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.

Woman in sitting poseWoman in sitting poseMother and daughter having lunch

Symptoms of restless legs syndrome

People who have restless legs syndrome often describe the sensation as:

  • Aching
  • Creeping
  • Crawling
  • Itching
  • Pulling
  • Throbbing
  • Tingling

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 treatment.

RLS causes and risk factors

Primary RLS

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

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 neuropathyDamage 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.
  • Being female. 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:

  • Alcohol.
  • 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.

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.