Although it is one of the most common sleep disorders (affecting nearly 3 million Americans, according to the Mayo Clinic) Restless Legs Syndrome is also one of the most widely misunderstood. The urge to move your legs hardly seems like a serious medical issue.
But the truth is that restless legs syndrome can be a serious impediment to getting the proper amount of sleep, which in turn can cause other significant problems to health and wellness. Anyone who has experienced the frustration of not being able to fall asleep or stay asleep because of physical discomfort can attest to that.
Taking time to understand the underlying causes and steps for treatment are important in managing the symptoms of restless legs syndrome and ensuring the disorder does not prevent you from living an ordinary and healthy life.
What exactly is Restless Legs Syndrome?
Sometimes known as Willis-Ekbom Disease, Restless Legs Syndrome (RLS) is a neurological sensory disorder characterized mainly by the experience of severe discomfort in the legs which can only be relieved through movement. RLS can also be classified as a sleep disorder—as it often impairs the ability to sleep soundly—as well as a movement disorder.
The main symptom of RLS is the uncontrollable desire to move the legs. This impulse is caused by an unpleasant and uncomfortable sensation in the legs that ceases when moved. Patients describe this feeling anywhere from tingling and slightly annoying, to burning and painful. These sensations are mostly experienced in the evening, and especially when the legs have been inactive for some time (when resting in bed, sitting down for a while, etc.).
Other symptoms of RLS include periodic limb movement of sleep (PLMS), twitching of the legs, and other muscles when you are asleep or falling asleep. These involuntary movements can occur throughout the night, sometimes occurring up to every 15 seconds in extreme cases. More than three-quarters of RLS patients experience PLMS, though many people who do not have RLS also experience PLMS.
Because these symptoms are most strongly felt in the evening, and especially when patients are in bed, they cause a severe disruption to the sleep cycle by making it very difficult to fall asleep and stay asleep. RLS patients typically report that their best sleep comes in the early morning when symptoms seem to abate.
Though anyone can develop RLS at any time, older adults and women are the most likely candidates to experience the disease.
What causes Restless Legs Syndrome?
Unfortunately, the causes and mechanics of RLS are still mostly a mystery to science. Some studies suggest that RLS may be related to the regulation of dopamine, a neurotransmitter that plays a big role in stimulating movement.
However, researchers have linked the likelihood of getting RLS to a number of other factors. For one, family history is extremely important; up to half of all RLS cases are thought to be genetic, and having relatives with the disorder increases the chances you will get it by up to six times the normal odds. Patients with genetic causes of RLS are more likely to develop symptoms of the disease earlier in life.
According to the Cleveland Clinic, other conditions that contribute to the likelihood of getting RLS include:
- Iron deficiencies
- Parkinson’s Disease
- Rheumatoid arthritis
- Peripheral neuropathy
- Pregnancy after 20 weeks gestation
- Receiving dialysis treatment
- Taking certain antidepressants, antihistamines or anti-nausea medications
How do I know if I have Restless Legs Syndrome?
According to the Restless Legs Syndrome Foundation, a non-profit dedicated to raising awareness about the disorder, to receive a diagnosis you must demonstrate the following five symptoms:
- Extreme urge to move your legs: Usually accompanied by unpleasant sensations, and sometimes affecting the trunk and arms as well.
- Worsening of symptoms with inactivity: Sitting, resting, and especially lying down are all triggers of the symptoms of RLS
- Movement helps relieve symptoms: Engaging your muscles helps to ease the discomfort, at least in the moment you are using them.
- Most symptoms occur in the evening: RLS seems to exacerbate at night, and often are never even experienced during daytime hours.
- There is no other symptom-causing disorder: Some of the symptoms of RLS can be caused by arthritis, swelling, cramps or other disorders. Only when a doctor rules out these factors can all of the aforementioned symptoms be linked to RLS.
If all of the following conditions are met, your doctor will likely perform a few more tests to ensure that no other disease is causing your symptoms before passing down a diagnosis of RLS.
How do you treat Restless Legs Syndrome?
Because there is no cure for RLS, treating the disease is focused on managing its symptoms through lifestyle changes, and in some cases medication. Depending on the severity of the symptoms and the underlying cause of each patient’s RLS, different courses of action are prescribed.
For more mild symptoms, doctors often recommend changes to lifestyle aimed at combating symptoms. The most commonly prescribed include:
- Avoiding drugs and alcohol (Read more on the effects of alcohol and sleep), including smoking or vaping nicotine
- Maintaining a regular, healthy sleep schedule
- Implementing a regular exercise schedule, with particular focus on the leg muscles
- Regular massaging of the legs or affected areas
- Stretching and aerobic exercises before bed
- Use of heating and cooling pads, as well as other specialized medical equipment on the legs
For more severe cases of RLS, different medications may be prescribed depending on the particulars of an individual patient. Some of the most commonly used medications for RLS include:
- Iron supplements
- Anti-seizure drugs
- Dopaminergic agents
With all medications, there are significant risks and side effects. Additionally, symptoms of RLS have been known to rebound after initially successful treatments with medications, sometimes coming back with increased severity, in a process known as augmentation. Make sure to discuss your medical history and options for treatment at length with your doctor when seeking medications to treat RLS.