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Resting Easy with RLS

Slept Bed RLS Pro2 LLC Buffalo NYDoctors Christopher J. Lettieri and Arn H. Eliasson acknowledge the irony in their treatment for restless legs syndrome (RLS). While the sleep disorder is generally precipitated in patients by inactivity such as sitting or lying, patients who undergo the duo’s treatment are required to remain still for at least an hour to reap the benefits.

In two studies, the MDs at Walter Reed National Military Medical Center (Eliasson has since retired) showed that pneumatic compression devices (PCDs), the same ones that prevent deep vein thrombosis, can alleviate RLS symptoms in patients and even completely resolve the disorder in some people. “Because of the available treatments for RLS, we were looking for something different. The pharmacological treatments are largely effective but have side effects, plus some people can’t tolerate them,” says Lettieri, who is the Program Director of Sleep Medicine at Walter Reed and a Professor of Medicine at Uniformed Services University. “And the medications can cause other problems, such as fragmenting sleep. So sometimes you’re treating one sleep disorder but causing a different one. We were looking for a nonpharmacotherapy.”

The solution came in the form of an air pressure generator that’s approximately the size of a large toaster. The doctors employed Aircast VenaFlow PCDs in their large-scale study, although Lettieri says many other brands will yield the same results. Once the PCD is plugged in, flexible hoses carry compressed air to plastic bladders embedded in soft cloths wrapped around the patient’s lower legs. Patients easily don them at home in less than 30 seconds. “They’re pretty simple,” Lettieri says.

In one study, the PCDs were programmed to inflate the leg wraps for 5 seconds every minute. The therapeutic devices generated 40 cm H2O of air pressure with each inflation cycle, while the “sham” devices generated a 3- to 4-cm H2O pressure rise. Participants were instructed to wear them for 1 hour in the evening. The results were astounding. More than a third of subjects using therapeutic PCDs experienced a complete resolution of symptoms,1 while none using sham devices experienced complete remission. Subjects with more severe RLS experienced greater symptom reduction. After unblinding, therapeutic devices were provided to eight subjects, and three patients purchased commercially available, similar devices.

“It worked great,” Lettieri says. “People discontinued their medication without any rebound symptoms. Every measured variable, such as quality of life and daytime function, got better.” An intriguing residual benefit also came to light. While some patients’ symptoms returned within a few days of discontinuing PCD use, others reported continued improvement for weeks, even when not using the device. The cause for the residual effectiveness remains unknown. Lettieri cautions that at a point, each patient needed to return to using the PCD as symptoms came back.

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Roy, Sree. (2014, February 27). Resting Easy with RLS. Sleep Review Magazine. Retrieved April 15, 2014 from http://www.sleepreviewmag.com/2014/02/resting-easily-rls/.