Monday 5 December 2016

Disturbing a good night’s sleep and leaving you exhausted

Nina Byrnes

Published 09/08/2016 | 02:30

Dr Nina Byrnes
Dr Nina Byrnes

Advice from our GP on what a tingly sensation in legs can mean and on how best to lose weight.

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Q. I get pins and needles and a tingly sensation in my legs constantly, and feel the urge to move them up and down or go for a walk. This happens when I’m sitting or even sleeping. What can this be?

Dr Nina replies: Restless leg syndrome (RLS) results in a strong urge to move the legs during periods of inactivity. It is most common in those of Northern European descent, and is more common in women than men. Moving legs provides relief from the discomfort. Constant moving can disturb sleep, leaving you and those who sleep with you feeling tired and unrefreshed the next morning.

RLS can run in families. In this type, symptoms may get worse and increase over time. If it appears after age 45, it is less likely to be familial and is not progressive.

Evidence suggests that RLS may be linked to a faulty use of, or inadequate, iron in the brain. Iron is used in the brain to help make dopamine, and changes in the level of this hormone can be associated with movement disorders such as those which occur in Parkinson’s disease.

Other conditions such as kidney disease, rheumatoid arthritis, pregnancy, iron deficiency anaemia, and nerve damage may increase the risk of RLS.

Certain medication such as those used for nausea, psychiatric illness, antihistamines and certain blood pressure tablets (calcium channel blockers) can also increase the risk of RLS. Alcohol, caffeine, sleeps deprivation, and tobacco may trigger symptoms in those susceptible.

There is no test to diagnose RLS. Symptoms must be worse at night and ease in the morning, cause an overwhelming urge to move the legs, triggered by rest, relaxation or sleep and relieved by movement. Blood tests may help rule out iron or other vitamin and mineral deficiency.

There is no cure for RLS, but if an underlying condition, medication, or deficiency is suspected, treating this or changing medication may relieve symptoms. Regular exercise, reducing caffeine and alcohol and avoiding tobacco can also help. Having a cool, comfortable sleep environment, maintaining a restful bedroom, and going to bed and getting up at the same time are really important.

Mentally stimulating activities such as crossword puzzles or games before bed may help alleviate symptoms. In some people, taking supplements of iron, folic acid, B vitamins or magnesium can be helpful.

When symptoms occur, walking, rubbing or massaging the legs, applying hot or cold packs, or having a warm bath can help.

If lifestyle measures are unhelpful, medication is sometimes prescribed. Drugs used to treat Parkinson’s disease may relieve symptoms, but in some cases after prolonged use RLS returns and may be worse. Other remedies include muscle relaxants, sleep medication, painkillers or antiepileptics. Quinine has traditionally been used as a remedy for RLS but, it is most effective in reducing cramps rather than the urge to move the legs.

RLS, although troublesome, is not associated with any serious complications, or risk of other neurological disease. Although the symptoms are unusual, this is a real and often debilitating condition. As our understanding grows, treatments will hopefully continue to improve.

Q. I am overweight but  determined to turn that around. I keep getting different advice about the best diet to follow - it’s hard to decide which one is best. Have you any helpful tips or advice?

Dr Nina replies: You must take in fewer calories than you burn in order to lose weight. Eating all food groups is important for your health and well-being. The long-term commitment to change is what will sustain the weight loss. Portion control is important. Super-sizing bars and meals leads to overeating.

Appetite is acquired early in life. Research has shown that breastfed babies tend to be a healthier weight in adulthood. This may be due to the fact that they self regulate what they take at each feed from birth. We know that obese children are more likely to become obese adults. A parent’s example as regards diet is vital.

Metabolism and exercise play a role in how we burn energy and calories. If your body goes hours without food, your metabolism will slow down to compensate, so starving yourself or skipping meals is counterproductive.

Eating regularly through the day is important. Those who eat breakfast tend to be thinner than those who don’t. Eat three meals and two small snacks. Exercise is essential not just for the calories burned while exercising, but also for the boost to metabolism sustained after. It can take many forms, being anything from household tasks to formal gym sessions. Varying the type and intensity keeps it from being boring.

The single most important factor in any lifestyle change is to keep it realistic. Setting achievable goals leads to a sense of success. Aiming for an initial 5pc to 10pc weight loss is statistically proven to reduce your risk of obesity related illness even if you are still overweight at this goal.

Don’t go to extremes. It took years to gain the weight and it will take time to lose it. Slow and steady wins the race.

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