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Are you at risk for Willis-Ekbom disease?

April 1, 2018
Diabetes is a widespread disease with sometimes severe consequences for the oral cavity and the body as a whole. Now, in 2018, dental practices have a CDT code for chairside HbA1c screenings, D0411. Jamie Collins, RDH, CDA, herself a diabetes patient, shares just how much this change means, and what you can do to help patients catch diabetes sooner.
I am a hygienist, and there’s something you need to know.
I have restless legs syndrome.

By Marylou Barnes-Bartkiewicz, RDH, BS

What? You’ve never heard of it? Neither had I, but it turns out years of sitting in the job I loved as a dental hygienist, among other underlying factors, may have contributed to it. It’s also known as restless legs syndrome (RLS), and it is estimated to affect about one in 10 people in the US, with a higher incidence among women. It’s more common than type 2 diabetes. We may have witnessed one of our patients wriggling in the dental chair and assumed it was either anxiety or ADHD. Descriptions such as feeling “creepy crawly,” on “pins and needles,” or having “electrical sensations” deep in the legs when at rest or trying to sleep are common. It’s actually a neuromuscular disturbance of unknown etiology. Almost all of us would attest to having these types of symptoms occurring occasionally, perhaps during pregnancy or maybe on a long flight, and simply getting up and moving around relieves the symptoms.

However, if it becomes a chronic condition, the very act of “relieving it” regularly robs the person of much-needed sleep. People with chronic RLS often cannot sit for extended periods and will typically walk around the house for hours at night instead of sleeping. We’ve seen the research, which clearly shows how sleep deprivation can ruin your health, life, and family. I was encouraged to write my story in the hope that this article will raise awareness of this syndrome for my fellow dental hygienists and others whose occupations require long periods of time in the seated position, and so that we might recognize this syndrome in ourselves as well as in our “restless” patients.

Symptoms of restless legs syndrome (Willis-Ekbom disease) include:

• The strong need to move your legs that you cannot resist.
• Uncomfortable sensations deep in the legs described as electrical impulses, creepy crawly, or achy.
• Symptoms start or worsen at times of rest, which interferes with sleep.
• Movement of legs relieves symptoms, and symptoms return when movement is discontinued.
• No other medical condition can explain the symptoms.

For me it began as a teenager, which is not the norm. Evidently, I was predisposed, because most often patients develop symptoms after the age of 40. I had no name for it and wasn’t even fully aware of the reason I kept waking up and needed to get out of bed and move. In the 1970s (now you can guess I’m a bit “seasoned”), teenagers didn’t have easy access to information as we do today. It wasn’t until many years later that I looked back and understood what was happening to me. A few years later, during pregnancy, I developed varicosities that likely worsened the RLS. As years progressed, I continued to experience the annoying sensations and resulting sleep disturbance that I jokingly called “the bugs,” because that was the only way I could describe it. Google hadn’t been invented (now you really know I’m a relic), but I had discovered on my own that prioritizing cardio exercise four to five times a week helped, so that became my solution. Until it wasn’t.

Fast forward 20 years. While symptoms worsened, I discovered online that my symptoms actually had a name and I wasn’t alone! I discussed the problem with my doctor. However, since the frequency was “only” about 10 times a month, he recommended waiting to begin medication and to try other alternatives. That began the 10-year journey of poring over every piece of literature I could find, lots of out-of-pocket expenses on alternative treatments, and lifestyle and dietary changes. During this time, I made some progress in reducing the need to march around the house for hours in the middle of the night, and for a while this strategy worked. Until it didn’t.

I was encouraged to write my story in the hope that this article will raise awareness of this syndrome for my fellow dental hygienists and others whose occupations require long periods of time in the seated position, and so that we might recognize this syndrome in ourselves as well as in our ‘restless’ patients.

About a year ago, the symptoms suddenly increased to more than 20 nights a month, meaning that there were many nights with almost no sleep, and I was on the verge of losing my mind. Unfortunately, RLS symptoms increase with age. I broke down and began taking one of the available medications, which is also commonly used for other neuromuscular diseases such as Parkinson’s disease. The unfortunate reality is that for most patients, the medications that are currently available only work for a while, requiring a continuous increase in the dosage. When that no longer works, one must switch to new medications, often enduring severe rebounding symptoms coming off one medication and changing to the next. For long-term sufferers, opioids are the last resort.

Why is it that so little is known about something that affects so many? Often, it’s unrecognized or misdiagnosed, and then finally the diagnosis is made 10 to 20 years after the symptoms began. Even after the diagnosis of this potentially life-altering problem is made, suffering people often keep it to themselves.

Why? It almost sounds silly to complain about having “restless legs” when others around us have more serious, potentially life-threatening diagnoses. Meanwhile, the lack of sleep severely affects one’s health because, similar to the effects of sleep apnea, it often leads to fatigue and weight gain, high blood pressure, diabetes, and cardiovascular disease. Lack of sleep also contributes to difficulties in relationships and cognitive ability, and for some, results in the inability to work. All of these issues can lead to financial problems, depression, and anxiety.

For those in my chosen profession, my hope in writing this article is to raise awareness of this syndrome and encourage hygienists to make small changes in their lives to possibly help prevent RLS from happening to them. So how can we prevent RLS? Unfortunately, there are no prescribed recommendations that I’ve found yet. The best we can do at this point is note the conditions commonly associated with RLS and try to prevent those if possible. For instance, avoiding the medications listed on the RLS website may be helpful. In addition, while varicose veins aren’t proven to cause RLS, it is common in the history of many patients who are later diagnosed with RLS. For that reason, as well as for overall health, it’s a good idea to reduce the risks of developing them.

Thankfully, much research has been done for our profession to improve traditional dental seats and to reduce the problems they cause. The invention of the saddle stool provides a much better support system. As Cindy Purdy, RDH, CEAS, professional relations manager for Crown Seating explains, “There have been many options and changes in seat designs ... with hopes of increasing blood flow. The elevated seating position of a saddle stool allows for a more open position much more than a traditional seat, thereby allowing an increase of blood flow to lower extremities.”

It makes sense that better seats which improve circulation may be one way to reduce the risk of varicose veins. In addition to proper seating, wearing (the dreaded) compression stockings or “sleeves,” elevating legs, and even massage therapy may help reduce the risk of varicose veins. Because the history of being sedentary is a common finding in those diagnosed with RLS, prioritizing movement during the workday is highly recommended as well. Though going to the gym three to four times a week is important for overall health, it unfortunately can’t undo the consecutive hours of sitting in clinical dental hygiene. Rather, taking a walk at lunchtime, and impractical as it sounds, marching in place and stretching between patients is important. Scary as it sounds, research is showing that “sitting is the new smoking.”

Recommendations to reduce health risks due to extended periods in a seated position:

• reduce risk of varicose veins by use of proper seating, compression stockings or sleeves; avoid sitting with legs crossed; elevate legs
• make an effort to intersperse movement/stretching in various ways during hours of sitting to rejuvenate the body and promote circulation
• cardio exercise at least three to four times a week
• massage therapy

These suggestions are simply ones I’ve deduced from many years of research, but hopefully there will someday be actual documented ways to prevent RLS. Much scientific research is still needed to find etiology, improve treatments, and find a cure for RLS. If you believe you have this syndrome, are experiencing “creepy crawly” or electrical sensations deep in your legs when at rest, and your sleep is adversely affected from it, talk with your doctor.

The RLS website recommends having your iron (ferritin) level checked, having a sleep study, and getting properly diagnosed, so you can then work on finding ways to alleviate the symptoms and restore sleep. For some, simply raising the iron (ferritin) level reduces symptoms. Your doctor may recommend avoiding particular antihistamines and antidepressants known to trigger RLS symptoms. In addition, some RLS patients discover reducing or eliminating alcohol, caffeine, tobacco, flour, or sugar to be helpful. Many find alternative medicine therapies, such as acupuncture and massage, beneficial, as well as yoga and stretching. However, if those changes aren’t enough, your doctor may prescribe one or a combination of several available medications. There’s likely to be much trial and error, but the goal of restoring healthful sleep is paramount in order to reduce serious illnesses that can result from sleep deprivation.

Current treatments/lifestyle changes to reduce symptoms and restore sleep:

• raising ferritin levels in the blood
• reduction or elimination of caffeine, alcohol, smoking, flour, sugar
• reduction or elimination of certain medications, with doctor’s approval
• stretching/movement throughout the day
• exercising throughout the week
• alternative medicinal therapies
• pharmaceutical therapies

For a more complete explanation and information, go to rls.org.

Marylou Barnes-Bartkiewicz, RDH, BS, is an Oral Care Specialist for Hylife Oral Health Alliance.