What Is Restless Legs Syndrome?
Restless legs syndrome (RLS) is a sensory disorder causing an almost irresistible urge to move the legs. The urge to move is usually due to unpleasant feelings in the legs that occur when at rest. People with RLS use words such as creeping, crawling, tingling, or burning to describe these feelings. Moving the legs eases the feelings, but only for a while. The unpleasant feelings may also occur in the arms.
Effects of RLS
RLS can make it hard to fall asleep and stay asleep. People with RLS often don’t get enough sleep and may feel tired and sleepy during the day. This can make it difficult to:
- Concentrate, making it harder to learn and remember things
- Carry out other usual daily activities
- Take part in family and social activities
Not getting enough sleep can also make you feel depressed or have mood swings.
RLS can range from mild to severe, based on:
- How much discomfort you have in your legs and arms
- Whether you feel the need to move around
- How much relief you get from moving around
- How much sleep disturbance you have
- How tired or sleepy you are during the day
- How often you have symptoms
- How severe your symptoms are on most days
- How well you carry out daily activities
- How angry, depressed, sad, anxious, or irritable you feel
Types of RLS
There are two types of RLS:
- Primary RLS is the most common type of RLS. It is also called idiopathic RLS. “Primary” means the cause is not known. Primary RLS, once it starts, usually becomes a lifelong condition. Over time, symptoms tend to get worse and occur more often, especially if they began in childhood or early in adult life. In milder cases, there may be long periods of time with no symptoms, or symptoms may last only for a limited time.
- Secondary RLS is RLS that is caused by another disease or condition or, sometimes, from taking certain medicines. Symptoms usually go away when the disease or condition improves, or if the medicine is stopped.
Periodic Limb Movement Disorder
Many people with RLS also have a condition called periodic limb movement syndrome (PLMS) or periodic limb movement disorder (PLMD). PLMD is a condition in which a person’s legs twitch or jerk uncontrollably about every 10 to 60 seconds. This usually happens during sleep. These movements cause repeated awakenings that disturb or reduce sleep. PLMD usually affects the legs but can also affect the arms.
RLS can be unpleasant and uncomfortable. However, there are some simple self-care approaches and lifestyle changes that can help in mild cases. RLS symptoms often improve with medical treatment. Research is ongoing to better understand the causes of RLS and to develop better treatments.
What Causes Restless Legs Syndrome?
In most cases of restless legs syndrome (RLS), no cause can be found. When no cause can be found, the condition is called primary RLS. It is known, however, that primary RLS tends to run in families. People whose parents have RLS are more likely to develop the disorder. This suggests that there may be a genetic link that increases the chance of getting RLS.
Secondary RLS is RLS that is caused by another disease or condition, or as a side effect of certain medications. Some of the diseases and conditions that can cause RLS are:
- Iron deficiency (with or without anemia)
- Kidney failure
- Parkinson’s disease
- Damage to the nerves in the hands or feet (peripheral neuropathy) (pe-RIF-e-ral noo-ROP-a-the)
- Rheumatoid arthritis (ROO-ma-toyd ar-THRI-tis)
RLS is common in pregnant women. It usually occurs during the last 3 months of pregnancy and usually improves or disappears within a few weeks after delivery. However, some women may continue to have symptoms after giving birth or may develop RLS again later in life.
Some of the types of medicines that can cause RLS are:
- Antiseizure medicines
- Antinausea medicines
- Some cold and allergy medicines
RLS symptoms usually go away when the medicine is stopped.
Certain substances can trigger RLS symptoms or make them worse. These substances include:
Who Is At Risk for Restless Legs Syndrome?
Restless legs syndrome (RLS) may affect as many as 12 million people in the United States.
RLS affects both men and women. The disorder occurs more often in women than in men.
The number of cases of RLS rises with age. Many people with RLS are diagnosed in middle age. But in up to two out of every five cases, the symptoms of RLS begin before age 20. People who develop RLS early in life usually have a family history of the disorder.
RLS can affect people of any race or ethnic group. The disorder is more common in persons of northern European descent.
RLS is common in pregnant women. It usually occurs during the last 3 months of pregnancy and usually improves or disappears within a few weeks after delivery.
What Are the Signs and Symptoms of Restless Legs Syndrome?
Restless legs syndrome (RLS) has several major signs and symptoms:
- An almost irresistible urge to move the legs or arms when sitting or lying down
- An unpleasant feeling in the legs
- Difficulty falling asleep or staying asleep because of the unpleasant feelings in the legs or arms
- Daytime sleepiness, which results from a lack of restful sleep due to the repeated limb movements
Urge To Move
RLS gets its name from the urge to move the legs when sitting or lying down. This urge is due to unpleasant feelings in the legs that are relieved by movement. Typical movements are:
- Pacing and walking
- Jiggling the legs
- Stretching and flexing
- Tossing and turning
- Rubbing the legs
The urge to move the legs usually is due to unpleasant feelings in the legs. People with RLS describe these feelings as:
- Hard to describe
Children may describe RLS symptoms differently than adults.
The unpleasant feelings in RLS usually occur in the lower leg (calf). But the feelings can occur at any place between the thigh and the ankle and also in the arm. The feelings are worse:
- When lying down or sitting for a long period of time
- During the evening or night, more so than during the day
The unpleasant feelings also:
- Make it hard to fall asleep or stay asleep
- Are not as bad or go away when you move
Duration and Severity
RLS symptoms tend to get worse over time. They may begin in childhood and develop slowly over several years. People with early symptoms are more likely to have other family members with RLS than people who develop RLS later in life.
Symptoms tend to worsen faster when RLS occurs later in life. RLS that occurs later in life is also more likely to result from an underlying condition or illness than RLS that occurs early in life.
People with mild symptoms may only notice them when they are still or awake for a long time, such as on a long airplane trip.
How Is Restless Legs Syndrome Diagnosed?
The way that you describe your symptoms is very important in diagnosing restless legs syndrome (RLS). Your doctor will:
- Take a complete medical history
- Do a complete physical examination
- Order other tests
The diagnosis of RLS usually requires the following four conditions be present:
- An urge to move the legs due to an unpleasant feeling in the legs.
- The urge to move the legs, or the unpleasant feelings in the legs, begins or gets worse when you are at rest or not moving around frequently.
- The urge to move the legs, or the unpleasant feelings in the legs, is partly or completely relieved by movement (such as walking or stretching) for as long as the movement continues.
- The urge to move the legs, or the unpleasant feelings in the legs, is worse in the evening and at night, or only occurs in the evening or at night.
Your doctor will take a medical history and ask questions such as:
- Can you describe your symptoms?
- When did your symptoms first begin?
- When during the day or night do the symptoms usually occur?
- When are your symptoms worse?
- Do symptoms interfere with your sleep?
Your doctor will also ask about your sleep habits, such as:
- The time you go to bed and get up
- Your routine before going to bed
- Noise, light, and interruptions in the room where you sleep
- Whether you snore
Your doctor will ask about how you feel during the day, including whether:
- You are tired and sleepy when you wake up and during the day.
- You have trouble concentrating.
- You doze off or have difficulty staying awake doing routine tasks, especially driving.
Your doctor will ask questions to find out if your symptoms are a result of a possible underlying condition. Questions might include:
- Do members of your family have similar symptoms?
- What medicines (over-the-counter and prescription) do you take?
- Do you snore loudly and frequently?
- Do you gasp for air during sleep?
- Do you use caffeine, tobacco, or alcohol?
A physical exam is done to:
- Identify any underlying condition that may cause RLS
- Rule out other disorders
Your doctor also will pay special attention to:
- The nerves in your spinal cord (especially) and legs and arms
- The blood flow in your legs and arms
There is no test currently available to diagnose RLS.
However, blood tests can be used to look for underlying conditions that can cause RLS. These tests check for:
- Low iron stores or iron deficiency
- Kidney disease
- Other vitamin and mineral deficiencies
How Is Restless Legs Syndrome Treated?
The goals of treatment for restless legs syndrome (RLS) are to:
- Relieve symptoms
- Increase the amount and quality of sleep
- Treat or correct any underlying condition that may cause RLS
Types of treatment include:
- Lifestyle changes and other nondrug treatments
Lifestyle changes can improve and relieve symptoms of RLS. Lifestyle changes may be the only treatment needed for mild RLS. Some lifestyle changes that may help include:
- Avoid things that can make symptoms of RLS worse:
- Caffeine—Chocolate, coffee, tea, and some soft drinks contain caffeine. Although it may seem to help overcome daytime sleepiness, caffeine usually only delays or masks RLS symptoms, and often makes them worse.
- Some medicines—Some types of over-the-counter and prescription medicines can also make RLS symptoms worse. These include:
- Antidepressants (most of them)
- Antinausea medicines
- Antipsychotic medicines
- Adopt good sleep habits:
- Keep your bedroom or sleep area cool, quiet, comfortable, and free of unnecessary light.
- Use your bedroom for sleeping, not for watching TV or using computers or cell phones.
- Go to bed every night at the same time and wake up at the same time every morning. Some people with RLS find it helpful to go to bed later in the evening and get up later in the morning. The important thing is to get enough sleep so that you feel rested when you wake up.
- Follow a program of moderate exercise
Other activities that also may help relieve symptoms include:
- Walking or stretching
- Taking a hot or cold bath
- Massaging the leg or arm
- Using heat or ice packs
Medicines can help relieve some symptoms of RLS. Doctors prescribe medicines to treat RLS in people:
- With clearly defined symptoms
- Whose symptoms cannot be controlled by lifestyle and nondrug treatments
No single medicine is helpful in all persons with RLS. It may take several changes in medicines and dosages to find the best approach. Sometimes, a medicine will work for a while and then stop working.
Some medicines may not be safe for pregnant women.
Always talk with your doctor before taking any medicines, even over-the-counter medicines.
Medicines used to treat Parkinson’s disease also are used to treat RLS. Even though these medicines help reduce RLS symptoms, RLS is not a form of Parkinson’s disease. The medicines help reduce the amount of motion in the legs. They include:
- Levodopa (le-vo-DO-pa)
- Is best used to treat mild cases of RLS
- Is short-acting
- Works for a while but does not work long term in most people
- Dopamine agonists (pergolide (PER-go-lid), pramipexole (prah-mih-PEX-ohl), and ropinirole (roh-PIN-ih-roll))
- Are used to treat moderate and severe cases of RLS
- Are used to treat mild cases of RLS if levodopa stops working
- Are long-acting
The U.S. Food and Drug Administration recently approved ropinirole to treat moderate to severe RLS.
Other medicines may be used to treat RLS, including:
- Strong pain-relieving medicines (narcotics).
- Used most often when symptoms are severe
- May be used in people who don’t respond to dopamine agonists
- Sedatives (benzodiazepines (BEN-so-di-AZ-e-pens)).
- Help with falling asleep
- May cause daytime sleepiness
- Are not recommended for people with sleep apnea and for older persons
- Medicines used to treat epilepsy (anticonvulsants: gabapentin (gab-ah-PEN-tin), carbamazepine (kar-bam-AZ-e-pen), and valproate (val-PROH-ate)). These types of medicines are:
- Considered when dopamine agonists fail
- Most effective in persons with daytime and evening symptoms, as well as sleep-onset symptoms, and in those who describe the unpleasant feelings in the legs as painful.
- Iron supplements, if iron deficiency appears to be contributing to RLS. Iron supplements should only be used if recommended by a doctor.
If symptoms continue, you may be referred to a sleep doctor who treats sleep disorders.
Above modified and courtesy of NHLBI
Below – original contribution. Older content to be deleted or modified.
Restless Leg Syndrome
Restless Leg Syndrome or RLS is a commonly misdiagnosed disorder, which affects men, women and possibly children. Signs of RLS can begin at any age, although people who suffer from it most are around age 50. Many people ignore their symptoms because they are so hard to describe and do not seem serious. However, people who suffer from RLS often lose sleep, which can severely affect their quality of life.
Restless Leg Syndrome is a neurological disorder that is indicated by a strong urge to move (typically) the legs while at rest. People most often experience this urge as tingling or burning sensations felt deep within their lower legs. Movement such as walking or massaging ones legs often offers temporary relief from the sensations, although the urge to move will remain present. As much as 10% of the U.S. population is affected by RLS, although it does frequently go undiagnosed or misdiagnosed. When RLS occurs in children, it is commonly misdiagnosed as “growing pains” or ADD (Attention Deficit Disorder). Misdiagnosis is more prevalent with children because health care professionals rely so strongly on the description of the sensations, which children often have a hard time verbalizing.
Signs and Symptoms…
Although RLS can affect anyone, the occurrence is twice as common in women as in men. Most often people will notice their symptoms begin in the evening or when lying down to sleep. Symptoms can also be brought on by long periods of inactivity, like a long car trip or flight. The sensations experienced include burning, crawling with bugs, or a tingling sensation. Over time these uncomfortable feeling can become painful. Frequently the sensations occur in the legs, between the knee and the ankle. However, some people report the same sensations in their thighs, arms, feet and hands. These sensations usually occur on both the right and left sides of the body; however, less commonly they can occur on just one side.
At the very onset of sleep, many people report the sensations becoming more intense, making it incredibly difficult to fall asleep. People also report a significant loss of sleep due to the urge to get up and move around when resting. Movement of the limbs causes the sensations to be less intense, but when lying back down, the symptoms reappear. Many people with RLS agree that their symptoms disappear in the early morning hours causing them to get less sleep than they need. Of the people who have severe RLS, about 90% also suffer from PLMD (periodic limb movement disorder), which is characterized by periodic spontaneous movements of the limbs while awake or asleep.
Signs of RLS can begin at any stage in life. If other medical issues related to RLS are present, such as diabetes, it can progress more rapidly. Treatment of the related condition may cause a decrease in the symptoms. However, if there is no underlying medical condition, the symptoms of RLS can slowly present over a period of years, sometimes starting at a young age. In the early stages of RLS, many of the afflicted have reported their symptoms will spontaneously disappear for a short period of time, but then gradually return. Very rarely the symptoms of RLS can cease for up to a year in the early stages of the condition, but often eventually return.
Healthcare providers must rely very strongly on the patient’s description of their symptoms. Because of this, RLS can be difficult to recognize. When a healthcare provider screens for RLS, they will take into consideration the patient’s current health, medical history and family medical history. In about 50% of the cases where people are affected by RLS, other people in their family have had it as well suggesting it may be hereditary. Although there are no laboratory tests that lead to a diagnosis of RLS, a healthcare provider may order tests to rule out other possible existing conditions.
In 1995, the IRLSG research group determined four common criteria that are usually present when diagnosing Restless Leg Syndrome. These four items are present in almost every described case of RLS, although any combination of these four can indicate the disorder.
- Desire to move limbs combined with parasthesias and/or dysesthesias (creepy, crawly sensations, burning, tingling)
- Symptoms are present only when at rest or become worse when resting. The symptoms are temporarily relieved by movement.
- Restlessness of affected limbs.
- Symptoms are worse at night, and decrease as the day draws closer.
Currently the exact cause of RLS is unknown. However, the disorder can be linked to other health conditions. Researchers have found that there may be a genetic link as people with RLS report family members having it as well. When RLS runs in families it tends to present at an earlier age, with a more gradual onset of symptoms.
Recent research indicates that RLS may be related to some chronic medical conditions. RLS symptoms are frequently reported in patients with diabetes, kidney failure, peripheral neuropathy and Parkinson’s disease. When these medical conditions are treated, the symptoms typical to RLS may decrease or completely disappear. Occasionally, women who are pregnant, especially in their third trimester are prone to some of the common symptoms. In these cases, the symptoms usually disappear with in four weeks after delivery. People who suffer from anemia or an iron deficiency are more likely to develop RLS compared to people with normal blood iron levels. Medications like anti-nausea, anti-seizure, antipsychotic or cold and allergy pills can promote RLS symptoms. In cases such as this, the patient can see their health care provider for an adjustment of their medication in an attempt to reduce the symptoms.
Other commonly used substances like tobacco, caffeine and alcohol can trigger symptoms in individuals who are already susceptible to developing RLS. To reduce the symptoms a person can remove those substances from their diet.
Successful treatments for RLS exist. If RLS is related to another present medical condition, the medical condition can be treated and the RLS symptoms often will decrease.
Lifestyle changes may help reduce the symptoms of RLS for some. These changes may include smoking cessation, or consuming less alcohol and caffeine. Some medications can aggravate RLS. Medications should be reviewed by a physician. Routine exercise may help dissipate symptoms; however, some people have found an increase with their symptoms when they begin exercising. Be sure to keep an open line of communication with a healthcare provider when starting an exercise regimen. People who suffer from RLS have found that a hot bath or leg massage works well to make the symptoms less intense. Heating pads and cold packs often help as well.
If symptoms are severe enough and persist on a regular basis, a healthcare provider may consider medical therapy. Some of the most commonly prescribed are dopaminergic agents and benzodiazepines. These drugs often alleviate the symptoms of RLS. Other medications that have been used to treat RLS include anticonvulsants. These drugs block the receptors in the brain that cause the tingling and burning sensations often associated with RLS. A healthcare provider may also prescribe drugs from the opiate class. These drugs are usually reserved for more severe cases of RLS because they are classified as narcotics. They work by promoting relaxation and diminishing pain. As with any medication, there are possible side effects from these drugs.
There is currently no cure for RLS, although much research is being conducted on this disorder. If you are experiencing any of these symptoms, contact your healthcare professional to find an acceptable treatment plan. Before seeing a provider, keep a sleep diary, record the intensity of the symptoms, and how often then occur. This will help the healthcare provider determine the severity of the symptoms and formulate a treatment plan.
Reviewed September, 2007