Sleep Care

Restless Legs Syndrome, Insomnia, and Brain Chemistry

For those with restless legs syndrome (RLS), lying down at night and trying to rest becomes a frustrating battle to fall asleep, due to the body’s relaxation triggering the kicking and jerking movements characteristic of RLS. These movements not only disrupt their sleep, but can be disruptive and harmful to bed partners as well, depending on their severity. Some experience the sensations as mildly uncomfortable, or describe them as feeling like ants are crawling on their legs. Others experience pain if they don’t move their legs frequently. iStock_000000239107SmallTypically, drugs prescribed to treat RLS symptoms focus on the neurotransmitter dopamine, which is used by the brain to control intentional muscle movement and actions. When dopamine processes are disrupted or altered, involuntary muscle movements will result, such as those characteristic of Parkinson’s disease. Interestingly, there are some people with RLS who still report getting a poor night of rest, despite their leg movements being adequately controlled through medication. Few hours of sleep or even insomnia are common complaints, although problems with daytime tiredness the next day are not often reported. A new study by a team of researchers at John Hopkins University School of Medicine may shed some light on why this

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occurs. Their work was recently published in the journal Neurology. Looking at a different neurotransmitter In their study, the team looked at MRI images and noted glutamate activity levels between 28 subjects with significant RLS symptoms and 20 subjects without RLS. The researchers were particularly interested in activity in the thalamus, the area of the brain responsible for sleep, consciousness, and alertness. Glutamate is a neurotransmitter that is involved in arousal in the brain. After recording the glutamate activity levels in the thalamus of each subject, the researchers then had participants go through a two-day sleep study, assessing how much sleep individuals were actually getting. The team found fewer hours of sleep were associated with higher levels of glutamate activity for those patients with RLS. This relationship was not seen in those without RLS. A new approach to RLS treatment Since drugs used to treat RLS symptoms typically focus on dopamine interactions, the study’s findings on the importance of glutamate activity levels may explain why poor sleep continues even after the leg movements stop. It also may open up a new avenue for treating RLS, utilizing drugs that seek to lower glutamate activity. The researchers noted that while such drugs are currently available,

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they are not usually utilized as a first course of treatment for RLS. These drugs may be helpful, as those centered on dopamine tend to lose their effect over time, requiring higher doses that may eventually cause more problems than they solve.

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