It’s estimated that 65% of Americans don’t get the recommended 7 to 9 hours of sleep at night. Many are impacted by sleep apnea due to an obstruction in the airway, but others may have a sleep disorder called Restless Legs Syndrome. It’s more common than Type 2 Diabetes and tragically few know that they have it. It’s estimated that 8% of the population suffer from this neurological condition. Of those 3% need medication to control it to improve their quality of life.
Importance of Sleep
It’s vital to get between 7 to 9 hours of sleep each night for good health. During certain stages of sleep the brain clears the metabolic debris from daytime usage which helps prevent dementia. In addition, the immune system destroys abnormal cells that could lead to cancer and fights infections. Two chronic reasons that good sleep is disrupted is either sleep apnea and or restless legs syndrome. Both can be present at the same time.
Sleep Apnea
Sleep apnea results in times throughout the night when you literally stop breathing. The brain detects the low oxygen level and stimulates the release of adrenalin to wake you up. You resume breathing and improve oxygenation but at a price of higher blood pressure, heart rate and a host of other adrenalin side effects. Continuous Positive Airway Pressure (CPAP) devices deliver small amounts of pressure to keep the airway open.
Restless legs syndrome is still poorly understood. It’s a neurological problem coming from the brain that results in twitching and or leg movements throughout the night during certain cycles of sleep. Low oxygen in the brain may stimulate the problem or the leg movements may come from something occurring in the brain. It’s unclear but good sleep is disrupted.
Five Characteristics of Restless Legs Syndrome (RLS)
While loud snoring is a key sign of sleep apnea, restless legs syndrome may be less obvious as a cause for your sleep disorder. If you notice your bedding is in disarray in the morning or your partner complains of you tossing and turning throughout the night you may have it. The following are the five key symptoms:
- You have a strong urge to move your arms and legs.
- Symptoms are worse when you’re resting, sitting or inactive.
- Symptoms are relieved with movement.
- Symptoms are worse in the evening or at night.
- You may have Periodic Limb Movements (PLM’s) which are jerking of the arms or legs that interferes with sleep.
If you think you may have sleep apnea or restless legs syndrome don’t suffer any longer. Get it checked out. The consequences of poor sleep and chronic adrenalin surges may include stroke, stress on the heart, high blood pressure, heart disease, damaged heart valves, irregular heart rhythms, poor mood, daytime sleepiness, loud snoring, diabetes, obesity, gastroesophageal reflux disease, sexual dysfunction, frequent nighttime urination, colds, dementia, cancer, or sudden death.
Diagnostic Sleep Studies
There are 2 major types of sleep studies. Your healthcare provider will generally begin with a Take Home Sleep Study Test. You pick up the device and are provided with simple instructions on how to use it. At bedtime a nasal canula is applied to your nose, much like when taking oxygen. A small monitor goes on top of your chest while a pulse oxygen saturation device is attached to your finger. The equipment is returned the following morning and analyzed by a technician.
Throughout the night data is gathered of oxygen levels, respiratory rates and snoring. It detects the frequency that your breathing was interrupted, the length of time and how your oxygen levels were altered while you slept. However, it doesn’t provide any information on restless leg activities. You need an In-house Sleep Lab Test for that information.
The Sleep Lab Study is done in a clinic or hospital setting where you spend the night and is a much more comprehensive test. In addition to measuring oxygen levels, respiratory depth, frequency, and apneas (when you stop breathing), you’re connected to electrodes that measure neurological data. The number of times twitching, or leg movement occurs is noted and the relationship with sleeping and apnea episodes.
What is not detected is the cause for the neurological sleep disorder. Is the sleeplessness caused by being awakened several times at night because the legs are moving? Or are the legs moving because the brain is lacking oxygen? Researchers are beginning to better understand restless legs syndrome, but much is still unknown.
Sleep Specialists
Most sleep clinics are run by pulmonologists who specialize in sleep apnea. It’s more difficult to find a neurologist who specializes in Restless Legs Syndrome. However, you can locate the one nearest to you via the Restless Legs Syndrome Foundation (rls.org) which also has a wealth of information. For both problems the National Sleep Foundation (thensf.org) has helpful information as well.
Lifestyle Treatments for Sleep Apnea and Restless Legs Syndrome
Lifestyle changes may help and are worth a try. The National Sleep Foundation (www.thensf.org) and the Restless Legs Syndrome Foundation (www.rls.org) have a great amount of bedtime hygiene ideas which may help.
- Reduce caffeine, alcohol, refined sugars and chocolate.
- Keep physically active during the day.
- Avoid long naps (>20 minutes).
- Go to bed at the same time each night.
- Maintain a healthier weight as obesity is a leading cause of sleep apnea.
Treatments for Restless Legs Syndrome
Low iron levels have been associated with Restless Legs Syndrome. The typical hemoglobin blood test may look normal but further exploration with a ferritin level may show a problem. Other iron level tests are done as well to look for abnormalities. Guidelines to control RLS encourage a ferritin level >75. Low levels are treated with oral or IV iron. There are a variety of medications that may relieve symptoms, but they also have potential side effects.
The Restless Legs Foundation has set up a website for healthcare providers to answer their questions at RLS Curbside (www.RLSCurbside.org). If you suffer from this problem, join the RLS Foundation (www.rls.org) or the national sleep foundation (www.thensf.org) for more information to advocate for resolution and better sleep.
Bedtime Prayer
Dear Lord, as I prepare to sleep, I thank you for all the blessings that you have showered upon me this day. Forgive me for any sins of omission or commission. Help me to rest deeply tonight so that I may be ready and eager to serve you tomorrow. In His heavenly name, our Father, Son and Holy Spirit. Amen
It is in vain that you rise up early and go late to rest, eating the bread of anxious toil; for He gives to His beloved sleep (Psalm 127:2).
If you’d like to read my other blogs you may visit my website for more information (jenniejohnsonrn.com). Author of Helping the Hurting: Nursing Ministry in the Body of Christ (2022) and Wake Up Call 911: It’s Time to Reduce your Risk for a Heart Attack and Stroke (2015).
Paperback copies of both books for sale. Email me for details at: ask@jenniejohnsonrn.com.
References:
“NSF Poll Highlights Strong Link between Sleep and Depressive Symptoms in US Population,” National Sleep Foundation, (March 9, 2023) https://www.thensf.org/nsf-poll-highlights-strong-link-between-sleep-and-depressive-symptoms-in-us-population/
“Symptoms & Diagnosis,” Restless Legs Syndrome Foundation, (February 24, 2024) https://www.rls.org/understanding-rls/symptoms-diagnosis
- Silber et al. “The Management of Restless Legs Syndrome: An Updated Algorithm,” Mayo ClinicProceedings(July 2021). https://www.mayoclinicproceedings.org/action/showPdf?pii=S0025-6196%2820%2931489-0
ã All rights reserved 2024, Jennie E. Johnson, RN-BC, PhD
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