Down to your last legs?

Thursday, April 30, 2009

Down to your last legs?

SLEEP DEPRIVATION

Shaking limbs at night can be a neurological movement disorder

For over a year, Mdm Josephine Tan (not her real name) could not get a good night’s sleep because strange, prickling sensations in her legs would invariably lead to them shaking.

“My legs kept moving,” said the retired banker, who is in her late 60s. “On nights when the attacks were bad, the shaking would be so violent that it’d disturb my husband too.”

The worst part, added Mdm Tan, was that her problem was dismissed by her doctor friends, who had not heard of the condition.

But the dark rings under her eyes, poor appetite and fatigue due to lack of sleep were proof that she wasn’t imagining her troubles.

What Mdm Tan suffers from is Restless Legs Syndrome (RLS), a neurological movement disorder that sleep expert Dr Lim Li Ling, director of the sleep disorders unit at Singapore General Hospital, believes is under-recognised in Singapore.

Dr Lim is the co-editor of medical publication Sleep Medicine: A Clinical Guide to Common Sleep Disorders and author of the guide’s chapter on RLS.

She said that the disorder affects less than 1 per cent of the population in Singapore but added that this figure may be an under-estimate because RLS is not widely known to healthcare professionals who are not familiar with sleep-related disorders.

“These symptoms are often mistaken for similar conditions such as leg cramps and arthritis pain,” she said. As a result, many cases of RLS may not be diagnosed.

Shake a leg

Living with RLS can be frustrating at the very least. For Mdm Tan, it is physically and emotionally debilitating.

The condition causes uncomfortable creepy-crawly sensations in the legs, accompanied by an irresistible urge to move the legs.

Often, inactivity worsens the condition, according to Dr Kenny Pang, a sleep specialist and ENT consultant, and director of the Pacific Sleep Centre.

He added that sufferers tend to experience worse attacks in the evening and at night. According to Dr Pang, almost 85 per cent of RLS sufferers report difficulties falling asleep. And when they do sleep, their rest is disturbed by the involuntary, repetitive and periodic jerking of their limbs. As a result, many RLS sufferers feel tired or sleepy during the day.

While the exact cause of RLS is unknown, it has long been associated with iron deficiency.

The mineral is needed by the body to produce dopamine, or neurotransmitter. Dopamine pathway abnormalities are thought to be a factor in RLS, said Dr Lim.

Genes may also play a part. Occasionally, RLS is associated with medical conditions such as nerve disease, kidney failure and pregnancy. Iron deficiency is common in the latter two conditions.

No permanent cure

For Mdm Tan, having to see several doctors and undergo weeks of tests before she was diagnosed with RLS was a costly and distressing experience. Even more depressing was the fact that there is no permanent cure.

But making simple lifestyle changes can alleviate symptoms, said Dr Pang. They include cutting down on caffeine, smoking and alcohol, and following a regular sleep and exercise routine.

Drugs such as dopamine agonists used to stimulate dopamine may relieve the symptoms. So can iron supplements, if the patient is iron-deficient.

For those with RLS arising from kidney failure or pregnancy, treating the underlying conditions can alleviate the symptoms.

Mdm Tan now keeps her restless legs under control by taking medication and following an elaborate evening routine of walking, practising qi gong and wrapping her legs in a thermal wrap before she goes to bed.

“Imagine having to live your life with this disorder. I was depressed when I found out there wasn’t a cure but I told myself I won’t be defeated by it,” said the gung-ho lady.

From TODAY, Health – Tuesday, 28-April-2009

In collaboration with Health Promotion Board