My twitching leg disrupts my sleep. Help!

Q: I am a 49-year-old working woman and my sleep is always interrupted by the twitching of my leg, normally the right leg. Sometimes, the twitching may happen on the left leg as well.

It can be minor jerking or it can be more active with the leg "jumping".

At the same time, I will feel pressure on the right side of my head.

I wake up with pain in my lower back as well as bruises on my legs.

I have been having such interrupted sleep every few nights.

One general practitioner (GP) prescribed muscle relaxant, which helped for a few days.

Another GP said it is psychological.

I read up and found my symptoms are similar to something called the "restless leg syndrome", so I ate more green vegetables, which was supposed to help, but it did not solve the problem.

I also read that this syndrome may be due to a lack of magnesium, so I tried taking 300mg of magnesium per day. I have finished two bottles but it did not help much either.

I have also tried taking painkillers, massaging with ointment and soaking in hot water, but all were of no use.

I am writing this mail in the middle of the night because I cannot sleep again. Please help.

A: Periodic leg movements are characterised by periodic episodes of limb movements - mostly in legs - that occur during sleep.

They are characterised by behaviour ranging from shallow, continual movement of the ankles or toes, to wild kicking of legs and arms, which can result in bruises and injuries.

These movements affect people only during sleep, mainly during the earlier stage, called non-rapid eye movement stage of sleep.

These movements disturb the sleep rhythm, which leads to poor sleep, daytime sleepiness and tiredness during the day.

Higher rates of depression, memory impairment, fatigue and excessive daytime sleepiness have been reported in patients with periodic leg movements.

The incidence of such movements increases with age. They occur in 5 per cent of people aged 30 to 50 years and in 44 per cent of people over the age of 65.

In most cases, the cause of periodic leg movements is idiopathic (unknown).

Periodic leg movements can be secondary to various causes such as the use of certain drugs, iron deficiency, anaemia (the deficiency of oxygen-bearing red blood cells), renal failure and neuropathy (a group of disorders resulting from damage of nerves outside of the brain and spinal cord).

Periodic leg movements can be associated with restless leg syndrome, another disorder characterised by an irresistible urge to move the legs while at rest.

Patients having symptoms suggestive of either periodic leg movements or restless leg syndrome should consult a sleep physician and undergo clinical examination and investigation with overnight polysomnography.

Polysomnography measures the nasal airflow, blood oxygen level, snoring, heart rate, electrical activity of the brain and movements of the limbs during sleep.

Periodic leg movements can be treated with medication such as benzodiazepines (tranquillisers).

In severe cases, drugs such as gabapentin (a painkiller) can be used.

Before embarking on treatment with such medication, the patient has to be evaluated for any secondary causes of periodic leg movements. If present, these have to be treated.

Dr Shahul Hameed
Consultant neurologist at the department of neurology at National Neuroscience Institute at Singapore General Hospital

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