Restless Legs Syndrome (RLS)
Restless legs syndrome or RLS is a relatively common neurological condition in which a person has an inordinate need to move their legs. It begins with an uncomfortable pain, throbbing sensation or tingling in the legs that can only be relieved by moving them. The symptoms can be so overwhelming that the individual must constantly be moving their legs in order to feel comfortable. It can look like wiggling the legs constantly under the covers at night or like having the urge and acting on the need to “walk off” the discomfort. The illness can be mild and irritating or extremely severe, resulting in a lack of sleep due to an inability to get comfortable.
To make matters worse, RLS usually manifests itself in the evening or in the nighttime, when all you really want to do is relax and fall asleep. It can occur right when you’re lying down to sleep or can awaken you from sleep. The lack of sleep that occurs in people who have restless legs syndrome can be so profound that it can contribute to daytime motor vehicle accidents, daytime irritability, and a lack of concentration on the job. RLS is a common disease, affecting as many as 10 percent of people in the Western world.
About 2-3 percent of all people in the US have moderate to severe RLS. Not everyone seeks medical attention for this disorder because they think that the problem cannot be treated or that doctors won’t take them seriously when they describe the symptoms. They don’t realize that RLS is a real disorder with the possibility of treatment for those than need it. Untreated RLS can lead to depression and chronic anxiety along with all the other symptoms that go along with not getting enough rest or sleep.
Risk Factors for RLS
Some people are more likely to get restless legs syndrome more than others. These include:
- Women. Twice as many women are sufferers of RLS when compared to men.
- Older age. The incidence of RLS increases with age. Even as this is true, school-age children can suffer from RLS, even though they are young. Episodes of RLS tend to increase in severity and frequency as a person ages.
- Having iron deficiency. Being low in stores of iron in your body or being anemic from iron deficiency can contribute to getting RLS.
- Having peripheral neuropathy. These are people who have damage to the distal nerves of the arms and legs because of alcoholism, diabetes or other neurological condition.
- Having kidney failure. The kidneys release erythropoietin that triggers the bone marrow to make more red cells. If you suffer from kidney failure, you can easily become anemic, leading to iron deficiency and RLS.
- Pregnancy. Women who are pregnant can develop RLS during their pregnancy that goes away once they deliver their baby.
It is estimated that more than 80 percent of individuals with RLS also suffer from a common disorder known as periodic limb movements of sleep, also known as PLMS. People who have PLMS will have leg jerking or twitching symptoms occurring every half minute or so during the time when they are sleeping. These people also get very little sleep as they are constantly awakened by their moving limbs. PLMS is more common than RLS so it is possible to have PLMS and not have restless legs syndrome but not the other way around. These are believed to be related disorders in part because they can be treated similarly by doctors.
Signs and Symptoms of RLS
The basic features of RLS are the uncomfortable sensations in the legs that worsen when a person is sitting down or lying down. Usually the legs are the only body part involved in these abnormal symptoms; however, some people can feel similar uncomfortable feelings in the trunk, the arms, or the head. Usually both sides of the body are affected at the same time. Another feature of this disorder is that moving the affected body parts seems to relieve some of the discomfort, at least temporarily. This means that the person with RLS often kicks or wiggles their legs when the disease is active or the end up pacing the floor, unable to lie down comfortably. The symptoms tend to be worse in the evening and night with a relatively asymptomatic period during the mornings.
Common triggers of RLS include having to sit for a long period of time such as while traveling in a car or airplane, having the leg immobilized in a cast after a fracture, and a lack of sleep. The lack of sleep sets up an uncomfortable cycle in which the legs move constantly, interfering with sleep, which further worsens the symptoms. The onset of sleep is the most part of sleep affected; if the person is able to fall asleep, the RLS symptoms lessen. The symptoms can happen every night but typically occur at least twice in any given week.
Symptoms of RLS can spontaneously go away over a period of weeks to months before showing up again. Over the course of time, the symptoms usually get worse in intensity and more frequent.
What is the cause of RLS?
No one knows exactly what causes RLS although it appears to run in families and be partly a genetic condition. This is especially true in people who get the disorder prior to the age of 40 years. Some research has indicated that low levels of iron within the brain can trigger the disease, while other research studies have found genetic differences in people who have RLS that runs in families. RLS is related to the neurotransmitter called dopamine, which seems to be diminished in the basal ganglia of the deeper parts of the brain. People who have Parkinson’s disease have a similar problem and these people also have a greater tendency toward having RLS.
Medications can make the symptoms of RLS worse. Some medications that make RLS worse include antihistamines like Benadryl® or diphenhydramine, prochlorperazine or metoclopramide, which are used to treat nausea and medications used to treat psychosis, such as Haldol® and any medications based on phenothiazine. Alcohol has been found to increase the symptoms of the disorder.
Diagnosis of RLS
There are no known tests for RLS. All that is necessary to confirm the disorder are the symptoms as described above that interfere with activities of daily living or with the onset of sleep. A neurological examination of those with RLS is usually normal during the day. Some doctors routinely check iron levels in those with RLS and a sleep study can show the symptoms, along with the symptoms of periodic limb movements in sleep.
How can you treat RLS?
Sometimes, the best treatment for RLS is to get rid of any underlying medical conditions contributing to getting the disease, such as diabetes or peripheral neuropathy. People with RLS should avoid smoking, drinking alcohol, or drinking too much caffeine, especially in the evening. Taking iron and other mineral supplements such as folate and magnesium can reduce the symptoms of the disorder. Good sleep habits also help, such as going to bed and arising at the same time every day, massage of the legs before sleep or even taking a hot bath or using a hot water bottle on the legs before sleep can help.
There are drugs to treat RLS. Drugs that increase dopamine in the brain can help reduce the symptoms of RLS. These include many of the medications also used in the treatment of Parkinson’s disease. There are also medications specifically used to treat RLS, including pramipexole, rotigotine and ropinirole. Benzodiazepines such as Klonopin or Valium can help promote a better sleep pattern and can reduce the symptoms of RLS. Other medications used to manage RLS symptoms are opioids that can reduce the painful feelings of RLS and certain anti-seizure medications, like gabapentin or pregabalin.
The Prognosis of RLS
RLS generally lasts a lifetime and there are no cures out there for the disorder. Treatment is directed at symptoms and some people can spontaneously recover from RLS without any form of intervention.