RLS or, if they
have, don't take it seriously.  Every medical expert interviewed for this
article agrees with what Joseph F. Lipinski, Jr., M.D., of the Medical
University of South Carolina, said:  "This syndrome is unbelievably common and
can completely disrupt a patient's life.  Yet it is virtually unrecognized by
general physicians.  It isn't taught in medical schools, and it can be mistaken
for other disorders such as anxiety."

Confusion is compounded for the layperson because RLS, in nearly 90 percent of
all cases, is accompanied by something called periodic limb movements in sleep,
also known as nocturnal myoclonus.

PLMS symptoms are leg twitches that occur every 20 to 40 seconds during sleep
(and sometimes during wakefulness).  These regular twitches, which can also
keep sufferers awake, can occur independently of RLS.  Some people discover
they have PLMS only after their bed partner protests at being continually
kicked.  PLMS should not be confused with full-body jolts, experienced by many
on the edge of sleep, which are called hypnic jerks.  Nor should RLS be
confused with nighttime leg cramps.

A crawling sensation

How do you know if you have RLS?  The odds are that you do if (a) you have a
disagreeable "crawling" sensation in the legs, (b) you need to move your legs
to relieve the sensation, (c) you are usually afflicted in the evening or at
night, and (d) you are even more aware of the symptoms when you lie down.

Although symptoms begin shortly after a person retires for the night, some also
suffer during the day.  These people are often unable to nap or even sit still
for more than a few minutes.  When symptoms occur around the clock, it can
become impossible to work, travel, or even sit down for an entire meal.

People use some ingenious tactics in an attempt to reduce the effect of daytime
RLS.  One woman's husband went so far as to rig a stationary bicycle in their
van so while he drove she could cycle.  Another sufferer, unable to sit still
in an airplane, wrote to the airline president and obtained permission to stand
at the back of the plane during flight.

No matter when the symptoms occur, relief can only be obtained by walking,
massaging or stretching muscles, using hot or cold compresses, doing deep knee
bends, working the legs in a bicycling motion, or when immense fatigue explodes
into anger, emulating a woman in Arlington, Texas, who "began to beat on my
legs with my fists."

This woman was told she had a calcium deficiency, a hormonal problem, that she
was on the go too much, that she was getting too much - or not enough -
exercise, that she was on her feet - or sitting - too long.

She found out the name of her problem only after reading a newspaper article
about the Night Walkers, a national support group known officially as the RLS
Foundation.  Thanks in large part to two devoted women, Pickett M. Guthrie of
Raleigh, North Carolina, and {*filter*}ia N. Wilson of Orange Park, Florida, who
launched the nonprofit foundation with their own meager funds in 1992, this
debilitating condition is finally beginning to get the attention it deserves.

A medical advisory board - 11 physicians distinguished in the field of sleep
disorders and chaired by neurologist Arthur S. Walters, M.D., of the Robert
Wood Johnson Medical School - determines the accuracy of medical information
provided by the Foundation.

A long history

RLS, like PLMS, has been around a long time.  It was described in the 17th
century, but the first detailed study of the illness was conducted in the
mid-20th century by a Swedish neurologist, Karl Ekbom, M.D.  He was the first
to use the term "restless legs" in the medical literature.  For a few years the
affliction was known as Ekbom's syndrome - which had the advantage of sounding
more important than today's more widely used term restless legs syndrome.

So what causes RLS?  There are abundant theories, but no neat answers.  Doctors
who have studied it agree on one thing:  The syndrome is complicated.  It's
even possible that some cases are related to metabolic, vascular or neurologic
factors.

(to be continued in next message)

Linda

Specialists have reported that RLS can be triggered, but not caused, by anemia,
circulatory problems, diabetes, {*filter*}ism, pregnancy, antidepressants, or
diseases of the kidneys, nerves or muscles.  Also mentioned, albeit less often,
are caffeine, calcium channel blockers, folic acid deficiency, and iron
deficiency.

The condition tends to run in families, suggesting that susceptibility to it is
genetic.  Some researchers, like J. Steven Poceta, M.D., of the Scripps Clinic
and Research Foundation in La Jolla, California, believe that "familial RLS
cases are the worst.  They tend to be more severe and less responsive to
treatment."

Lucky patients may experience remissions.  As reported in a 1992 issue of the
journal Sleep, "Sudden remissions, which may last for months or even years, are
as difficult to explain as relapses, which also appear without any apparent
reason."

Prescription: difficult

Prescribing treatment for RLS is usually a hit-or-miss proposition.  A dozen
different doctors, hearing a patient describe symptoms, might order a dozen
different medications.

Unfortunately the most commonly prescribed {*filter*} have little or not effect:
aspirin, ibuprofen and other pain-killers, sleeping pills, tranquilizers,
muscle relaxants, antidepressants (some of which aggravate, or even cause
symptoms), vitamin and mineral supplements, quinine, and allergy {*filter*}.  People
have tried hypnosis, deep massage, acupuncture, thermal baths, meditation, and
an alarming array of {*filter*}.  In desperation some turn to {*filter*}.

The prescription drug of choice for people with severe RLS is Sinemet CR (a
long-acting combination of L-dopa and carbidopa), normally used to treat
Parkinson's disease.  This does not imply any causal relationship between RLS
and Parkinson's, but RLS often responds to medications that replace or simulate
the neurotransmitter dopamine, the lack of which causes Parkinson's.

Some doctors combine Sinemet with other dopamine-like {*filter*} like Permax
(pergolide) or Parlodel (bromocriptine) in an effort to avoid the daytime
rebound Sinemet sometimes causes.  Over the past year, more doctors have begun
prescribing Permax alone.

For mild cases, however, a physician might initially prescribe something in the
benzodiazepine family, one of a group of medicines known as central nervous
system depressants.  The most favored benzodiazepine medication for RLS is
Klonopin (clonazepam).

A third category of {*filter*} used for treatment is a combination of acetaminophen
and narcotic analgesics, which include Tylenol III (codeine), Percocet
(oxycodone), and Darvocet (propoxyphene).

Some doctors hesitate to prescribe such {*filter*} for fear patients will become
{*filter*}ed.  But a study of their use for RLS, conducted by seven scientists for
the journal Sleep, concluded as have other studies that they "can be
successfully used long-term with little risk of addition."  Some geriatricians,
however, feel that older people should not use propoxyphene and warn that
narcotics can cause side effects including constipation and difficulty
urinating.

Despite the myriad types of treatments, all the experts are in agreement on one
point:  A physician should monitor any medications taken for RLS.  Every person
reacts differently; a drug that creates no side effects in one patient could
knock another for a loop.  Further, older people tend to be more sensitive to
all these {*filter*}' side effects.

Research continues

Fortunately, more and more is being discovered about RLS and thanks not only to
Guthrie and Wilson's work in the area but also to the proliferation of sleep-
disorder centers.  At the end of 1978 there were only three such centers in the
U.S. accredited by the American Sleep Disorders Association.  Ten years ago, at
the end of 1984, there were 34.  Today there are a whopping 258.

And this year, for the first time, the scientific community afforded RLS major
recognition when a two-hour symposium on the subject was a major part of the
annual meeting of the Association of Professional Sleep Societies in Boston.

The hunt continues for better treatment.  Studies are also under way to
determine whether or not circadian variability (biological rhythms) causes
individuals to suffer more at night.

Researchers are also delving into brain functions with pet (positron emission
tomography) scanners to find out more about the role of neurotransmitters,
dopamine in particular, on RLS.  And specialists are looking for a genetic
cause.  If the responsible gene for familial RLS is found, it could lead to new
therapies.

RLS Foundation board member Lipinski best summed up the problem with RLS in
America today after he screened a colleague's patients for the condition.  The
surprised Lipinski found several who were affected.  Later, in a note he wrote
to the colleague thanking him for the RLS information, he cited an old English
saying that "the eye does not see what the mind does not know."

For more information about RLS send a self-addressed stamped business-size
envelope to RLS Foundation-MM, P.O. Box 314, 514 Daniels St., Raleigh, NC
27605.

(end)

Take care!
Linda

As a free-lance writer, I *resent* your posting a copyrighted story
without permission from the owner of the copyright.  This is actually
theft and I wouldn't be surprised if you could get sued for it.
I suggest you don't do this again.

***************

   ***************

   As a free-lance writer, I *resent* your posting a copyrighted story
   without permission from the owner of the copyright.  This is actually
   theft and I wouldn't be surprised if you could get sued for it.
   I suggest you don't do this again.

   ***************
   >
   >NIGHT WALKERS
   >Do your legs seem to have a life of their own?
   >Your torment has a name
   >by Robert Yoakum
   >
        [the rest of the lengthy quoting of the original clipped.]
   --

As opposed to your quoting the entire copyrighted story too?  Did you
get permission?

You might consider learning how to trim quotations before posting.
See the Usenet guidelines posted periodically in news.announce.newusers
(and I have copies I can forward).

        /J

Thank you for posting this.