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New research confirms that sleep disturbances are linked to pain and depression, but not disability, among patients with osteoarthritis (OA).  Results from a new study found that poor sleep increases depression and disability, but does not worsen pain over time.

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Older women with disordered breathing during sleep were found to be at greater risk of decline in the ability to perform daily activities, such as grocery shopping and meal preparation, according to a new study led by researchers at the Johns Hopkins Bloomberg School of Public Health and the University of California, San Francisco.

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People with moderate to severe obstructive sleep apnoea may have an intrinsic inability to burn high amounts of oxygen during strenuous aerobic exercise, according to a new study led by researchers at University of California, San Diego School of Medicine.

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This webinar will be a clinical presentation in assessing a child who presents with snoring. Snoring is a very common presentation in childhood with some studies suggesting that up to 30% of children will snore at some point in their life. Within those that snore, there will be some who have obstructive sleep apnoea.

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Sleep apnoea may make it hard for you to remember simple things, such as where you parked your car or left your house keys, a small study suggests.

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Researchers believe that disrupted circadian clocks are the reason that shift workers experience higher incidences of type 2 diabetes, obesity and cancer. The body's primary circadian clock, which regulates sleep and eating, is in the brain. But other body tissues also have circadian clocks, including the liver, which regulates blood glucose levels.

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Restless Legs Syndrome

“Worms crawl under my skin if I don’t keep moving my legs”

“My legs decide they want to run and I have to follow”

“After I get in bed a gremlin grabs my legs and leads me around like a puppet”

These statements may sound bizarre or unbelievable to someone who haven’t experienced Restless Legs Syndrome (RLS), but the feelings are all too real for suffers of this disorder.

What is Restless Legs Syndrome?

Restless Legs Syndrome

Restless Legs Syndrome (RLS) is a movement disorder. Restless Legs Syndrome (RLS) is characterised by an irresistible urge to move and stretch your legs.  The more effort put in to keeping them still, the stronger the urge becomes to move them.  While symptoms vary, many people say their legs feel “creepy” or “crawly”.  This is quite different from the pain of a muscle cramp.

Symptoms of Restless Legs Syndrome

  • Uncontrollable urge to move legs
  • Uncomfortable feelings in the legs
  • Feelings of itching, crawling under the skin or pins and needles in the legs
  • Feeling of heat radiating from legs
  • Symptoms are worse when resting or inactive, especially sitting or lying down
  • Symptoms are relieved when you move your legs

Some people with RLS have symptoms only at certain times.  Others have them on a regular basis.

Problems associated with RLS

  • May prevent you from falling asleep or staying asleep, resulting in poor sleep quality
  • May experience tiredness during the day
  • Inability to perform well at work or take part in social activities
  • May experience difficulty travelling by car or airplane during the day due to being still
  • May interfere with your ability to stay seated at the movies, concerts and in business meetings
  • The sleep loss and disturbance of daytime activities can even lead to anxiety and depression.

Periodic Limb Movements (PLM)

Most people with RLS also have periodic limb movements (PLMs). These movements tend to consist of an extension of the big toe. This occurs together with an upward bending of the ankle, knee or hip. The movements are sometimes described as jerks or kicks.

PLMs occur at regular intervals. They usually happen every 20 to 40 seconds. They also tend to occur in clusters in the first half of the night. PLMs usually occur in the legs but may also affect the arms.

PLMs occur most often when you are asleep. You are unaware of them and have no control over them. On rare occasions you may notice the PLMs may cause movement when you are awake. They are an involuntary response to an uncomfortable feelings in your legs.

Like RLS, PLMs may contribute to poor sleep quality. These leg movements often cause you to briefly wake up from your sleep. These brief awakenings are called “microarousals”. They can cause your sleep to feel restless or disturbed.

You also may find yourself falling asleep easily during the day. This can occur while you are reading, watching TV, working or driving. PLMs also may disturb the sleep of your bed partner. He or she may complain of being kicked or bumped during the night. Your leg movements may also twist or pull the covers off the bed.

How Common is RLS?

RLS often appears in otherwise healthy people. It can occur at any age in both men and women. Between five and 15 of every 100 people have the discomfort of RLS at some time in their lives. It may come and go over the years without any obvious cause.  Studies show that more than 80% of people with RLS also have PLMs, but the majority of people with PLMs being the primary concern, do not have RLS.

RLS In Children

While it occurs more often in women and in older people, recent reports show that RLS can affect children. RLS in children may be called “growing pains” by mistake. Children with RLS also may be misdiagnosed with attention-deficit/hyperactivity disorder (ADHD).  RLS causes them to be restless and inattentive.

RLS In Pregnancy

RLS also can be severe during pregnancy, especially during the last six months due to hormonal changes and reductions in essential minerals in the blood.

Causes of RLS

RLS may be hard to describe, but it is not a psychological or emotional condition. Researchers are unsure of its exact cause. Current studies are focused on a brain chemical known as dopamine. Medications that increase dopamine in the brain have been effective at relieving RLS symptoms.

Some people have medical conditions that seem to increase the chance of developing RLS. These conditions include the following:

  • Low blood iron levels
  • Poor blood circulation in the legs
  • Nerve problems in the spine or legs
  • Muscle disorders
  • Alcoholism
  • Specific vitamin or mineral deficiencies

RLS Is Hereditary

RLS may also be inherited from a parent. If you have this form of RLS there is a good chance other members of the family are affected. About 50% of people with RLS who don’t have one of the medical conditions listed above have a family member with similar symptoms. This strongly suggests a genetic element for this disorder in some people. For unknown reasons, hereditary cases of RLS tend to more severe and harder to treat.

No matter what the cause, some medications may trigger RLS. These include over the counter allergy and cold medications. Caffeine, alcohol and tobacco use may make the condition worse.

How is RLS Diagnosed?

You may need to see a sleep specialist or neurologist who has expertise with RLS. Your doctor will base a diagnosis on a complete medical history and physical exam.

Additional tests may help determine if your complaints are related to another medical condition. These tests might include blood tests, x-rays or an overnight sleep study. Most of the time RLS symptoms are so unique that the diagnosis will be obvious.

Having all of these symptoms clearly indicates that you have RLS:

  • You have intense urge to move your legs
  • You have unpleasant sensations in your legs that you might describe with these words: creeping, crawling, pulling, tingling or electric feelings
  • Symptoms are worse when resting or inactive, especially when sitting or lying down
  • Moving your legs relieves the symptoms
  • Symptoms are worse in the evening or at bedtime

How is RLS Treated?

The first step in treating RLS is to see if you have any other conditions that are related to the problem. Other conditions that might be related to RLS include the following:

  • Iron deficiency anaemia
  • Diabetes
  • Arthritis
  • The use of medications

Detecting and treating these conditions may sometimes relieve the symptoms of RLS. For many people with RLS, their symptoms continue even after they receive treatment for other conditions. Other people may have the inherited a form of RLS that is not caused by any other disorder.

Home Remedies

Home remedies are enough to help some people with mild or occasional RLS. These remedies include:

  • Hot baths
  • Leg massage
  • Applied heat
  • Ice packs
  • Aspirin or other pain relievers
  • Regular exercise
  • The elimination of caffeine
  • Staying mentally active in the evening sometimes relieves symptoms. Try a crossword puzzle or play a board game (although stimulating the mind can sometimes hinder the initiation of sleep).

Prescription Medication

When symptoms are severe or home remedies are ineffective you can take prescription medications to treat RLS. Some people respond better to certain medications than to others, so your Doctor may have you try several drugs over a period of time.

Several factors will affect the success you have with any of these drugs. The severity of your condition will be important. Other medications that you take will also have an impact on your treatment success. All medications have potential side effects. A doctor needs to monitor carefully your treatment for RLS.

Tips On How to Sleep Well...

There are some general guidelines that help promote good sleep.

  1. Go to bed only when you are sleepy.
  2. If you are unable to fall asleep after about 20 minute, get out of bed. Leave your bedroom and do something relaxing. Come back to bed only when you are sleepy.
  3. Only use your bed for sleep, sex and to recover from illness.
  4. Wake up at the same time every day, including weekends and holidays.
  5. If you have trouble sleeping at night, avoid napping during the daytime. If you need to take a nap, make it less than one hour and take it before 3pm.
  6. Begin rituals to help you relax before bedtime, such as taking a warm bath or reading for a few minutes.
  7. Exercise on a regular basis, but do it earlier in the day.
  8. Maintain a regular daily schedule to keep your brain’s internal clock running smoothly.
  9. Eat a light snack before bedtime, but avoid a big meal.
  10. Avoid caffeine, alcohol and cigarettes late in the day.
  11. Set aside time during the day to get all of your worries out of your system.
  12. Avoid sleeping pills or use them cautiously under the supervision of a doctor.
  13. Never drink alcohol while taking sleeping pills or other medications.
  14. Talk to your doctor or a sleep specialist if you have an ongoing problem related to your sleep.
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