HUZURSUZ BACAK SENDROMU TEDAVİSİNDE GENEL BİR YAKLAŞIM / A GENERAL APPROACH TO THE RESTLESS LEG SYNDROM

Sample person: A lady of 28 years old.

Complaints: The legs feel extremely uncomfortable, typically in the evenings while she is sitting or lying down. It makes her feel like getting up and moving around. When she does so, the unpleasant feeling temporarily goes away.

The symptoms can disrupt sleep, leading to daytime drowsiness and make traveling difficult.

The patient describes symptoms as unpleasant sensations in the calves, thighs or feet. Sometimes the sensations may be in the arms, often expressed as crawling, creeping, pulling, throbbing, itching, pain, tugging, burning, the desire to move or handle the legs, onset during inactivity, relief by movement, less bothersome during the day and are felt primarily at night, night-time leg twitching.

She experiences heavy menstrual periods, She has iron deficiency, no bleeding from your stomach or bowels,  no kidney failure which decreases iron stores in the blood.

Having There is no RLS in the family, no peripheral neuropathy-diabetes and alcoholism. We, in consideration of some studies, suspect that the condition may be due to an imbalance of the brain chemical dopamine. This chemical sends messages to control muscle movement.  caffeine, no typical exercise program.

On listening to this symptoms, we decided that she suffers from restless legs syndrome (RLS).

She has a complete blood test. The patient was also checked for diabetes, anaemia, uraemia, alcoholism and rheumatoid arthritis because these are all associated with the condition.

7. Therapeutics/Results:
8. Advil , (2400 mgperday),
9. Ropinirole (Requip) (4 mg once Daily-3 hours before bedtime).
10. Suggested Supplementation/Treatments:
11. Supplements:
12. a) Zindum Metallicum 6C for over-stimulated nervous system.
13. b) Calcium, 500 mg, 3 times a day after meals and bed time, use calcium lactate form if you are not allergic to dairy products or calcium chalate form
14. c) Magnesium, 1000 mg Daily, needed to balance with calcium and relax the muscles.
15. d) Melatonin, start with 1,5 gr Daily, taken 2 hours or less before the bedtime. If this is not effective, gradually increase the dosage until an effective level is reached (up to 5 mg Daily).
16. e) Vitamin B complex 400 mg, (as directed on the label, to help promote a restful state)
17. f) Panthothenic acid (Vitamin B5), 50 mg Daily, good for relieving stress.
18. g) Inositol, 100 mg Daily at bedtime, to enhance REM sleep.
19. h) Nacinamide, 100 mg Daily, 100 mg Daily, promotes serotonin production.
20. h) Vitamin C with bioflavonoids, 500 mg Daily, to reduce stress.
21. i) Zinc, 15 daily, to aid recovery of body tissues while sleeping
22. j) Iron (500 mg/day).
23. k) Folic acid (600 mg/day).
24. l) Dehydroepiandesterone (DHEA) hormone and 5-Hydroxy L-tryptophan (5-HTP)
25. m) Vitamin E, 200 IU/day

II: Herbs

1. California poppy, hops, kava kava- especially for stress and anxiety, lemon falm, passion flower, scullcap and valarian root will be used in rotation.
2. The combination of California poppy, passion flower and valerian, to promote sound sleep and beneficial REM sleep. California poppy and chammomile, to strenghten the nervous system before the bedtime

III. Diet:

1. In the evening, eat bananas, dates, figs, milk, nut butter, tuna, turkey, whole grain cracker or yougurt. These foods are high in tryptophan, which promotes sleep, eating grapefruit half at bedtime also helps
2. Do not eat large and heavy meals two hours before bedtime.
3. Cut back on or eliminate caffeine, alcohol and tobacco, chocolate and caffeinated beverages, such as coffee, tea and soft drinks especially 4 to 6 hours before bedtime. Nicotin is actually a neurostimulant and can cause sleep problems.
4. Avoid bacon, cheese, chocolate, eggplant, ham, potatoes, saurcraut, sugar, sausage, spinach, tomatoes and wine close to bedtime. These foods contains tyramine, which increases the release norepinephrine, a brain stimulant.
5. Avoid nasal dicongestants and cold medicications before the bedtime. They may have drawsiness but also opposite effect for some people

1. Moderate, regular exercise not later than 4 p.m. Take it easy, don’t resist the need for movement. Stand while you work or read. Begin and end the day with stretching exercises or gentle massages. And:

• Massage legs while soaking in a warm bath. Warm and cool packs in turn.
• No stress. Try relaxation techniques, such as meditation or yoga.
• Good sleep hygiene.
• Keep controlling the blood pressure

9) Notes for further consideraiton

1. Establish a set of habits and follow them consistently among them:
   1. To follow a regular sleep schedule.
   2. To take a cognitive behavioral therapy.
   3. Do not remain passively awake.
   4. To take a Stimulus Control Therapy.
   5. To take a relaxation training.
   6. To record the biofeedback.
   7. To keep a sleep diary.
   8. Avoid of napping.

Take into consideration those given below for a better sleep;

1. Find ways to relax.
2. Make the bed comfortable.
3. Create a sleep-friendly space in your bed room.
4. Hide the clocks.
5. Get out of bed if you’re not sleeping.
6. Use your bed and bedroom only for sleeping or sex.
7. Spend a little time in the sun.
8. Exercise and stay active.
9. Drink less before the bedtime.
10. Have a comfortable bed room.
11. Manage stress of daily life.
12. Have a routine and enough relaxing bedtime.
13. Prevent interruptions in the sleep.
14. Tai chi and Yoga will help to relax.
15. Don’t skip meals, especially breakfast. Change your eating habits.
16. Don’t go to bed hungry. Avoid large, high-fat meals late in the day.
17. Learn problem-solving skills.
18. Be social.

IIII. A consultation from neurologist is recommended.