If you’re feeling anxious about something or you’ve had too much caffeine, you may find yourself feeling a little restless.
For some people, however, restlessness is a serious problem and one that can make it difficult to fall asleep at night – it’s called restless legs syndrome (RLS).
Restless legs syndrome affects roughly 7% to 10% of the American population, according to the National Institute of Neurological Disorders and Stroke (NIH).
This condition occurs in both men and women, though women experience it at a higher rate. Though this condition affects as many as 1 in 10 American adults, it is frequently misdiagnosed as insomnia or another neurological disorder.
In this article, we’ll cover the topic of restless legs syndrome in detail. You’ll learn what it is and the most common symptoms as well as its causes. You’ll also learn when you should see a doctor about your symptoms and what treatment options may be available.
What is Restless Legs Syndrome?
Also known as Willis-Ekbom Disease, restless legs syndrome is characterized by uncomfortable or unpleasant sensations in the legs as well as an irresistible urge to move.
In most cases, symptoms develop in the late afternoon or evening, and they may increase in severity over time with the worst symptoms happening at night when you are at rest.
Symptoms of RLS may also occur when you are inactive or sitting down for extended periods of time.
The severity of restless legs syndrome symptoms can increase in severity during the night, often making it difficult to fall asleep or to return to sleep after waking.
In many cases, moving the legs or walking around relieves some degree of discomfort, but symptoms may resume when activity stops.
Because symptoms are triggered by resting, restless legs syndrome is classified as a sleep disorder. It is also classified as a movement disorder because movement is often required to resolve symptoms.
Restless legs syndrome is most accurately classified as a neurological sensory disorder, however, because symptoms are produced in the brain itself.
In the moment, symptoms of restless legs syndrome can cause extreme discomfort. At night, these symptoms can interfere with sleep which may then lead to daytime sleepiness and chronic sleep deprivation.
These things can affect your ability to concentrate, your mood, your performance at work or in school, and even your personal relationships.
If left untreated, RLS can lead to a 20% decrease in work productivity as well as an increased risk for depression and anxiety.
What Are the Symptoms of Restless Legs Syndrome?
The primary symptom of restless legs syndrome is an irresistible urge to move the legs.
This sensation may be accompanied by other sensations in the lower limbs that are difficult to define and vary from one person to another. The actual sensation you experience may be unique to you, but these sensations have been described in the following ways:
For some, the sensation feels like small electric shocks. How long your symptoms last may vary from case to case, but most people find that their symptoms worsen over time.
Some are lucky, however, and may go weeks or months at a time without symptoms.
This tends to happen in cases were RLS stems from another condition, medication, or pregnancy – symptoms may resolve as soon as the underlying condition is no longer a factor.
Because the symptoms of restless legs syndrome can often be resolved with movement, many people who have this disorder try to keep their legs in motion by pacing, tossing and turning in bed, and moving their legs while sitting.
Symptoms may vary from day to day in both frequency and severity. For some, symptoms only occur occasionally but, for many, they occur more than twice a week and lead to a burdensome interruption of sleep that can lead to daytime impairment in concentration and function.
Some people with RLS experience remission, generally in the early stages of the disorder, but symptoms worsen over time for most cases.
Generally speaking, restless legs syndrome does not cause any medical complications.
This does not, however, mean that it isn’t a serious problem. As was mentioned earlier, as many as 2% to 3% of the population experiences
RLS symptoms severe enough to significantly reduce their quality of life. For these cases, pharmaceutical treatment may be necessary, but other cases can often be resolved or managed with non-drug therapies.
Additionally, about 80% of people with RLS experience periodic limb movement of sleep (PLMS) which is characterized by involuntary twitching or jerking movements of the legs (and sometimes arms) during sleep, roughly every 15 to 40 seconds throughout the night.
What Causes Restless Legs Syndrome?
There is no known cause for restless legs syndrome, though researchers have identified a genetic component to be a factor in cases where the onset of symptoms occurs before the age of 40.
There is also evidence to suggest that low levels of iron in the brain may contribute to RLS as can insufficiencies of certain brain chemicals like dopamine.
Dopamine is a brain chemical needed to produce smooth and purposeful muscle movements.
Dysfunction in the area of the brain that controls movement (known as the basal ganglia) can result in involuntary movements – this is the case with Parkinson’s disease, a condition which can increase your risk of RLS.
Other factors and underlying conditions which may contribute to RLS include the following:
- Low levels of iron in the blood
- End-stage renal disease and hemodialysis
- Smoking cigarettes or using other tobacco products
- Consumption of alcohol and/or caffeine
- Taking certain medications (ex: anti-nausea drugs, antipsychotics, antidepressants, older antihistamines, and cold/flu medications)
- Sleep deprivation or sleep disorders
Restless legs syndrome can affect any person at any time, though there are certain factors that increase your risk for developing the condition. RLS is more common in women than in men, and your risk increases with age. Other risk factors include the following:
- Iron deficiency – With or without anemia, iron deficiency can trigger or worsen RLS. It is particularly common in people with a history of bleeding from the bowels or stomach, women with heavy menstrual periods, and people who frequently donate blood.
- Peripheral neuropathy – A condition characterized by nerve damage to the extremities, peripheral neuropathy is often a complication of chronic health problems such as diabetes and alcoholism, and it can increase your risk for RLS.
- Kidney problems – Iron deficiency and kidney failure often go hand-in-hand and can increase the risk for RLS, especially with other changes to your body chemistry.
- Spinal cord conditions – Lesions on the spinal cord have been correlated with restless legs syndrome and having anesthesia to the spinal cord may increase your risk of developing RLS.
- Pregnancy – Hormonal changes during pregnancy can trigger or worsen symptoms of RLS for many women. In most cases, symptoms go away within a month after delivery.
The causes of restless legs syndrome vary from one person to another. If you have one or more of the risk factors above and you’re experiencing symptoms of RLS, you should speak to your doctor sooner rather than later before the problem gets worse.
How is Restless Legs Syndrome Diagnosed?
Restless legs syndrome is incredibly common, affecting up to 10% of the American population – more than even type 2 diabetes. As many as 2% to 3% of people who have this condition have symptoms severe enough to affect their quality of life and to necessitate medical treatment. If you’re concerned about your RLS symptoms, talk to your doctor.
In order to make a diagnosis of restless legs syndrome, five features must be present:
- You have a strong urge to move your legs, typically caused by or accompanied by an unpleasant or uncomfortable sensation in the legs.
- Your symptoms are triggered or worsened by periods of resting or inactivity, such as sitting or lying down.
- Your symptoms get better when you move, such as walking or stretching, as long as the activity continues.
- Your symptoms tend to be worst in the evening or at night, or they only occur during evening or nighttime hours.
- Your symptoms cannot be accounted for by another medical condition such as leg cramps, positional discomfort, arthritis, or swelling.
In order to diagnose you with restless legs syndrome, your doctor will review your medical history and perform a physical exam.
Make sure to provide as much information as you can about your symptoms, so your doctor can make an accurate diagnosis.
In addition to reviewing your symptoms, your doctor may perform other tests to rule out any underlying conditions which could be causing or contributing to your symptoms.
In some cases, your doctor may even recommend an overnight sleep study – particularly if your doctor is concerned that you may have another sleep disorder like sleep apnea.
What are the Treatment Options for Restless Legs Syndrome?
Because the cause of restless legs syndrome can be different from one case to another, diagnosis is not always easy.
Once you have a diagnosis, however, you can talk to your doctor about the treatment options that may be available to you.
Some of the most common treatment options for restless legs syndrome include the following:
- Iron supplements – If your doctor diagnoses you with iron deficiency in addition to RLS, iron supplements may help to resolve your symptoms. Be mindful that these supplements can cause side effects such as upset stomach and constipation, so talk to your doctor about how best to manage or avoid these side effects.
- Anti-seizure medications – The FDA has approved an anti-seizure medication called gabapentin enacarbil for the treatment of moderate to severe RLS. This treatment has been seen to be just as effective as dopaminergic agents and has not yet been reported to lead to a worsening of symptoms caused by medication. Other anti-seizure medications such as gabapentin and pregabalin may be effective as well, though they may have a higher risk for side effects.
- Dopaminergic agents – These are drugs which increase the effects of dopamine, and they are commonly used to treat Parkinson’s disease. When taken at night, dopaminergic agents have also been shown to reduce RLS symptoms. Some examples of FDA-approved medications include pramipexole, rotigotine, and ropinirole. These are generally well tolerated but come with a risk of side effects such as dizziness and nausea – there is also the risk that these medications could cause a worsening of symptom with long-term use.
- Opioid medications – In severe cases of RLS where the patient doesn’t respond to other treatments, opioid medications like codeine, methadone, oxycodone, and hydrocodone may be prescribed. Low doses are typically effective for RLS, but there is a risk of side effects such as nausea, dizziness, constipation, and sleep apnea as well as a risk for dependence.
- Benzodiazepines – These drugs are typically used to treat anxiety and insomnia but may help with RLS symptoms as well. Examples include clonazepam and lorazepam, and they have a high risk for side effects, so they should be a last resort.
- Lifestyle changes – In people with mild to moderate restless legs syndrome, certain lifestyle changes may provide some relief. Examples include reduced consumption of alcohol and tobacco products, regular exercise, improved sleep habits, leg massage, warm baths, and use of hot or cold compresses. There are also certain stretches and exercises which may provide relief.
In addition to making changes to your lifestyle in hopes of mitigating your RLS symptoms, you may want to make some changes to your sleeping habits as well. Fatigue can worsen your symptoms, so it is important to give yourself the best possible chance for a good night’s sleep.
Healthy sleep hygiene starts by establishing a consistent sleep schedule – you should try to go to bed and wake up at the same times each day.
Start winding down about thirty minutes before bedtime by turning off the TV and any mobile devices – you might even do a relaxing activity like soaking in a hot bath or reading a book.
When it comes time to sleep, make sure that your bedroom is cool, quiet, and dark. You might need to use blackout shades to keep it dark as well as earplugs or a sound machine to provide some white noise to help you fall asleep.
Unfortunately, even with treatment restless legs syndrome is often a lifelong condition that cannot be cured.
Modern therapies can, however, control the disorder to minimize symptoms and to help you achieve a restful night’s sleep.
Treatment with a combination of medication and lifestyle changes is the best way to keep your RLS symptoms at bay for as long as possible.