Restless legs syndrome (RLS) may happen because of mental or physical problems, or it may be an adverse effect of some medications. It is also known as Willis-Ekbom disease.
Restless legs syndrome may be classed as 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 affects up to 1 in 10 people at some time during their life.
The vast majority of cases of RLS resolve on their own over time or once simple lifestyle changes have been made.
- RLS can is classed as either primary or secondary.
- Many people can treat the issues at home.
- The condition is often caused by a combination of mental and physical factors.
- Women are more likely to be affected with RLS during pregnancy.
RLS is classified as a sleep disorder.
Symptoms can occur when a person is 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.
What does it feel like?
A person with RLS has a strange and unpleasant sensation in the legs, and sometimes the arms, and a strong urge to move them. People have described these feelings as:
- similar to 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 during the night. Symptoms often worsen in the evening and at night, and may be relieved for a short while in the morning.
How long will restless legs syndrome last?
Symptoms of primary or idiopathic RLS typically worsen over time, but, for some people, weeks or months may pass without any symptoms. If the RLS stems from a condition, illness, pregnancy, or medication, it may go away as soon as the trigger has gone.
RLS can pose problems for women during pregnancy.
Women who already have RLS can find that symptoms get worse during pregnancy. However, becoming pregnant can lead to RLS in its own right. Symptoms tend to get worse as the pregnancy progresses and are especially likely in the third trimester.
The cause of the increased incidence of RLS during pregnancy is unknown, but the following factors are believed to be involved:
- low levels of minerals or vitamins, such as iron and folate
- sleep deprivation as a result of changes in the body and discomfort
- changes in the hormones
- increased sensitivity of the senses
This condition has not been widely researched during pregnancy. However, some of the drug treatments used outside of pregnancy, such as rotigotine and gabapentin, have not been assessed for safe use in women who are pregnant.
Behavioral treatments, such as mild exercise and a healthy sleeping pattern, are often recommended as a first-line treatment for women during pregnancy.
If iron levels are low and thought to be the cause of RLS, oral iron supplements are safe to prescribe during pregnancy. In severe cases, higher concentrations may be administered intravenously (IV) through a drip.
If another cause is suspected that may require medication, and the above treatments do not have the desired effect, drugs should be prescribed at the lowest possible dosage to reduce risk.
Warm baths are a simple home remedy that can help relieve symptoms.
If a person cannot manage symptoms of RLS alone, they may be prescribed medications.
The medication will depend on the individual but might include:
- Iron: Supplementation with iron may help people who have low iron levels. This, in turn, may help improve symptoms.
- Alpha 2 agonists: These may help in cases of primary RLS, but they will not affect on periodic limb movement during sleep.
- Painkillers: Ibuprofen, a non-steroidal anti-inflammatory drug (NSAID), may help with mild symptoms.
- Anticonvulsants: These treat pain, muscle spasms, neuropathy, and daytime symptoms. Neurontin, or gabapentin, is a popular anticonvulsant.
- Benzodiazepines: These 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: These medications raise the levels of 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: These 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.
- 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 oxycodone hydrochloride, methadone hydrochloride, and levorphanol tartrate are common high-dose opiates.
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.
There are two main types of RLS:
Primary or idiopathic RLS
Idiopathic means that the cause is unknown.
It is the most common type and has the following characteristics:
- It usually begins before the age of 40.
- It can start as early as childhood.
- It may have a genetic cause.
- Once primary RLS starts, it tends to be lifelong.
Symptoms may be sporadic, or 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 usually starts after the age of 45 years, and it does not tend to be hereditary. This types of RLS is distinctly different:
- Onset is sudden.
- Symptoms do not usually worsen over time.
- Symptoms may be more severe.
Diseases and symptoms that can trigger secondary RLS include:
- iron deficiency
- kidney failure
- Parkinson's disease
- rheumatoid arthritis
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. Some medications, such as selective serotonin reuptake inhibitors (SSRIs) and antidepressants may trigger RLS. These drugs affect the activity of dopamine.
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 disorder (PLMD)
PLMD is a similarly related sleep disorder, sometimes called periodic limb (leg) movement during sleep (PLMS). In people with PLMD, the limbs twitch or jerk uncontrollably while sleeping. It is also 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.
Lifestyle changes and common medications that may help alleviate RLS symptoms include:
- 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, meditation, and tai chi may help.
- Exercise - using legs more can help alleviate symptoms. If the patient has a sedentary lifestyle, walking instead of driving, taking up a sport, or exercising the legs in a gym can help.
Sleep hygiene for restless legs syndrome
Sleep hygiene is important, as tiredness makes symptoms worse.
- Sleeping in a cool, quiet bedroom.
- Going to bed at the same time every night, and getting up at the same time every morning.
- Reduce the amount of light you are exposed to for an hour before bed.
- Avoid stimulating drinks, such as caffeine or sugar.
- Avoiding or reducing alcohol consumption and tobacco.
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.
In 1998, a small study of 10 people found that magnesium reduced the symptoms of insomnia in people with RLS, and suggested that may be a useful treatment for people with PLMD. However, the study considers magnesium investigational. People with kidney disease should be cautious with intake of magnesium.
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.