Restless Legs Syndrome (RLS) is a neurological disorder that causes pain, unpleasant sensations in the legs and an uncontrollable urge to keep them moving. This pain is the primary symptom of Restless Legs Syndrome and usually worsens at night. Pain and the need to move the legs often occur when a person is trying to go to sleep. This is because the disorder is triggered by lying down and relaxing. When a person with RLS tries to go to bed, the overwhelming need to keep their legs moving can keep them up all night.
Several studies have shown that moderate to severe Restless Legs Syndrome affects up to 10% of the U.S. population. Another 5% are affected by a milder form of RLS. The disorder occurs in both men and women, although it is much more common in women. Restless Legs Syndrome affects all ages but as someone gets older, the symptoms become longer and much more frequent.
Common symptoms of Restless Legs Syndrome are usually uncomfortable sensations in the legs with an uncontrollable urge to move them. These sensations are triggered when resting but relieved by movement. These symptoms sometimes occur in other parts of the body but the legs seem to be most affected by RLS.
Most patients with Restless Legs Syndrome also have periodic limb movement disorder (PLMD) which causes leg movements during sleep.
Restless Legs Syndrome symptoms feel like creeping, crawling, pulling, tingling beneath the skin and:
- Can last up to 1 hour or longer
- Occur when sitting for long periods of time or at night when trying to sleep
- Can be affected by daily stress, emotional upset, or not getting enough sleep
- Develop between 1- p.m. and 4 a.m. in most cases
- Can make it difficult to sit during air or car travel, or through classes or meetings
- Sometimes occurs in arms, feet, and upper legs
There also appears to be two distinct forms of Restless Legs Syndrome, early-onset meaning those who get RLS at a young age, and late-onset, those who have symptoms starting later in life.
- People who have Restless Legs Syndrome at a young age (teenage years or younger) tend to have a family history involving it.
- People with late-onset Restless Legs Syndrome usually do not have a family history but suffer from a problem with the nervous system.
Currently, there is not a specific test for Restless Legs Syndrome.
When diagnosing, physicians usually focus on the person’s descriptions of the symptoms and ask specific questions about their symptoms such as:
- How would you describe your sleeping problems and how long have you had trouble sleeping?
- On average, how long does it take you to fall asleep and do you wake up multiple times during the night?
- How often does this sleeping problem occur on a weekly basis?
- What do your leg problems feel like, can you describe them?
- What kinds of medications are you taking, including antidepressants, herbal medicines, alcohol, and over the counter or prescription drugs?
Sometimes, people who have Restless Legs Syndrome find it helpful to keep a journal or some sort of record of their sleep. A bed partner can help one keep track of their sleeping habits. This can be helpful for doctor visits and keeping a track on the severity of a person’s symptoms.
There is a set of four basic criteria to determine if one has RLS:
- Symptoms are worse at night and virtually unnoticeable in the morning or during the day.
- A strong, overwhelming urge to move or shake the affected part of the body.
- Symptoms seem to be triggered by rest, relaxation, and sleep.
- Symptoms that are relieved by movement.
Treatments of Restless Legs Syndrome are usually lifestyle changes that may reduce or relieve symptoms in mild to moderate RLS.
These lifestyle changes can include limiting the intake of: caffeine, alcohol, and tobacco, maintaining a regular sleep pattern, exercising, massaging the legs, taking a hot shower, or using heat or cold on the affected area.
There are medications that help with the symptoms of Restless Legs Syndrome but no single drug helps every RLS patient. Requip (ropinirole) and Mirapex (pramipexole) are both approved by the Food and Drug Administration for the treatment of moderate to severe Restless Legs Syndrome.
Common drugs prescribed to treat symptoms of Restless Legs Syndrome:
- Dopaminergic agents, such as levodopa and carbidopa, which are largely used by Parkinson's Disease patients, can reduce RLS symptoms when they are taken in the evening before bed.
- Opioids such as codeine, oxycodone, or propoxyphene can help diminish pain and relax a person so that they may fall and stay asleep easier.
- Anticonvulsants, such as gabapentin and pregabalin can decrease some of the creeping sensations caused by nerve pain.
These drugs have side effects and a person should talk with their doctor or pharmacist before taking any medication.
For most cases of Restless Legs Syndrome, the cause is unknown. Researchers believe RLS may have a genetic component, as specific gene variants have been associated with the disorder. Low levels of iron may also contribute to Restless Legs Syndrome.
Restless Legs Syndrome is related to a part of the brain that is responsible for producing muscle activity and movement. These pathways are disrupted by RLS which causes the involuntary movement in the limbs.
Although there is not concrete evidence, Restless Legs Syndrome seems to be connected to the following:
- Chronic diseases such as kidney failure, diabetes, and peripheral neuropathy.
- Certain medications such as anti-nausea drugs, antipsychotic drugs, antidepressants that increase serotonin, and some cold or allergy medications may aggravate symptoms of Restless Legs Syndrome.
- Pregnancy, most often occurring in the last trimester.
Although RLS is not a sign of a serious disorder and is not life-threatening, it can still be painful and affect quality of life.
Individuals that have trouble sleeping or who have symptoms of Restless Legs Syndrome should talk to their doctor. People affected by RLS can also learn about techniques, listed above under treatments, which help promote muscle relaxation and stress reduction.
Restless Legs Syndrome affects millions of individuals in the United States ranging from older citizens to children. Childhood RLS affects almost one million children with one in three having moderate to severe symptoms.
Some people affected by Restless Legs Syndrome will not seek medical attention; some don’t believe they will be taken seriously or that their condition is untreatable.
If you have any concerns about Restless Legs Syndrome, contact your doctor right away.
Living with Restless Legs Syndrome often times means that a person must learn how to manage situations where they will be sitting for long periods of time.
The following tips are meant to help address common concerns:
- Choose an aisle seat at the movies, so that you can get up and move easier.
- Make sure to get enough stretch breaks at work or school.
- Tell friends, family, and coworkers why you have to move more often, they will most likely understand and be accommodating.
- Try sleeping with a pillow between your legs; it may help prevent nerve pain in the legs.
- Compression socks and stockings are commonly used by individuals with RLS to apply pressure.
For more information about living with Restless Legs Syndrome, talk to your doctor