It’s four in the morning and I’ve been walking in a tight circle in my room, on and off, for three hours.
The sensation I’m struggling with is hard to describe: an uncomfortable, shuddering, electric almost-pain running through my legs.
Not long ago I was going up and down stairs, which turned out to be a great relief for my calves. Before this I did yoga postures. Even though my body is pushing me, I’m so tired I can barely open my eyes.
When things calm down, I go back to bed for a few seconds until the feeling starts again. And the only way to alleviate it is to move. I take off the duvet, get out of bed, and start again.
I am pregnant and have restless legs syndrome (RLS), a common disorder described by the NHS as an overwhelming urge to move my legs to stop an uncomfortable sensation.
That’s not even half of it. Affected people describe it as carbonated water in their veins; insects that crawl under the skin; burning, itching, tingling, or internal tingling.
RLS, also known as Willis-Ekbom disease, especially affects the feet, calves, and thighs, but can also affect the arms and torso.
Up to 10 per cent of people in the UK will experience it. It’s a common condition, but many won’t have heard of it, suggests Dr Julian Spinks, GP and president of RLS-UK.
India Sturgis developed restless legs syndrome during pregnancy. The disease especially affects the feet, calves and thighs.
Symptoms tend to be worse at night and are related to fatigue, but this can prevent sleep, creating a vicious cycle. As such, RLS is considered a sleep disorder and can cause insomnia and trigger anxiety and depression.
According to Dr. Spinks, it’s hard to say exactly what causes it, as “it’s so under-researched.”
“We used to think it was mainly due to low levels of dopamine, the chemical neurotransmitter that sends signals between brain cells and is involved in muscle movement, since the most effective drugs for treating RLS were dopamine agonists, which they effectively mimic dopamine,” he explained. explains. “We now know that this is not the whole picture.”
In fact, he says, taking these medications for too long (sometimes as early as age three, but usually after age five) can make symptoms worse.
The most likely cause of RLS is now thought to be a lack of iron in some parts of the brain. “This affects brain function, including dopamine pathways, causing RLS sensations through the central nervous system, although how, why, and the mechanism of action remain a mystery,” says Dr. Spinks.
There may be a genetic predisposition to it. It can also accompany other conditions, such as kidney disease, magnesium and calcium deficiencies, arthritis, Parkinson’s disease, and hormonal changes.
That it gets worse at night could be a clue as to why it happens. “We have a brain sleep-wake cycle,” says Dr. Spinks. “So it may be that the changes that occur in the brain when you go to sleep start to cause this.”
Similarly, some medications can trigger symptoms, including some antidepressants, antihistamines (often taken for hay fever and allergies), as well as blood pressure medications such as calcium and lithium channel blockers.
“Many of them have brain effects and cause drowsiness, which many believe could cause symptoms,” he adds. Women are twice as likely to develop RLS as men, possibly due to hormonal fluctuations, especially during pregnancy or menopause, but also due to lower iron stores due to blood loss during menstruation. It usually develops in middle age (40 to 45 years).
RLS is a manifest mystery. As a result, the Internet is flooded with theories on how to cure it.
Two of the strangest ones I tried included placing an elastic band around the middle of each foot (the pressure is said to disrupt uncomfortable internal signals) and drinking tonic water (which contains quinine, a compound once used to treat cramps in the legs). legs). None worked.
RLS is a common disorder described by the NHS as an overwhelming urge to move your legs to stop an uncomfortable sensation.
Having never experienced RLS before, not even during a previous pregnancy (my first child is now six years old), it hit me like a freight train, at 37 years old. When it started, at eight weeks pregnant, every time I tried to sleep or take a nap, I dismissed it. as yet another strange symptom of a small human’s growth.
But soon, even lying in a dark room reading to my six-year-old daughter felt like torture, so I read The Magic Distant Tree with my legs in the air, ankles spinning, bending and flexing, while my daughter He laughed and told I’m crazy. I felt crazy.
Five years ago this became official when I was diagnosed with chronic insomnia and generalized anxiety disorder (GAD), from which I recovered, but the return of anxiety and insomnia, however temporary, is something I wanted to avoid.
As my pregnancy progressed, the sensation became more intense and occurred perhaps 50 or more times a day. I tried everything: yoga, Epsom salt baths (magnesium sulfate is believed to help relax muscles), massages (a battery-powered massage gun was quite effective), rubbing Vicks on my legs (not sure why). what, but he was willing to do it). try it) and eliminate sugar (there is anecdotal evidence that this could contribute to some people’s symptoms), caffeine, and alcohol (in the same way).
I went to the GP, discussed it with five midwives, two consultants, a psychiatrist and a neurologist, but no one knew what to suggest other than a hot bath and waiting in the hope it would get better once I had my baby.
Commonly prescribed medications (dopamine receptor agonists such as pramipexole or ropinirole, or alpha-2-delta ligands such as pregabalin or gabapentin) are not considered safe during pregnancy. A neurologist told me I could try clonazepam for sleep (a tranquilizer), but this should be a last resort as there are risks including reduced fetal growth and premature birth.
My options were, then, a hot bath or a benzodiazepine. With 100 days left in my pregnancy, I was starting to dread the night and had dizziness during the day from being awake for entire nights.
Thank goodness for Googling in the early hours: I found an article by Professor Guy Leschziner for the BMJ about RLS.
Professor Leschziner is a neurologist specializing in sleep disorders and someone I interviewed for a book I’m writing about anxiety.
I emailed him and he responded immediately with some phrases that changed everything, but could be summed up in one word: codeine.
Codeine is an opioid pain reliever that is considered safe during pregnancy, but because it can cause dependence, it is not recommended long-term. It acts on the central nervous system and the brain, blocking pain signals, as well as RLS sensations.
“I wouldn’t recommend it widely, but it may be useful for some people,” says Professor Leschziner. “I prescribe it for people who have very intermittent RLS or when a situation would be unmanageable for them, such as during pregnancy or a long-haul flight or car trip.”
I went back to my GP and asked him – codeine is listed as a recommended treatment for RLS in the National Institute for Health and Care Excellence (NICE) guidelines. I started taking 15 mg.
That first night I slept better; The feeling was still there, but it was reduced dramatically. The next day my head felt like mine again and I could see a way out. As the days passed, as my sleep banks recovered, the sensation diminished even more.
I wish someone had suggested it sooner but, according to Dr Spinks, “it’s lucky your GP knows a lot about RLS,” he says, as it’s not on their training curriculum.
Professor Leschziner says that while 10 to 15 percent of RLS patients require medication, most manage the condition by testing for low iron levels and taking iron supplements or infusions, eliminating medications that exacerbate symptoms. and doing exercise and massage for breakouts.
Why might massage and exercise help? “It is possible that by receiving other sensory information from running or rubbing your legs, you are creating other sensory neural signals that interrupt the transmission of RLS discomfort or pain.”
As my due date approached, I increased the codeine to 30 mg as the symptoms progressed, but I continued to sleep and stayed sane. After my baby, a very happy boy, was born in June, I stopped codeine and the RLS went away after three weeks.
If I encounter it again in life (a risk once you experience it during pregnancy, studies show), I will now be much better equipped and won’t need rubber bands.
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