A person with restless legs syndrome experiences twitchiness and discomfort in the legs, usually after going to bed. As this can lead to insomnia, it is considered a sleep disorder.
Restless legs syndrome (RLS) may happen because of neurological or circulatory problems, or it may be an adverse effect of some medications.
RLS may be mild or severe, depending on the frequency and severity of the symptoms, how well the symptoms can be relieved by moving around, and how much disturbance they cause.
It can affect up to 1 in 10 people at some time during their life.
Contents of this article:
What does restless leg syndrome feel like?
Restless legs syndrome can cause discomfort in the legs.
A person with RLS has a strange and unpleasant sensation in the legs, and sometimes the arms, and a strong urge to move them.
Patients have described these feelings as:
- Like electric shocks
The only way to relieve the discomfort is by moving the legs.
The sensations tend to occur when the individual is resting or inactive, and not only after they go to bed. Symptoms often worsen in the evening and at night, and may be relieved for a short while in the morning.
Symptoms can occur when awake in a confined space, such as an airplane seat or at the cinema.
As RLS leads to difficulty falling asleep and staying asleep, the person may be tired during the day. This can have an impact on learning, work, concentration, and routine tasks and activities.
Lack of sleep can eventually lead to mood swings, irritability, depression, an undermined immune system, and other physical and health problems.
Types and causes
There are two main types of RLS.
Primary, or idiopathic RLS
In an idiopathic condition, the cause is unknown.
Idiopathic RLS is the most common type. It usually begins before the age of 40 years, and it can start as early as childhood. This type may be hereditary, with a genetic cause.
Once primary RLS starts, it tends to be lifelong, and symptoms gradually worsen and become more prevalent over time.
In mild cases, the person may have no symptoms for a long time.
A secondary disorder is caused by another disease or condition. Secondary RLS generally starts after the age of 45 years, and it does not tend to be hereditary.
Onset is sudden, and symptoms do not usually worsen over time, but the symptoms may be more severe.
Diseases and symptoms that can trigger RLS include:
Exactly how RLS happens is not well understood, but it may be related to how the body processes dopamine, a neurotransmitter that plays a role in controlling muscle movements.
It is also linked to pregnancy. Around 20 percent of women experience RLS during the last trimester of pregnancy, although the reasons are unclear.
Periodic Limb Movement during Sleep (PLMS)
In people with PLMS, the limbs twitch or jerk uncontrollably while sleeping. It is considered a type of sleeping disorder. The movement may cause the individual to wake up frequently during the night, and this can undermine the quality and length of sleep. It can lead to RLS.
How long will it last?
Symptoms of RLS generally worsen over time, but, for some people, weeks or months may pass without any symptoms.
If the RLS stems from a condition, illness, or medication, it may go away as soon as the trigger has gone.
Some women get RLS during pregnancy, but it goes away after giving birth.
People with RLS who experience kidney failure often cease to have symptoms following a transplant, although dialysis will not bring relief.
Treatment and tips
If certain underlying conditions triggers the RLS, and those conditions are treated, the RLS may go away or improve. This is often the case with iron deficiency and peripheral neuropathy.
A constant need to move the legs can lead to a lack of sleep.
Lifestyle changes and over-the-counter (OTC) medications that may help alleviate RLS symptoms include:
- Painkillers: Ibuprofen may help with mild symptoms
- Warm baths and massages: These can relax the muscles and reduce the intensity of symptoms
- Warm or cool packs: Some people prefer warm, some cold, and others say that alternating hot and cold is helpful
- Relaxation techniques: Stress can make RLS worse, so exercises such as yoga and tai chi may help
Sleep hygiene is important, as tiredness makes symptoms worse.
- Sleep in a cool, quiet bedroom
- Go to bed at the same time every night, and getting up at the same time every morning
Exercise and physical activity can help RLS, but it can also aggravate it. Most patients find moderate exercise helpful, but too much can make symptoms worse. Working out late in the evening may also be unhelpful.
Avoiding or reducing caffeine improves symptoms in some people, but it may take some weeks to see an improvement. Coffee, tea, chocolate, and many sodas contain caffeine.
Avoiding or reducing alcohol consumption and tobacco may help.
When other therapies have not worked, medications may help. The drug, or drugs, prescribed will depend on the individual.
Alpha 2 agonists stimulate the alpha 2 receptors in the brain stem, and they activate the neurons that control muscle movement and make sensations less active. They may help in cases of primary RLS, but they will have no effect on periodic limb movement during sleep. Catapres, or clonidine hydrochloride, is an Alpha 2 agonist.
Anticonvulsants treat pain, muscle spams, neuropathy, and daytime symptoms. Neurontin, or gabapentin, is a popular anticonvulsant.
Benzodiazepines are sedative medications that help people with persistent and mild symptoms to sleep through the effects of RLS. Restoril, or temazepam, Xanax, or alprazolam, and Klonopin, or clonazepam, are examples.
Dopaminergic agents raise the levels of the transmitter, dopamine, a neurotransmitter, in the brain. They can treat the unpleasant leg sensations associated with RLS. Levodopa and carbidopa are common dopaminergic agents.
Dopamine agonists also raise brain dopamine levels and treat unpleasant leg sensations. They may cause adverse effects in older patients, although some report more side effects with levodopa. Permax (pergolide mesylate), (Parlodel) bromocriptine mesylate, Mirapex (pramipexole), and Requip (ropinirole hydrochloride) are common dopamine agonists.
Opiates treat pain and can relieve RLS symptoms. Doctors may prescribe these when other medications have failed. Codeine and propoxyphene are low dose opiates, while are oxycodone hydrochloride, methadone hydrochloride, and levorphanol tartrate are common high-dose opiates.
Parkinson's disease and Epilepsy drugs are sometimes used for RLS as they can reduce involuntary movements.
More self-help tips
Citing this work, the University of Maryland Medical Center suggests that low levels of magnesium may contribute to RLS. Magnesium is available in whole grains, nuts, and green leafy vegetables.
Some people find that spraying magnesium oil onto the affected part can help, but this should not be used without first asking a doctor.
Studies into the effects of vitamin D on RLS have produced mixed results. Some link high Vitamin D with fewer symptoms, while others suggest that additional vitamin D is linked to a higher incidence during the summer months.
Staying hydrated may also help. This can be achieved by drinking plenty of water and avoiding caffeine and alcohol.