Restless Legs Syndrome and Related Disorders - Diagnosis

Diagnosis

A diagnosis of restless legs syndrome or nocturnal leg cramps often relies solely on the patient's description of symptoms. In general, the recommended approach is first to take a sleep and personal history. The doctor may conduct an interview that includes the following questions:

• How would the sleep problem be described?
• How long has the sleep problem been experienced?
• How long does it take to fall asleep?
• How many times a week does it occur?
• How restful is sleep?
• What are the leg problems like (cramps, twitching, crawling feelings)?
• What is the sleep environment like? Noisy? Not dark enough?
• What medications are being taken (including the use of antidepressants and self-medications for insomnia, such as herbs, alcohol, and over-the-counter or prescription drugs)?
• Is the patient taking or withdrawing from stimulants, such as coffee or tobacco?
• How much alcohol is consumed per day?
• What stresses or emotional factors may be present?
• Has the patient experienced any significant life changes?
• Does the patient snore or gasp during sleep (an indication of sleep apnea, a condition in which breathing stops for short periods many times during the night and which may worsen symptoms of restless legs syndrome or insomnia)?
• If there is a bed partner, is his or her behavior distressing or disturbing?
• Is the patient a shift worker?

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Keeping a Record of Sleep. To help answer these questions, the patient may need to keep a sleep diary. Every day for 2 weeks, the patient should record all sleep-related information, including responses to questions listed above described on a daily basis. Recording sleep behavior using an extended-play audio or videotape can be very helpful in diagnosing sleep apnea.

A bed partner can help by adding his or her observations of the patient's sleep behavior.

Sleep Disorders Centers

In some cases of an uncertain diagnosis, high-risk patients may need to consult a sleep specialist or go to a sleep disorders center. At most centers, patients undergo an in-depth analysis, usually supervised by a multi-disciplinary team of consultants who can provide both physical and psychiatric evaluations. Centers should be accredited by the American Academy of Sleep Medicine.

Among the signs that may indicate a need for a sleep disorders center are: