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Night Moves: Menopause, Sleep, and Restless Leg Syndrome

This article was originally posted on genneve.com

Sleep is elusive enough for many women in menopause. You’re exhausted, desperate to get just a few hours of uninterrupted REM, you start to drift off at last, when suddenly your leg starts… tingling. Then pins-and-needles, then throbbing, then an overwhelming urge to move your leg, which brings relief, for maybe a minute, until the whole thing starts again.

According to the National Institutes of Health, Restless Leg Syndrome (RLS) affects up to 10 percent of adults in the US, and it’s more common in women than men. It’s also more common in older people, meaning a lot of sufferers are women in menopause.

What is Restless Leg Syndrome?

RLS sufferers generally report unpleasant sensations in the leg – tingling, electric shock, itching, crawling, throbbing – plus an irresistible urge to move. It may affect both legs or just one. It may move from one leg to the other, and for up to 80 percent of RLS sufferers, it’s accompanied by the jerking or twitching of legs and arms known as PLMS: periodic limb movement of sleep.

RLS is classified as a “sleep disorder” because symptoms generally start in the evening and worsen through the night. Obviously, restless leg syndrome can have a huge impact on quality and quantity of sleep.

Moving generally relieves the symptoms temporarily, meaning someone with RLS may feel compelled to shift positions constantly or even get up and walk around. Many find that symptoms disappear for a time in the very early morning, allowing for at least a little sleep – that is, if you don’t have other issues keeping you awake.

What Causes RLS?

Like so many neurological disorders, the exact cause isn’t well understood. It can be genetic, though in most cases the symptoms show up before age 40 when there’s a genetic component.

It’s possible that RLS is caused by the part of the brain that controls movement – the basal ganglia. If that area isn’t able to utilize the brain chemical dopamine properly, the disruption could cause the sensations and involuntary movements of RLS.

Other factors that may contribute to the development of RLS include iron deficiencyrenal diseasemedications such as anti-nausea, antipsychotic, antidepressants (which are frequently prescribed for women in menopause), even some cold and allergy medsPregnancy, especially toward the end, can trigger RLS, though it generally disappears a month or so after delivery. Nerve damage has shown to be related in some cases, and three of the usual suspects for menopause symptoms: smoking, caffeine, and booze.

How could perimenopause or menopause be a factor? Many women in perimenopause who suffer heavy bleeding may have an iron deficiency, so that could contribute. Also, it’s thought estrogen helps muscles relax, so as estrogen declines, we lose that natural relaxant.

How Do I Get Restful Legs?

Now that you know what it is, how can you treat your restless leg syndrome? First things to look at may be the list of “other factors” above – are you taking any of the medications, are you nearing the end of a pregnancy, are you getting enough iron? When those conditions change, you may find your RLS goes away.

Diabetes is also a related condition that can worsen RLS, so if you have other risk factors for diabetes, you might want to be tested. If you’ve been diagnosed, check with your doctor to be sure it’s being managed correctly.

If none of those are causing your RLS, there are things you can do. As ever, we suggest lifestyle modifications first:

  1. Bump up your iron and magnesium, as both of these can help. Magnesium helps muscles relax and it’s possible some cases of RLS are triggered (or worsened) by a magnesium deficiency. Both supplements can cause digestive upset, so talk to a doc, add them carefully, and try to increase your intake primarily through food.
  2. Eat for menopause. If hormone changes may be affecting RLS, adding back some estrogen via food may help. Registered Dietitian Krista Haynes suggests legumes, flaxseed, and alfalfa sprouts. Calcium-rich foods may help muscles relax. Ms Haynes also suggests having lavender essential oils nearby at bedtime to provide further relaxation.
  3. Exercise moderately and not too close to bedtime. Excessive exercise can worsen RLS, but gentle exercise such as walking at a normal pace can bring some relief.
  4. Be good about sleep habits. Known as “sleep hygiene,” having healthy, regular habits around bedtime can help calm you and prepare your mind and body for sleep.
  5. Stretching has been shown to help RLS sufferers. RN Mary Ann Wilson has some great RLS stretches, especially for those of us who spend most of our day stuck at a desk. Yoga may also provide relief.
  6. Reduce or reject caffeine, alcohol, nicotine. Studies have shown that all three of these can worsen a whole lot of menopause symptoms, so hard as it may be to lessen intake or give them up entirely, you might find a decent night’s sleep is worth it.
  7. Take a warm bathGet a massage. Sometimes the best care is self-care, so consider indulging yourself in some calming comfort.
  8. A restiffic foot wrap. This adjustable foot wrap may help reduce symptoms by targeting pressure points on foot muscles. According to Berkeley Wellness, researchers thought pressure on the foot would signal the brain to relax leg muscles. The wrap has only undergone small studies, so more research is needed to determine if the restiffic is truly effective.
  9. Tracking. Some sufferers have reported keeping a sleep diary to help track triggers and successful strategies really helps them to manage the condition.

Medications are available that can help, if you do all the above and find you’re still suffering.

Mayo Clinic lists Requip, Neupro, and Mirapex (dopamine agonists) as possible options. Other medications known as “dopaminergic” drugs (Sinemet) affect the levels of dopamine in your brain. However, there are concerns about the phenomenon known as “augmentation” – the worsening of RLS symptoms after long-term use of some dopaminergics. Be sure to ask your doctor about the risks versus the benefits.

Other medications that may work are sedatives to help you stay asleep, symptoms or no. Anticonvulsants such as gabapentin have been shown to provide some relief, as have opioids. Opioids, however, are very addictive, so they may only be prescribed for a short time and for those with extreme symptoms.

There is no “cure” for RLS, and symptoms may worsen with age. However, a combination of good lifestyle choices plus medications, if necessary, may lessen the symptoms enough to allow you to sleep.

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