Please Note! This section provides a schematic overview of select sleep disorders that must be confirmed by a physician or sleep specialist. This information has been presented for educational purposes only.

Restless Legs Syndrome
(Willis-Ekbom Disease)

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The Impacts of Poor Sleep Quality Are Significant

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The Characterization of RLS

RLS is also known as Willis-Ekbom Disease
RLS is characterized by an irresistible urge to move the legs often accompanied by uncomfortable or painful symptoms. The sensations are worse at rest and occur more frequently in the evening or during the night (exhibiting a circadian component). Walking or moving the legs relieves the symptoms. RLS is not the same as cramping, compression or other chronic musculoskeletal conditions in the legs or limbs. The urge is often difficult to articulate, but its ramping up of a "necessity" to repeatedly move the limb is the defining feature, not the fact that there is discomfort or pain in the limb/legs.
RLS patients may also experience accompanying periodic limb movements during sleep that comprise periodic limb movements of sleep (PLMs). The PLMs limb movements in RLS patients are often associated with frequent arousals from sleep and may occur in up to 80% to 90% of patients with RLS, however RLS is a movement disorder that radically interferes with sleep onset as opposed to periodic limb movement disorder which presents frequent micro-arousals during sleep.

Severe RLS may progressively shorten sleep time to five hours or less per night. Increased rates of depression and anxiety are reported with RLS patients. RLS treatment consists of levodopa or dopamine-receptor agonists to address the motor and sensory features of the disorder. Iron, dopamine, and genetics appear to be primary factors in the RLS pathology. Iron deficiency increases the risk for RLS. Several medications have been reported to precipitate or aggrevate RLS, including dopamine-receptor antagonists, many antidepressants and sedating antihistamines.

In contrast to RLS, positional discomfort, which can occur from compressive pressure on nerves, is sometimes confused with RLS, however, the discomfort is resolved by changing body position without requiring any continued body movement. The discomfort does not include an irresistible urge to move the legs. RLS patients often have difficulty describing both the urge and the sensations.
Sleep-related leg cramps are also worse at night, relieved by movement, and in some cases, interpreted as an urge to move. However, leg cramps always involve muscle hardening or muscle pain that requires stretching of the muscle, not strictly movement, to relieve the underlying urge. Following movement, leg cramps will have residual pain and tightness that is unresponsive to movement, whereas RLS symptoms are relieved and no longer manifest during movement.

Periodic Limb Movement Disorder (PLMD)

PMLD, though consisting of the stereotypical periodic limb movements of sleep (PLMs) that are highly probable in RLS patients, is a separate disorder of sleep and does not present the same symptom set that RLS does to interrupt sleep onset. PLMD requires separate diagnostic criteria (an overnight PSG study) because the symptoms manifest during sleep. PLMs occur most often in the lower extremities and involve extension of the big toe in combination with partial flexion of the ankle, the knee, and sometimes the hip. Movements may be vigorous and associated with an autonomic or cortical arousal during each repetitive sequence (often hundreds per night). Typically, the patient is unaware of the limb movement or the micro-arousals and report only unrefreshing sleep and/or excessive daytime sleepiness. (See the Sleep Architecture section of this platform to understand why unrecognized micro-arousals can translate into serious consequences).

The Restless Legs Syndrome 'URGE'

U

Irresistible Urge

The urge to move builds up until movement can diminish; but repeats

R

At Rest Symptoms

The urge builds during rest and at night with a circadian component

G

Get Up & Move

Get up to move is only relief; RLS not same as leg cramps or tightness

E

Evening is Worse

The urges that build during rest are worse in the evening (circadian)

If patients or practitioners need to find a sleep specialist associated with a sleep center in their area, the American Academy of Sleep Medicine (AASM) has developed a sleep center: locator.

Sleep Is Not Rest

Although Nourish Sleep is a non-clinical entity, we do not operate outside of a responsible care pathway. Nourish Sleep screening does not constitute confirmation of a sleep disorder or lack thereof. Only a face-to-face clinical evaluation with a clinician or board certified sleep physician can affirm the necessity for further diagnostics or treatment. Our role is to educate you and provide you a rigorous, but highly tailored and comprehensive understanding of your specific sleep quality. Although we work collaboratively with a diverse array of clinical and educational resources to fulfill that mission, Tri-Nourish Inc and Nourish Sleep constitute non-clinical entities offering non-clinical services. Our goal is to assist your sleep quality in a pre-pathological (preventative) approach that takes into consideration domains that impact health and wellbeing before they transition into common sleep, mental or physiological disorders. Poor sleep quality radically impacts productivity, performance, health, emotional resilience, and safety— well before the sleep disorder threshold has been breached.