Restless Legs Syndrome

Written by Zulekha Nishad

Last Updated June 13, 2024

kaneesha allen Fact checked by Kaneesha Allen

Do you have trouble sleeping at night? Do you find yourself constantly shifting your legs, unable to find a comfortable position? If so, you may be suffering from Restless Legs Syndrome, or RLS for short. In this article, we'll take a closer look at what RLS is, what causes it, and, most importantly, what you can do to manage the symptoms and get a good night's sleep.

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Key Takeaways:

  • Restless leg syndrome can significantly impact daily routines and sleep quality.
  • It's the sensation of creeping, burning, tingling, or pulling in the legs.
  • RLS symptoms can extend to other body parts like the arms, head, and trunk of the body, causing discomfort.
  • Treatment for restless legs syndrome usually includes lifestyle adjustments that limit caffeine, regular physical exercise, good sleep hygiene, and medication like iron supplements, dopamine agonists, and gabapentin to manage symptoms.
restless legs syndrome

 

What is Restless Leg Syndrome?

Restless Legs Syndrome (RLS), also called Willis-Ekbom disease, is a common neurological disorder. It is characterized by an intense urge to move specific body parts, primarily the legs, to relieve uncomfortable sensations during periods of rest, sitting, or sleeping. RLS can worsen with age and lead to sleep disruption, making it difficult to fall asleep and stay asleep.

Although restless legs syndrome may present in childhood, it is often misdiagnosed as attention deficit disorder or growing pains, and the correct diagnosis may not be made until later in life.

The condition is often accompanied by Periodic Limb Movement Disorder (PLMD), where repetitive, involuntary limb movements occur during non-REM sleep, causing further sleep disruption and worsening sensory symptoms.

While there is no cure for RLS or PLMD, various treatment options and support services, such as the Restless Legs Syndrome Foundation, are available to help individuals manage their symptoms and improve their quality of life.

Symptoms of Restless Legs Syndrome

The major symptoms of restless legs syndrome include:

  • An irresistible urge to move the legs often accompanied by an uncomfortable sensation that can be described as creeping, crawling, tingling, or burning.
  • Discomfort that worsens when resting or sitting and improves with movement or stretching.
  • Difficulty falling asleep or staying asleep.
  • Repetitive, involuntary limb movements during sleep (known as Periodic Limb Movement Disorder, or PLMD) that can cause further sleep disruption and exacerbate RLS symptoms.
  • Fatigue and daytime drowsiness due to poor quality sleep.
  • Reduced concentration, memory, and productivity.
  • Mood changes, anxiety, and depression.

The severity of symptoms can vary from person to person and may fluctuate in intensity and frequency. RLS symptoms are typically most severe in the late afternoon or early evening, but they can also occur when a person sits still for long periods, such as during an exam or while watching a movie.

symptoms of rls

Causes of Restless Legs Syndrome

The causes of RLS are not fully known, but there are two main types or categories of RLS: primary and secondary, which have different causes and risk factors.

Primary RLS, which accounts for most cases of RLS, has no identifiable cause, and its onset is often hereditary. However, researchers think that it could be related to abnormalities in brain chemicals, such as dopamine or iron deficiency.

Secondary RLS is when another medical condition causes restless leg syndrome. These include iron-deficiency anemia, pregnancy, kidney failure, peripheral neuropathy, or the use of certain medications. In such cases, treating the underlying medical condition may help alleviate the symptoms.

Below, we have mentioned in detail a few factors that are related to RLS:

  1. Genetic Factors

When a person develops restless legs syndrome at a young age, it may be caused by genetic factors. Research shows that people with an early onset of RLS have as many as 60% of their first-degree relatives affected by the same. However, people who develop RLS later in life tend to have other underlying causes.

  1. Neurotransmitter Imbalance

Since it is a neurological disorder, another leading cause suspected is an imbalance of neurotransmitters, especially dopamine. RLS is linked with lower dopamine levels, which causes muscle spasms and involuntary muscle movements. This may also explain why RLS symptoms tend to occur more during the evening. Dopamine levels naturally decrease towards the end of the day, which may cause the symptoms to worsen.

  1. Spinal cord conditions

Restless Legs Syndrome (RLS) symptoms have been linked to spinal cord lesions caused by damage or injury. Taking spinal cord anesthesia, such as a spinal block, could increase the risk of developing restless legs syndrome.

  1. Iron Deficiency

Restless Legs Syndrome can also be caused by iron deficiency, which arises from the brain's limited capacity to absorb iron from the bloodstream and transfer it to the neurons. This deficiency can have various impacts on the body, such as controlling dopamine levels, which leads to Restless Legs Syndrome.

  1. Kidney Issues

Kidney issues may lead to iron deficiency, which in turn causes restless legs syndrome (RLS). This explains why people with kidney issues are more prone to RLS.

  1. Parkinson's disease

People with Parkinson's disease are more likely to develop RLS symptoms. It may be so because both conditions are treated by increasing the brain's dopamine levels. This is achieved by taking certain medications, like dopaminergic agonists.

  1. Pregnancy

Restless legs syndrome patients may experience a hormonal imbalance during their pregnancy. It is also found that some pregnant women experience RLS symptoms, especially in their third trimester.

  1. Chronic Diseases

Certain medical conditions (such as diabetes) can trigger symptoms of restless legs syndrome.

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Restless Legs Syndrome Diagnosis

When it comes to diagnosing RLS, your healthcare provider will take note of your medical and family history and ask you to elaborate on any symptoms you may be experiencing. The International Restless Legs Syndrome Study Group has set forth the following criteria that must be met in order for a diagnosis of RLS to be made:

  • You feel a strong, sometimes uncontrollable urge to move your legs, usually accompanied by an uncomfortable sensation.
  • Your symptoms get triggered when you're inactive (resting, sitting, lying down), especially during the night.
  • Your symptoms exhibit a circadian pattern, with the most severe manifestations occurring during the nighttime or evening hours.

While the criteria mentioned above are important in diagnosing RLS, your healthcare provider may still conduct additional physical and neurological exams.

Blood tests, specifically those testing for iron deficiency, may also be performed as other potential causes are ruled out. If necessary, they may refer you to a sleep specialist, which could mean an overnight stay at a clinic to be evaluated for other sleep disorders, especially sleep apnea.

Make sure to provide all the information regarding the medications and supplements you take. And also, let your provider know if you have any chronic health conditions.

How is RLS treated?

Sometimes, the key to treating restless legs syndrome lies in addressing an underlying condition. For example, if you have an iron deficiency, correcting it may greatly relieve your symptoms. This could involve receiving iron supplementation orally or intravenously. However, it's important to always take iron supplements under medical supervision and only after your provider has checked the iron level in your blood.

If an underlying condition isn't the culprit behind your RLS symptoms, don't worry - there are still effective treatment options. Your healthcare provider may prescribe medications or recommend lifestyle changes, such as exercise or avoiding caffeine, to help alleviate your symptoms.

treating RLS

Prescription Medications to Treat RLS

When the symptoms are frequent or severe, your healthcare provider will likely prescribe medications to treat the condition. The most prescribed medication options for RLS include:

  1. Drugs that increase dopamine

Dopaminergic drugs like ropinorile, pramipexole, and rotigotine patch affect the level of brain chemical dopamine in the brain, thereby helping reduce the motion in your legs.

  1. Anti-seizure medications

Anti-seizure drugs like gabapentin enacarbil and pregabalin help reduce sensory disturbances. These medications are particularly effective in patients with painful RLS due to neuropathy.

  1. Muscle relaxants and sleep medicines

Drugs like clonazepam, eszopiclone, temazepam, zaleplon, and zolpidem can help you relax and sleep better. However, due to their addictive nature, these drugs are usually reserved for patients with severe symptoms.

  1. Opioids

Opioids, such as ramadol (Ultram, ConZip), codeine, oxycodone (Oxycontin, Roxicodone, etc.), and hydrocodone (Hysingla ER), can also be used to relieve symptoms of RLS. But considering the risk of addiction, they are usually not prescribed unless the case is severe and other medications have not been effective.

Out of the listed choices, the FDA has sanctioned only four medications for Restless Legs Syndrome treatment:This includes ropinirole (Requip), gabapentin enacarbil (Horizant), rotigotine (Neupro), pramipexole (Mirapex). Nevertheless, it is strongly advised that you consult an expert doctor before contemplating any medication.

Lifestyle Changes for Restless Legs Syndrome

Medications alone do not tend to cure restless legs syndrome; thus, certain lifestyle changes must be adapted to help alleviate symptoms and manage this condition.

Maintaining a consistent sleep schedule

Getting at least seven hours of quality sleep per night can help alleviate fatigue, especially for those with a condition like RLS. It's important to create a comfortable sleep environment and establish a regular waking time to minimize sleep disruption, which can worsen symptoms.

maintaining a consistent sleep schedule to manage RLS symptoms

Cutting down on caffeine

Cutting down on caffeine is also recommended. Caffeine can trigger Restless Legs Syndrome symptoms and disrupt sleep by keeping the brain alert and focused, making it harder for individuals with a sleep disorder to fall asleep.

Practicing regular exercise

Regular exercise, particularly moderate activities such as cycling, walking, and leg stretching exercises, can significantly improve symptoms and reduce the urge to move the legs. 

Relaxation techniques

Stress worsens symptoms, so relaxation techniques such as yoga and meditation might help. Besides, light exercises, warm baths, massages, and warm or cool packs can also relax muscles and reduce the intensity of symptoms and uncomfortable sensations.

Restless legs syndrome in children

If you think only adults can feel the tingling and pulling sensations in their legs associated with restless leg syndrome (RLS), think again. Children, too, can experience the same. The only problem is that they may be having a difficult time expressing how they feel. Often, they'll refer to it as a "creepy crawly" sensation.

RLS can interfere with the child's sleep quality, which can affect every aspect of life. A child with this condition may often seem inattentive, irritable, or fussy and may be labeled disruptive or hyperactive.

To diagnose restless legs syndrome in children up to 12 years old, the adult criteria (as we mentioned before) must be met. The child must also be capable of describing the sensations they're experiencing in their legs using their own words.

RLS in children

If the child fails to express how they feel, two of the following conditions must be true:

  • There's a clinical sleep disturbance that's deemed age-appropriate.
  • A close biological family member, like a sibling or parent, has a history of RLS.
  • A sleep study confirms a periodic limb movement index of five or more movements per hour of sleep.

In addition to diagnosis, it's important to address any possible dietary deficiencies a child may have. Children with restless legs syndrome should steer clear of caffeine and also develop good sleep habits.

Restless legs syndrome in pregnant women

During pregnancy, many women experience symptoms of restless leg syndrome (RLS) for the very first time. This usually happens in the last trimester, and studies suggest that pregnant women are at two or three times higher risk of developing RLS.

Unfortunately, it's not entirely clear why this happens. However, some theories suggest that nutritional deficits, hormonal shifts, or nerve compression could be the reason.

Well, pregnancy-related symptoms like leg cramps and sleeping difficulties can be hard to distinguish from RLS. But if you're pregnant and experiencing symptoms similar to those of restless legs syndrome, it's important to have a discussion with your healthcare provider.

When should you see a doctor?

If you experience symptoms of restless legs syndrome on a regular basis and they are causing discomfort or interfering with your sleep and daytime activities, you should consult a doctor. Some people may have mild symptoms that do not require medical intervention, but others may need to see a specialist for management of their symptoms. It is also important to rule out any underlying medical conditions that may be contributing to your RLS.

Conclusion

Restless leg syndrome can be a debilitating condition that steals individuals' ability to relax and get the sleep they need to lead a productive life. The frustrating sensations caused by the condition can cause everything from minor discomfort to severe disruptions of daily routines. The good news is that, once correctly diagnosed, treatments for restless legs syndrome are relatively straightforward and usually provide relief.

Adopting a healthier lifestyle, limiting caffeine intake, engaging in regular physical exercise, and practicing good sleep hygiene habits are usually the first steps in managing RLS symptoms. With the right combination of lifestyle adjustments and medication, people can manage restless legs syndrome and its symptoms effectively.

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FAQs

  1. Are Willis Ekbom disease and restless legs syndrome the same?

Yes, Willis-Ekbom Disease and Restless Legs Syndrome (RLS) refer to the same condition and are characterized by an irresistible urge to move the legs, often accompanied by unpleasant sensations. This can lead to difficulty falling asleep or staying asleep, resulting in sleep deprivation and daytime fatigue. The condition can also affect other parts of the body, such as the arms, torso, and head.

  1. Who gets restless legs syndrome?

RLS can affect anyone at any age, although it is more commonly observed in middle-aged and elderly individuals, as well as in women, more frequently than in men. RLS may also be hereditary, with up to 50% of people with the condition having a family history of RLS. Certain medical conditions, such as iron deficiency anemia, kidney failure, and diabetes, as well as the use of certain medications, can also increase the risk of developing RLS.

  1. Does restless legs syndrome affect your sleep?

RLS can significantly impact your sleep quality, making it difficult to fall asleep or stay asleep throughout the night. The sensations associated with RLS can vary from person to person but are often described as tingling, crawling, or aching in the legs. These symptoms occur mainly at night, making it difficult to relax and drift off to sleep. In addition to this, the urge to move the legs can be so strong that it wakes a person up from sleep, further disrupting their rest.

  1. Is restless legs syndrome life-threatening?

RLS is not a life-threatening condition. However, it can significantly impact a person's quality of life, especially if left untreated.

  1. Does sleep medicine help with restless legs syndrome?

While sleep medicine can be effective in managing RLS symptoms, it is not a cure for the condition. It is important to work with a healthcare professional to develop a comprehensive treatment plan that addresses all aspects of RLS, including sleep disturbance, to improve your overall health and well-being.

  1. What is PLMD or periodic limb movement disorder?

PLMD is a sleep disorder that is associated with restless legs syndrome and involves involuntary movements of the limbs during sleep. These movements are repetitive and occur in a cyclic pattern, typically every 20-40 seconds.

  1. What makes restless legs syndrome symptoms worse?

RLS symptoms can be worsened by lack of sleep, high levels of stress, certain medications and substances, and changes in routine or activity level.

Establishing a regular sleep routine, managing stress through relaxation techniques, exercise, or therapy, avoiding medications that aggravate RLS symptoms, limiting or avoiding substances like caffeine, alcohol, and nicotine, and taking frequent breaks to move around can all help alleviate symptoms.

  1. Is RLS a neurological or sleep disorder?

Restless legs syndrome is a neurological disorder that's closely linked to a dysfunctional dopamine system. At the same time, RLS is also considered to be a sleep disorder. The common symptoms of RLS are heightened during periods of rest, and they can seriously disrupt a person's sleep. Many people with this condition report that they find it difficult to fall asleep or stay asleep due to the urge to move their legs.

  1. Is restless legs syndrome hereditary?

RLS has been found to have a genetic component, which means it can be inherited from parents to children. Studies have shown that there is a higher prevalence of RLS among family members of affected individuals compared to the general population.

  1. What are the home remedies for restless legs syndrome?

Given below are a few home remedies for those struggling with RLS:

  • Regular exercise
  • Applying warm or cool packs to your legs
  • Stretching before bedtime, especially the muscles in your legs
  • A gentle massage of the legs before bedtime
  • Taking an Epsom salt bath before bedtime

It is important to note that while these home remedies may help reduce RLS symptoms, they may not work for everyone.

  1. What prescription medications are available for restless legs syndrome?

There are different types of prescription medications available for treating RLS. This includes dopamine agonists, iron supplements, anticonvulsants, and opioids.

  1. What are the side effects of the medications used to treat restless legs syndrome?

Like all medications, the drugs used to treat restless legs syndrome (RLS) can cause side effects, some of which can be serious. Nausea, dizziness, drowsiness, hallucinations, and daytime sleepiness are some of the most frequent side effects of Dopamine agonists.

Using Iron supplements in high doses can lead to side effects such as constipation, nausea, vomiting, and abdominal pain. In rare cases, iron accumulation in the body can cause significant health issues.

Anticonvulsants used to treat RLS may cause dizziness, drowsiness, and blurred vision, while less common side effects include memory problems, depression, and suicidal thoughts. Opioids can cause constipation, nausea, and drowsiness, and they are highly addictive and hazardous when used improperly.

If you have any symptoms or worries regarding medication side effects, it is important to discuss them with a healthcare provider.

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Disclaimer: What is said in this article has been referenced from multiple sources and is intended only for educational and informational purposes. Please note that no content in this article is a substitute for professional advice from a qualified doctor or healthcare provider. Always consult an experienced doctor with any concerns you may have regarding a health condition or treatment, and never disregard any medical suggestions or delay in seeking treatment because of something you read here.

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