American Medical Association Family Medical Guide - American Medical Association [447]
Diagnosis
There are no tests for diagnosing restless legs syndrome. A diagnosis is usually made from the symptoms and from the information a person gives the doctor. Sometimes an underlying condition such as iron deficiency anemia, diabetes, rheumatoid arthritis, or hormonal changes during pregnancy or menopause produce symptoms of restless legs syndrome. In these cases, the symptoms usually subside once the condition is treated (or after childbirth). Some medications—such as calcium channel blockers (used for treating high blood pressure and heart disease), antinausea drugs, some cold and allergy medications, some tranquilizers (including haloperidol and phenothiazines), the antiseizure medication phenytoin, and antidepressant medications—can worsen the symptoms of restless legs syndrome.
Treatment
Doctors frequently recommend medication for treating restless legs syndrome. The drugs most often prescribed include benzodiazepines (which induce sleep by depressing the central nervous system) or dopaminergic agents (usually used to reduce tremors in people with Parkinson’s disease). The effectiveness of a medication depends on the severity of the symptoms.
People who have a less severe form of restless legs syndrome may find relief from the symptoms by walking, stretching, taking hot or cold baths, or practicing relaxation techniques or yoga. Lifestyle changes such as limiting consumption of caffeine and alcohol and eating a healthy, balanced diet also may help lessen the symptoms.
Narcolepsy
Narcolepsy is a chronic sleep disorder in which a person is overcome by such overwhelming sleepiness that he or she falls asleep at inappropriate times (for example, while eating dinner or having a conversation) during the day. These daytime “sleep attacks” are uncontrollable and often occur without warning. The sleep attacks appear to occur when the messages about sleep and waking sent by the brain to other parts of the body deviate from their normal course or arrive at the wrong time. This process causes a disturbance in the normal order and length of sleep stages, so that rapid eye movement (REM) sleep, when dreaming occurs, happens at sleep onset or even during the day. The person usually remains conscious.
Strong emotions such as anger, fear, or laughter, or strenuous physical activity often trigger these episodes. Some attacks can be accompanied by loss of muscle function and total body collapse, a condition called cataplexy.
Narcolepsy often interferes with a person’s job and personal life and restricts his or her activities. Roughly 1 in 2,000 people has narcolepsy, which can occur in people of all ages, although symptoms usually begin between ages 15 and 30. Narcolepsy seems to run in families, but it is often misdiagnosed as depression (see page 709), epilepsy (see page 686), or the side effects of medication. The length of time between the appearance of symptoms and a diagnosis of narcolepsy can be up to 15 years.
Symptoms
Overwhelming daytime sleepiness at inappropriate times is usually the first symptom of narcolepsy. People with narcolepsy also may experience sleep paralysis, in which their body becomes temporarily immobile during the time they fall asleep or wake up. A person may have intense, often frightening hallucinations (abnormal perceptions not based on reality) when he or she dozes off or falls asleep. Affected people sometimes display automatic behavior, in which they perform routine tasks repeatedly without full awareness that they are doing so.
Diagnosis
After performing a thorough physical examination and taking a detailed health history, your doctor will probably order two tests to diagnose narcolepsy. The first, called polysomnography, measures brain