Restless legs syndrome
Restless legs syndrome (RLS) is a condition that causes uncomfortable sensations in your legs and a strong urge to move them. The symptoms of RLS tend to be greatest in the evening or when you have been at rest for long periods, such as during a long car ride.
RLS: a movement disorder and a sleep disorder
Restless legs syndrome is classified as a movement disorder, as it causes you to move your legs.
RLS is also classified as a sleep disorder because it can cause you to lose sleep or have trouble falling asleep. This can cause excessive daytime sleepiness (hypersomnia), or the urge to sleep at inappropriate times during the day. You may feel drained, which in turn can negatively affect your mood and ability to perform daily activities.
Effective treatments for RLS are available
Thankfully, there are medications and lifestyle changes that can help ease symptoms. If RLS is interfering with your life, you should talk to your doctor to get the help you need.
Symptoms of restless legs syndrome
People who have restless legs syndrome often describe the sensation as:
For most people, the sensation is not painful. However, severe RLS may cause pain. RLS typically affects both legs. It is different from leg cramps or other leg pains, and it is accompanied by the irresistible urge to move the legs by walking or stretching. Usually, these symptoms are strongest in the evening and at night but gone by the morning.
In addition to the unpleasant sensation and need to move, common RLS symptoms include:
- Feeling drained and tired during the day.
- Having difficulty concentrating, remembering, or performing daily tasks.
- Inability to fall asleep or trouble staying asleep.
- Involuntary movements or jerks during sleep. This is referred to as periodic limb movement disorder (PLMD). Nearly 90% of people with RLS have PLMD, but not all people with PLMD have RLS.
- Mood swings or irritability.
- Tossing and turning in bed, or waking up frequently.
If you have these symptoms or develop them after taking a new medication, you should speak with your doctor. They can provide you with a diagnosis and help you find a treatment.
RLS causes and risk factors
It is sometimes impossible to find the underlying cause of your restless legs syndrome. This is referred to as primary RLS, meaning it is not related to another condition. Primary RLS appears to run in some families, meaning it can be hereditary. This indicates a genetic component at play in the development of primary RLS.
The brain region that controls movement. Experts think that this may be the result of a problem in the brain region that controls movement, the basal ganglia. The basal ganglia requires a specific chemical, called dopamine, to produce smooth, purposeful movements. If the balance of dopamine is disrupted, involuntary movements result. Dopamine imbalances are also associated with other movement disorders, namely Parkinson’s disease. Those with Parkinson’s disease are more likely to develop RLS.
Secondary RLS means that there is an underlying cause. Among the possibilities:
- Iron deficiency. Low levels of iron in the blood or brain can lead to lower dopamine levels, which can cause RLS. People with heavy menstrual periods or who have a history of intestinal bleeding may be at risk for iron deficiency.
- Kidney disease or kidney failure. Kidney disease and failure can lower the amount of iron available in the blood.
- Medications. Certain medications can cause the sudden development of RLS. These include anti-nausea and antihistamine drugs (like Benadryl), some antidepressants that increase serotonin levels, and some antipsychotic drugs.
- Peripheral neuropathy. Damage to the peripheral nerves that control movement can cause RLS.
- Pregnancy. Some pregnant people may develop RLS, typically in the last trimester of pregnancy. These symptoms usually go away after delivery.
Other risk factors
Other risk factors for restless legs syndrome include:
- Being over 40. RLS can develop at any age, but it usually develops later and gets worse with age.
- Female sex. Women are more likely than men to experience RLS.
- Having a family history of RLS.
- Having obstructive sleep apnea. People with a sleep breathing disorder called sleep apnea are more likely to suffer from RLS. However, the connection between the two conditions is not clearly understood.
- Having Parkinson’s disease.
- Having chronic, untreated medical conditions like diabetes, kidney disease, rheumatoid arthritis, Lyme disease, fibromyalgia, and others.
What triggers restless legs syndrome?
The symptoms of restless legs syndrome tend to fluctuate in frequency and intensity. Certain things may aggravate or trigger restless legs, including:
- Being still and sedentary for long periods, such as sitting at a desk or in a car for long periods.
- Lack of sleep.
- Stimulants like caffeine and nicotine.
- Stress and anxiety.
- Vigorous exercise, especially in the evening.
Consider keeping a diary of your sleep, food, and activities so you can see what triggers your symptoms. You can also talk to your doctor about these triggers so that they can better diagnose you.
How is restless legs syndrome diagnosed?
If you have symptoms of restless legs syndrome and they are interfering with your daily activities, you should talk to your doctor. Unfortunately, many doctors are unfamiliar with the condition or mistake the symptoms for another disorder, such as anxiety or another sleep disorder. Additionally, many people with RLS don’t connect the sensation in their legs to their sleep problem. This can make the condition harder to diagnose and treat. As such, finding an empathetic and expert care team that can properly diagnose restless legs syndrome is the first step to conquering the condition.
There is no single test that can diagnose restless legs syndrome. Instead, your doctor will ask you about your medical and family history, your symptoms, and your lifestyle. Your doctor will assess you based on the following criteria, established by the International Restless Legs Syndrome Study Group:
- You have a strong urge to move your legs, which is usually accompanied by an unpleasant sensation.
- This urge gets worse during periods of rest or inactivity.
- Movement eases symptoms temporarily.
- Symptoms are worse in the evening or at night.
- Symptoms can’t be explained by another medical or behavioral condition.
In addition, your doctor may take blood samples to see if you have iron deficiency or kidney disease, which may be the underlying cause of your RLS symptoms.
Treatments for restless legs syndrome
There is no single cure for restless legs syndrome, but lifestyle changes and medications can help.
If you have secondary restless legs syndrome, you will need to treat the underlying disease or change your medications to find lasting relief. You may have to try a variety of treatments to find the one that works for you.
Avoid your triggers. Consider keeping a journal of your symptoms, sleep quality, food intake, and activities so that you can identify potential triggers. Common culprits include alcohol, cigarettes, caffeine, and vigorous exercise. Try to avoid these.
Practice good sleep hygiene. Lack of sleep can make restless legs symptoms worse. Try to maximize your sleep quality by creating a cool, dark environment. Turn off your devices an hour before bed and maintain a regular sleep schedule, even on weekends. Some people find that other sleep aids, like weighted blankets, special pillows, and eye masks, can help. Additionally, if you have another sleep disorder like sleep apnea, you may need a CPAP machine or other device to improve your sleep.
Massages and baths. Massages and warm baths can help relax your leg muscles and reduce symptoms.
Hot and cold therapy. Try using hot and cold compresses on your legs to reduce the sensation.
Moderate exercise. Vigorous exercise at night can make RLS worse. However, moderate exercise is an important part of a healthy lifestyle. It can also improve sleep quality. Exercise regularly, and talk to your doctor about what exercises may be best for you.
Foot wrap. The FDA has approved the Relaxis pad and Restiffic foot wraps for RLS treatment. These wraps are designed especially for RLS patients, and they work by putting pressure on the bottom of your feet to relieve symptoms. These wraps require a prescription from your doctor.
Iron supplements. Iron deficiency is a common underlying cause of RLS. Your doctor may prescribe iron supplements to help relieve symptoms. However, only take these supplements as directed by your doctor. Taking too much iron can prevent the body from absorbing other important nutrients, causing side effects.
Dopamine agonist. A dopamine agonist is a drug that mimics the effects of dopamine to relieve restless legs symptoms. Drugs like pramipexole are often the first line of defense against severe RLS. However, they can cause side effects like daytime sleepiness and nausea. They can also lead to impulse control disorders, like excessive gambling or shopping. Long-term use of dopamine drugs can also contribute to augmentation, or a progressive worsening of RLS symptoms. You may start to experience symptoms earlier in the day. Symptoms may be more frequent and intense, or they may start to affect your arms. Be sure to talk to your doctor about the risks of augmentation and how it can be managed.
Anticonvulsant medications. Anticonvulsant medications like gabapentin enacarbil (Horizant) and gabapentin (Neurontin) can help reduce the unpleasant leg sensations of RLS. They are not associated with augmentation.
Benzodiazepines. These medications are usually prescribed to treat anxiety, muscle spasms, and insomnia. They do not treat RLS itself, but they can help you sleep better at night.
Opioids. For severe RLS that does not respond to other treatments, your doctor may prescribe low-dose opioid medications. However, these medications may worsen sleep apnea, cause unpleasant side effects, and lead to addiction. Be sure to talk with your doctor and follow their instructions when taking these medications.
Vitamins and supplements. Some research has indicated that vitamin C, D, and E supplements can help with restless legs. Some people also find magnesium helpful for RLS, as it is a natural muscle relaxant. However, be sure to consult with your doctor before taking any supplements or vitamins. These products are often unregulated and may not actually help your condition. They may even cause harmful side effects. Additionally, taking too much of a vitamin can prevent the absorption of other important nutrients.
Many of these medications should not be taken while pregnant. If you are pregnant and experience restless legs syndrome, talk to your doctor about what options you have.
Restless legs syndrome and your recovery outlook
Restless legs syndrome is a very real condition that is often overlooked or under-diagnosed. It can negatively impact your sleep and your life.
However, you have options when it comes to RLS treatment. And the first step to better sleep is finding a care team that meets your needs.
National Institute of Neurological Disorders and Stroke (NINDS). Restless Legs Syndrome Fact Sheet (https://www.ninds.nih.gov/restless-legs-syndrome-fact-sheet)
MedlinePlus: National Library of Medicine. Restless Legs (https://medlineplus.gov/restlesslegs.html)