Nighttime creepy-crawlies aren't limited to camping or Halloween. For approximately 10 percent of Americans, tingly, itchy sensations -- mostly between the ankle and the knee -- aren't the creeping of spiders or the fluttering of bats, but a neurological disorder called Restless Legs Syndrome, or RLS.
Most sensations occur in the lower legs, but the arms, torso and face may also be affected. Regardless of the geography, severe insomnia is the end result.
Psychological symptoms are not part of an RLS diagnosis, but RLS and psychology go together like the creepies and the crawlies.
Let's rewind to the 1800s, when the first overlap with psychology appears. Theodor Wittmaack, a German neurologist, called the disorder "anxietas tibiarum," loosely translated as "leg movements combined with anxiety or depression." Wittmaack hit the restless toenail on the head. This is the essential description of RLS.
Separating RLS from depression can be like trying to unscramble an egg. Put the symptoms of depression in a lineup, and five are instantly recognizable as problems due to lack of sleep. The culprits include:
1) Feeling depressed or irritable
2) Insomnia and/or extreme sleepiness
3) Trouble concentrating
4) Mental and/or physical sluggishness or agitation
Approximately 40 percent of individuals with RLS describe these symptoms to their doctor, so it can look like depression. Indeed, those with RLS have a two- to four-fold risk of developing a depressive disorder than those without RLS. But it's important to differentiate. Those misdiagnosed with depression may be prescribed SSRIs like Prozac or Zoloft, which can make the sensations of RLS worse.
For a long time, mystery shrouded whether RLS preceded depression, caused it, or was entirely different from it. Finally, in 2012, a study of over 56,000 women demonstrated that RLS comes first, then depression follows, most likely due to disturbed or lost sleep.
Among the 2 percent of kids with RLS, symptoms can do a good impression of ADHD. For unknown reasons, in kids, symptoms often happen during the day, not just at night. Picture a restless child fidgeting at his desk at school. He frequently leaves his seat to walk around and gets disciplined by the teacher. He can't concentrate on his work and seems distracted when he's supposed to be paying attention. It looks like ADHD, but it might not be.
To further complicate matters, kids with the double whammy of ADHD and a family history of RLS may be at risk for particularly severe ADHD symptoms. So far, studies have been small, but it is possible that iron deficiency plays a role in the overlap. Consult your doctor, however, before administering iron to kids on your own.
So what can you do to treat RLS? Often, treatment for RLS will significantly improve the depression, thanks to improved sleep. If antidepressant medication is needed, non-SSRIs like Wellbutrin or the tricyclics don't seem to cause the same worsening effects. As always, talk to your general physician or psychiatrist about medication. Aside from seeing a doctor, here are some changes to help you rest easier:
1) For very mild symptoms, over-the-counter pain relievers can lessen the sensations. Resist self-medicating with alcohol or over-the-counter sedatives -- each one can make RLS worse.
2) Targeted relaxation: Relax leg muscles by soaking in a warm bath, alternate warm and cool packs, or massage the legs.
3) Holistic relaxation: Yoga, meditation or calming spiritual practices can dissipate the stress that exacerbates RLS.
4) Exercise. Moderate, regular exercise is a universal balm. With RLS, avoid working out late in the day or at high intensities, as each may exacerbate symptoms.
5) Good sleep hygiene. A cool, dark, quiet room with no TV or other devices that bleep and bloop is important. If your schedule allows, some living with RLS recommend a later bedtime and later wakeup time. Others swear by a strict bedtime to ensure enough sleep.
6) Lifestyle changes: Experiment with cutting out caffeine, alcohol and tobacco.
7) Plain old distraction: Fancifully called "mental alerting activities" by researchers, individuals with RLS report all manner of productive ways to pass the midnight hours they would rather spend sleeping: remodeling a basement, knitting, composing poetry, writing a novel -- you name it.
Despite the increase in middle-of-the-night productivity, if you suffer from RLS, I know you'd much rather be sleeping peacefully. There is not yet a cure for RLS, but with information, support and patience to discover the treatments -- both medical and complementary -- that work for you, you can live well with RLS.