Take Action in the Fight Against Restless Legs Syndrome
Restless legs syndrome (RLS) is a condition that causes an uncontrollable urge to move the legs, usually because of an uncomfortable sensation. It typically happens in the evening or nighttime hours when you’re sitting or lying down. Moving eases the unpleasant feeling temporarily.
Restless legs syndrome (RLS), also called Willis-Ekbom disease, is a sleep disorder that causes an intense, often irresistible urge to move your legs (and even your arms or body). It occurs along with other sensations in your limbs described as pulling, creeping, tugging, throbbing, itching, aching, burning or crawling.
People of any age, including children, can have RLS. Symptoms of RLS may begin in childhood or adulthood, but the chance of having the syndrome increases significantly with age. RLS is more common in women than in men. Up to 10 percent of the United States population has RLS.
Restless legs syndrome (RLS) has been found to be a genetic syndrome in some cases, meaning that parents with RLS can pass it down to their children. Up to 92% of patients with RLS have a first-degree relative with the disorder. These patients tend to develop symptoms earlier in life (before age 45) than those with RLS without the genetic link.
Symptoms of restless legs syndrome include:
Leg (or arm) discomfort.
Urge to move legs (or arms).
Sleep disruption.
Bedtime behavior problems.
Behavior and work performance problems.
RLS is generally a lifelong condition for which there is no cure. However, current therapies can control the disorder, minimize symptoms, and increase periods of restful sleep. Symptoms may gradually worsen with age, although the decline may be somewhat faster for individuals who also suffer from an associated medical condition. A diagnosis of RLS does not indicate the onset of another neurological disease, such as Parkinson’s disease.
In addition, some individuals have remissions—periods in which symptoms decrease or disappear for days, weeks, months, or years—although symptoms often eventually reappear. If RLS symptoms are mild, do not produce significant daytime discomfort, or do not affect an individual’s ability to fall asleep, the condition does not have to be treated.
Symptoms:
The chief symptom is an urge to move the legs. Common accompanying characteristics of RLS include:
- Sensations that begin while resting. The sensation typically begins after you’ve been lying down or sitting for an extended time, such as in a car, airplane or movie theater.
- Relief with movement. The sensation of RLS lessens with movement, such as stretching, jiggling the legs, pacing or walking.
- Worsening of symptoms in the evening. Symptoms occur mainly at night.
- Nighttime leg twitching. RLS may be associated with another, more common condition called periodic limb movement of sleep, which causes the legs to twitch and kick, possibly throughout the night, while you sleep.
People typically describe RLS symptoms as compelling, unpleasant sensations in the legs or feet. They usually happen on both sides of the body. Less commonly, the sensations affect the arms.
Message UsRestless Legs Syndrome Causes
Chronic diseases.
Certain long-term medical conditions include RLS symptoms, including iron deficiency, Parkinson’s disease, kidney failure or renal disease, diabetes, and peripheral neuropathy.
Medications.
Some drugs might make symptoms worse, including anti-nausea meds, antipsychotics, some antidepressants, and cold and allergy medications that have antihistamines.
Pregnancy.
Some women have RLS during pregnancy, especially in the last trimester. Symptoms usually go away within a month after delivery.
Lifestyle.
A lack of sleep or another sleep disorder like apnea can trigger symptoms or make them worse. So can alcohol, tobacco, and caffeine use.
Restless Legs Syndrome
How is restless legs syndrome (RLS) diagnosed?
Unfortunately, there is no specific test for restless legs syndrome (RLS). The diagnosis is made based on your symptoms. A medical history, complete physical and neurological exam and blood tests may be conducted to rule out any other possible health problems associated with RLS. An overnight sleep study may be recommended to evaluate for other sleep disorders, especially obstructive sleep apnea.
Your healthcare provider will ask about any family history of RLS. They will also ask if you have any sleep complaints, such as insomnia (difficulty falling asleep or staying asleep) due to your symptoms. Your healthcare provider will also ask if you have trouble staying awake during the day and ask about other behavior or work performance problems.
To confirm a diagnosis of RLS, you must meet the following five criteria:
- Have an urge or desire to move your legs (or arms), usually occurring together with uncomfortable sensations such as pulling, tugging, crawling, itching, aching, or burning.
Also, the urge to move or uncomfortable sensations:
- Begin or worsen during periods of rest or inactivity.
- Are partially or totally relieved by activities such as stretching, walking or exercising the affected muscles.
- Are worse or occur solely in the evening or at night.
- Are not solely due to another medical or behavioral problem.
How is restless legs syndrome (RLS) treated?
Treatment of restless legs syndrome depends on the intensity of the symptoms. Treatment should be considered if quality of life is affected by insomnia and excessive daytime drowsiness. In cases of RLS due to ongoing medical disorders, specific treatment is also necessary.
Non-drug treatments. Non-drug treatments are tried first, especially if symptoms are mild. Non-drug treatments include:
- Getting regular exercise, such as riding a bike/stationary bike or walking, but avoiding heavy/intense exercise within a few hours of bedtime.
- Following good sleep habits, including avoiding reading, watching television or being on a computer or phone while lying in bed; getting 7 to 9 hours of sleep and following other healthy sleep habits. Not getting enough sleep can worsen RLS symptoms.
- Avoiding or limiting caffeinated products (coffees, teas, colas, chocolates, and some medications [check labels]), nicotine, and alcohol.
- Applying a heating pad, cold compress, or rubbing your legs to provide temporary relief to the leg discomfort. Also consider massage, acupressure, walking, light stretching or other relaxation techniques.
- Soak in a warm tub.
- Try magnesium supplements. They may be helpful.
- Reduce stress as much as possible. Try meditation, yoga, soft music or other options.
Iron supplementation. Iron deficiency is a reversible cause of RLS. If blood tests reveal you have low iron levels, your doctor may recommend taking an iron supplement.
Prescription medications. When RLS symptoms are frequent or severe, your healthcare provider will likely prescribe medications to treat the disorder. Medications options include:
- Dopamine agonists control the urge to move, sensory symptoms in the legs, and reduce involuntary leg jerks in sleep. Ropinirole (Requip®), pramipexole (Mirapex®) and the rotigotine patch (Neupro®) are the FDA-approved dopamine agonists used for RLS.
- Anti-seizure medications can slow or block pain signals from nerves in the legs. Examples include gabapentin enacarbil (Horizant®), gabapentin (Neurontin®) and pregabalin (Lyrica®). These drugs are particularly effective in patients with painful RLS due to neuropathy. Gabapentin enacarbil is the only medication in this class that is FDA-approved for RLS. However, the others may be effective.
- Benzodiazepines, clonazepam (Klonopin®) in particular, are sometimes prescribed for RLS but are usually reserved for more severe cases due to their addictive potential and side effects including daytime drowsiness.
- Opioids, such as methadone or oxycodone, can be used to relieve symptoms of RLS but because of the risk of addiction, they are usually not prescribed unless the case is severe and other medications have not been effective.
Living with Restless Legs Syndrome
Restless Legs Syndrome Prognosis
Restless legs syndrome is a lifelong condition that might get worse with age. But some people go into remission and don’t have symptoms for days to years.
Keep your doctor updated on how you’re doing. If you start to feel worse, they might suggest different lifestyle changes or medications.
It can help to talk to other people who know what you’re going through, whether it’s a family member who has RLS or a support group.
Risk factors
RLS can develop at any age, even during childhood. The condition is more common with increasing age and more common in women than in men.
RLS usually isn’t related to a serious underlying medical problem. However, it sometimes accompanies other conditions, such as:
- Peripheral neuropathy. This damage to the nerves in the hands and feet is sometimes due to chronic diseases such as diabetes and alcoholism.
- Iron deficiency. Even without anemia, iron deficiency can cause or worsen RLS. If you have a history of bleeding from the stomach or bowels, experience heavy menstrual periods, or repeatedly donate blood, you may have iron deficiency.
- Kidney failure. If you have kidney failure, you may also have iron deficiency, often with anemia. When kidneys don’t function properly, iron stores in the blood can decrease. This and other changes in body chemistry may cause or worsen RLS.
- Spinal cord conditions. Lesions on the spinal cord as a result of damage or injury have been linked to RLS. Having had anesthesia to the spinal cord, such as a spinal block, also increases the risk of developing RLS.
- Parkinson’s disease. People who have Parkinson’s disease and take certain medications called dopaminergic agonists have an increased risk of developing RLS.
Complications
Although RLS doesn’t lead to other serious conditions, symptoms can range from barely bothersome to incapacitating. Many people with RLS find it difficult to fall or stay asleep.
Severe RLS can cause marked impairment in life quality and can result in depression. Insomnia may lead to excessive daytime drowsiness, but RLS may interfere with napping.
