Published March 16, 2006 in issue 0511 of the HooK.

By JOHN HONG, MD [email protected]

Dr. Christopher Winter came for lunch and told us about all sorts of sleeping problems. He said his office lobby is filled with patients who are snoring, bobbing their heads up and down-- struggling to stay awake, drooping eyes red as Darth Maul's. Hmm, sounds like my dinner parties. Maybe he should play techno dance music to keep them awake? "Everybody dance now! Duh-duh-da-da-Duh..."

Actually, people with restless leg syndrome (RLS), might find that dancing and grooving actually help them feel better. RLS is characterized by "intense, spontaneous, continuous leg movement associated with unpleasant parathesias [tingling; pins and needles] that occur only at rest and are relieved by movement." (If everyone had RLS, would the obesity rate finally decrease? "I would love to sit and eat with you, but I've gotta run. My legs feel like I just used an Epilady-- yow!")

So unless you can sleep with pants like in Wallace & Gromit in The Wrong Trousers (a mechanical invention in which Wallace walked 24 hours a day, seven days a week, and couldn't stop the pants from moving), RLS causes involuntary jerking leg movements in bed.

The answer to "Got your foot in your mouth?" might actually be yes­ but usually for the RLS's sleeping partner. People with RLS can kick their partner out of bed-- even in the head. Sounds so Steven Seagal.

Perhaps 5-15 percent of Americans have mild symptoms of RLS, and 3 percent have moderate to severe RLS symptoms that occur at least two times a week. For some reason, the malady is two times more common in women then men-- especially the more children they've had. (Let me tell you, if I had an episiotomy, I'd have restless legs for life-- and I'd throw that info in my kids' face every time they misbehaved.)

The International Restless Leg Study Group proposed four features as minimum criteria for the diagnosis of RLS: 1) Desire to move the extremities, often associated with parathesias or dysesthesias [abnormal feelings to the legs/arms ­ kind of like how you might feel hunting with Dick Cheney]; 2) Motor restlessness; 3)Worsening of symptoms at rest with at least partial and temporary relief during activity; 4) Worsening of symptoms in the evening or at night.

What causes RLS? Usually, there is no known cause. Often though, there is a family history of RLS about 40 percent of the time. There might be a peripheral nerve problem (meaning nerves in the legs) but some studies have shown the problem might stem from dopamine in the brain. Dopamine is not one of the Seven Dwarves-- it's an important chemical in the brain involved with movement and thinking. Another important chemical in the brain is hypocretin, which helps keep you awake, and this also might be involved in RLS.

Some medical conditions can cause RLS symptoms, like iron deficiency, diabetes neuropathy, kidney failure, Parkinson's disease, pregnancy, arthritis, back problems, and venous insufficiency.

Stretching and exercise can be very helpful in treating RLS. However, for people who need medication, drugs that increase dopamine are used-- well, like dopamine itself. But dopamine does have side effects, so pramipexole and ropinirole-- with fewer side effects-- are being used more frequently.

It might be advantageous to sleep like Jennifer Beals-- dancing to "She's a Maniac" from Flashdance-- because you could lose some weight while you sleep. But RLS doesn't allow you to sleep well, and so you end up feeling tired all day. Plus, your spouse is likely to pour a bucket of water on you like in Flashdance-- and trust me, it won't be quite as sexy as it is in the movie.

Got a medical question? Dr. Hook wants to hear from you!

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