Pins and needles early mornings

[KateG]

Every morning at around 4.30am I am awoken by an unpleasant sensation of tingling/pins and needles.  It starts in my hands and breasts and then I can't keep still, especially my legs. It passes after a couple of minutes though sometimes it can happen 2 or 3 times. I am always very tired and when I am overly warm my energy evaporates.  I have had a couple of strange experiences with a severe buzzing through my body when I almost passed out.  Initial searches on the web ( my GP doesn't seem to have any idea or interest) took me to a MS site.  Any ideas most welcome. Thanks.

[Joanna Fong, MD]

Hi Kate.  Your symptoms of tingling sensation in your arms and legs can be due to two categories of disease processes:

1)  Peripheral nervous system (nerves outside your brain and spinal cord)
2)  Central nervous system (brain and spinal cord)

**The tingling sensation in your arms in the morning sounds very much like carpal tunnel syndrome (CTS).  The clinical features of CTS are variable, but usually include pain and numbness or tingling sensation in the thumb, first two fingers, and the radial-half of the ring finger (the distribution of the median nerve). These sensory changes may involve the entire palm area in some cases due to variable nerve innervation. In addition, pain may radiate proximally into the forearm, and occasionally to the shoulder.

Many patients experience pain at night and are awakened by abnormal sensations; they will typically report shaking their hand to return normal feeling. Activities associated with frequent or persistent flexion or extension of the wrist also often exacerbate the symptoms. Prolonged use, as in writing or working at a handcraft, may be followed by unbearable pain. Patients who are habitual clenchers (jaw, hand, rectum) and who drive long distances to work are more prone to work-related symptoms, particularly if the workplace is stressful.

Physical examination is usually normal early in the course of the disease. However, as the duration of nerve entrapment increases, flattening of the thenar eminence typically occurs. These patients may have thumb weakness and motor incoordination manifested by difficulty performing pinch-grasping, writing, or holding small utensils.

Current recommendations of the National Institute of Occupational Safety and Health (NIOSH) for work-related carpal tunnel syndrome are mainly clinical.  A detail neurological examination is often sufficient.  EMG/NCS (needle test for the nerve) can be done to confirm diagnosis and predict prognosis.  This can be done through the neurology department.

**As for as your leg symptoms, it can be also due to similar mechanism as CTS (i.e. nerve compression).  However, it can also be due to something called "Restless Leg Syndrome" (RLS).  In patient with RLS, although the subjective symptoms of RLS are often difficult to describe, the clinical features are highly stereotyped. The hallmark of RLS is a marked discomfort in the legs that occurs only at rest and is immediately relieved by movement. The abnormal feelings are typically deep seated and localized below the knees. Distribution is usually both sides, but some asymmetry may occur and the arms can be affected in more severe cases.

Terms that patients use to describe the symptoms include crawling, creeping, pulling, itching, drawing, or stretching, all localized to deep structures rather than the skin. Pain and tingling paresthesia of the type that occurs in painful peripheral neuropathy is usually absent, and there is no sensitivity to touching of the skin.

Symptoms typically worsen towards the end of the day and are maximal at night, when they appear within 15 to 30 minutes of reclining in bed. In severe cases symptoms may occur earlier in the day while the patient is seated, thereby interfering with attending meetings, sitting in a movie theater, and similar activities. In milder cases patients will fidget, move in bed, and kick or massage their legs for relief. Patients with more severe symptoms feel forced to get out of bed and pace the floor to relieve symptoms.

**Other possible causes for your symptoms (although less likely) are central.  MRI brain can be used to rule out diseases such as multiple sclerosis, stroke, tumor, vascular diseases, etc.  

THIS INFORMATION IS PROVIDED FOR GENERAL MEDICAL EDUCATION PURPOSE ONLY.  PLEASE CONTACT YOUR PHYSICIAN FOR DIAGNOSTIC AND TREATMENT OPTIONS OF YOUR SPECIFIC MEDICAL CONDITION.

[quillswriting]

Judging by the term GP you used I assume you're from the UK also?

I too get the same thing, I get pins and needles, buzzing sensations which are rythmic, among many other things.  My doctor is not interested either, after my many visits to see him about this and other symptoms he referred me to a psychiatrist insisting my problem was of a psychiatrict nature.  The psychiatrist whom I did see told me that my problem is neurological and luckily he specialised in M.E. etc... before he went into psychiatry.  He has written a letter to my doctor to recommend I see a neurologist and get an MRI done.

The central nervous system causes these sensations.  It can range from tension to MS.  (Not meaning to scare you) I have suspected MS with all of my other symptoms.  

But apparently anxiousness can cause it too and make CFS  (ME) and MS symptoms feel worse.

Can you change GP?
If not, try what I did, I contacted Cloverleaf Advocacy to get a medical advocate to help with my case.  They're a charity so they're free.  Their website is www.cloverleaf-advocacy.co.uk
Your GP will probably want to do blood work on you if you are experiencing paresthesias (pins and needles, tingling etc...) to rule other things out.  In the meantime, a suggestion for you, nerve damage and irritation causes paresthesias, try taking supplements like B12, the B Vitamins are good for energy but B12 also helps to repair the nerves.  They do regenerate themselves, but B12 is a good start, and it lifts your mood.

[KateG]

Thank you for that.  Yes I am from Manchester England. I have an appointment with my GP on Friday and will discuss these symptoms again.  If I get nowhere I will try the B Vitamins for a while before I do anything else.  I am also being treated for depression with dosulepin.  I have lost quite a lot of weight. I did wonder if the symptoms had anything to do with anxiety - this is particularly bad in the mornings when I wake up. Thankyou for taking the time to reply. What you have said is helpful. I wish you well in sorting out your own symptoms.  Please stay in touch.  Best wishes. KateG

[JonM]

I would just like to add that I have lost lots of weight too before and it caused me to sleep differently and experience pains, pinches and numbness while sleeping, in places I never felt before.  Also I would recommend that you make sure you're drinking alot keeping your fluids up, as being dehydrated can contribute to what you're describing.  Hope you feel better!

[KateG]

Hi JonM
Thank you for your reply. Have you been diagnosed with anything or are you still trying to sort out your symptoms? Do you still have the symptoms and are you still losing weight?  Thanks for the advice about fluids.  I know I don't drink as much as I should. Hope to hear from you again.  Best wishes.

[healthrequest]

Your hand symptoms sound more like carpal tunnel syndrome, as you describe the classic 'flick sign' in which you awaken and need to shake the hands out. This is due to sleeping with the hands in a position that compresses and compromises the median nerve. I'd recommend trialing wrist splints at night to see if the hand symptoms go away, if they do, then you likely have the diagnosis for the hands. Relating to the other tingling/buzzing complaints, they sound very nonspecific and therefore can be clumped into a psychosomatic type problem...but your discomfort is alway legitimate, regardless of the source. Good luck.

[JonM]

Yes I have MS, and what you describe is likely not MS.  MS usually gets worse as the day progresses and generally quiets down with rest and sleep. Also MS generally doesn't flucuate much on a daily basis, it cycles more over weeks and months, not from day to night. A good self test is to exercise vigorously and see if the symtoms worsen.  Not that it would mean its MS but if it doesn't then its likely not. I agree with the other poster about carpal tunnel.  Try sleeping with your hands out straight from your arm.  I too have this problem sleeping and laying my hands straight keeps them from going numb.  I'm in the US and am under the care of a Nuerologist.  I strongly recommend you see this type of specialist.

[tggktf4]

Hi i am 41 year old woman of 2 children. I just lost my mother one year ago to ms. She had it for 33years. I recently started with a tingling in my hands and feet. Slightly concerned. Saw my md he did not seem to concerned. Told him I have history. Still trying toi gief\ve my loss. He ordered a ncs test for upper extremities to rule out carpal tunnel syndrome. Doctor put me on cymbalta for anxiety and depression. Thats a little reassuring. Takes a few days before it kinda takes affect. I try to ride my recumbent bike 5 to 10 miles per day. Trying to relax just not working. toni................

[lyn123]

I have had pins and needless in my hands and feet too, since about May.  It started just in the hands, then to the feet. I started having weird sensations in my legs.  Sometimes they feel as if the blood is cold running through them.  I 1st had a nerve conduction test on my hand.  It ruled out Capal Tunnel.  Then had numerous blood test, thyroid, lyme disease, calcium, magnesium, all ok.  Then I had a MRI of the brain.  It was normal.  Finally I was told my B-12 was in the normal range but very low in the normal range.  So they are giving me B-12 shots each week for 6 weeks, then monthly.  I do feel some better.  Not as wierd feeling.  But it has not gone away.  Sometimes I wake up with my feet and hands numb and tingly.   But sometimes it starts during the day.  I was worried to about MS.  Still not convienced it is not.  Sometimes I feel very shacky and nervous.  Like I could jump out of my skin.  They say it could also be anxiety, and want me to go on Cymbalta.  I am not depressed.  I have 2 small children and I am only 37.  I go to the Gym and exercise.  This just hit me all of a sudden.  I feel like the Dr.s think I am just crazy.  Seems like they want to put all women on nerve pills.  I want it to be just the b-12, but worried that it is not.  One time I felt more tingly in my feet after walking, but then other times I was okay.  I am so confused, worried, and don't know what to do next.  Anyone with any suggestions?  Thanks.

[JonM]

Pins and needles in the feet and hands can be a MS symptom, but in the abscence of other symptoms, youwon't get a diagnosis.  Read up on the MS sites what the symptoms are ask yourself, and don't be a hypercondriac, wheather you have had things such as vision disturbances, significant muscle weakness, patches of numb skin, etc.  Truth is MS can be diagnosed with just a clinical history.  MRIs, and other tests are used more to rule out other things.  So if this is all that your experiencing then something else is gonna have to happen before a Nuerologist will dx you with it.  For many people getting a definite MS dx takes several episodes of disparate symptoms, usually over several years.

[lyn123]

Thanks for you input.  Very nice to know I am not alone.

[antigone's moon]

In 2001 I went to the doctor for headaches.  She scheduled an MRI and it came back with the following .


There are several lesions scattered in the ventricles  and cisterns,
in the white matter and the corpus callosum.

I had numbness for about a week in the winter of 2002.  I had more MRI's and more MS testing done and I was cleared.  I was a mystery to my neurologist.   I had a baby in 2002.  After the baby, more MRIs and nothing in the brain had changed.   Another baby 2005 (had to take hormones to get the monthly cycle started).  MRI's in 2006, lesions stayed the same.  Monthly cycle would not resume, much testing done.  All is okay,  so they put me back on the pill.  Within 2 days of taking the pill my arm went numb.  I was taken off the pill and the numbness stopped.  I am hoping it all had to do with the pill, but am still awaiting blood results.

They checked my reflexes and all was great.  They checked my strength level and eye coordination and that was great too.

Waiting is so dificult.  My neuro. did order a Lymme test and other autoimmune disorders.   I hope your doctors do as well.

[johnnnnie]

hi i have very similar episodes for 6 years i have slowly been getting tested as i suffer jerks and jolts right through my body. now i suffer numbness in hands and feet also with pins and neddles hands very stiff in the morning also bulging beats in different parts of body like spasms and views would be great ty

[ChelleH]

Hi, I am new to this site and was drawn to it because I to wake up a lot of mornings with pins and neddles in my hands and arms (only my arms when its bad) and also my feet and legs, also like a burning and numbing sensation when at its worst. I also get them when I am sitting and laying! I have had this for the past two years after spending a few weeks in bed ill with a nasty virus my GP said could have beeen viral meningitis! I also have other symptoms like tiredness and picking up coughs and colds every 6 weeks, basically my imune system isnt the best and I have gone from being a 3-4 times a week gym person to not a lot. I to along with my family had the fear that it could have been MS but after seing a Doctor I was referered to at the local hospital and having nerve conduction tests (not pleasant atall)I was diagnosed with ME/CFS.The doc said he didnt think it was MS because although I have the pins and needles and a lot of muscle aches and pain at times, there was no sign of muscle waste. It did take 9mths to be diagnosed though!