Restless legs syndrome or RLS is also called Willis-Ekbom Disease. It is a disorder that causes a strong urge to move one’s legs. The symptoms of RLS commonly occur in the late afternoon or evening hours and they are more severe at night when the person is resting, like while sitting or lying in bed. RLS can also occur when someone is inactive and sitting for extended periods.
The symptoms of RLS can increase in severity during the night, making it difficult for the person to fall asleep or return to sleep after waking up. Walking or moving the legs can relieve the discomfort, however, the sensations often recur once the movement stops. RLS is classified as a sleep disorder because it occurs when the person attempts to rest or sleep. Aside from that, it is also a movement disorder because people are forced to move their legs in order to relieve symptoms.
Restless legs syndrome is one of the disorders that can cause exhaustion and daytime sleepiness, which in turn, can affect a person’s mood, concentration, and even personal relationships. There are a lot of people who have RLS that say they are often unable to concentrate, have impaired memory, or fail to accomplish daily tasks.
In the United States, there are an estimated 7 to 10 percent of the population that may have RLS. It occurs in both men and women, but women are more likely to have it. RLS can also begin at any age but many individuals who are affected severely are middle-aged and older.
Most of the people with RLS also experience periodic limb movement of sleep or PLMS. It is characterized by involuntary leg twitching or jerking movements during sleep. It typically occurs every 15 to 40 seconds or sometimes throughout the night.
Signs and Symptoms of Restless Legs Syndrome
The sensations of RLS range from pain or aching in the muscles to an itch you can’t scratch, a buzzing sensation, an unpleasant tickle that won’t stop, a crawling feeling, or limbs jerking while awake. These sensations usually begin or intensify during quiet wakefulness like when relaxing or trying to sleep.
Sometimes people find it difficult to explain the sensations and they usually don’t describe it as a muscle cramp or numbness. But they consistently describe the desire to move their legs which is the chief symptom of RLS. Here are the accompanying symptoms of RLS:
Sensations that begin after rest
The sensations described earlier usually begins after you lie down or sit for an extended time. It can happen when you’re in the car, airplane, or movie theater.
Relief with movement
The sensations lessen with movement like when you walk, jiggle your legs, or stretch them.
Intense sensations in the evening
The symptoms of RLS usually intensify in the evening.
Nighttime leg twitching
As mentioned earlier, RLS can be associated with another condition which is the PLMS, causing your legs to twitch and kick while you sleep.
Causes of Restless Legs Syndrome
Restless legs syndrome or RLS is often caused by iron deficiency or low total body iron status. Aside from that, other conditions associated with RLS include varicose veins, fibromyalgia, sleep apnea, diabetes, Parkinson’s disease, magnesium deficiency, and thyroid disease to name a few.
Here are other factors that may be associated with RLS:
Attention deficit hyperactivity disorder or ADHD has been observed to have an association with RLS. It’s because both of these conditions appear to have links to dysfunctions related to the neurotransmitter dopamine. There’s also a study in 2005 which suggested that 44% of people with ADHD have a coexisting RLS, and 26% of people with RLS had confirmed ADHD.
There are also certain medications that may cause or worsen RLS such as antiemetics, antihistamines, antidepressants, and antipsychotics. Aside from that, alcohol withdrawal can also cause RLS and as well as opioid withdrawal. RLS can also be worsened by surgery of any kind, and back surgery or injury can also cause a person to have RLS.
Based on studies, more than 60% of cases of RLS are inherited
Diagnosing Restless Legs Syndrome
There is no specific test for RLS, therefore, the condition is diagnosed by evaluating the person through the five basic criteria:
- A strong urge to move the legs that is often associated with unpleasant sensations.
- The urge to move the legs gets worse during inactivity.
- The urge to move the legs gets relieved by movements.
- The urge to move the legs intensifies at night.
- The four criteria above are not because of any other medical or behavioral condition.
Aside from these five basic criteria, a neurological and physical exam will also be done. Doctors may also ask for the person’s medical and family history and list of current medications. They might also be asked about how much time it takes for them to fall asleep or if there’s any pain related to symptoms.
Treating Restless Legs Syndrome
Walking and moving the legs or stretching the leg muscles can bring temporary relief to people suffering from RLS. However, the symptoms usually return instantly after moving and walking ceases. RLS is a lifelong condition for which there is no cure, but there are other treatments that people with RLS can try which can control the disorder, minimize the symptoms and increase periods of restful sleep.
Here are some of the treatment options for restless legs syndrome or RLS:
Changing lifestyle and activities may provide relief in people that have mild to moderate symptoms of RLS. Some of these changes can be decreasing or avoiding the use of alcohol and tobacco, maintaining a regular sleep pattern, exercising, and massaging the legs.
If you have low or low-normal blood tests that may be the cause of your RLS, you can take iron supplements that are available over-the-counter. However, there are some people whose iron levels are not improved by iron supplementation and others may require iron given through an IV line in order to boost their iron levels and relieve the symptoms of RLS.
These drugs are becoming first-line prescription medicines for people with RLS. But of course, consulting a doctor is important before taking medications like anti-seizure drugs.
This is another type of drugs that can increase dopamine effect which is largely used to treat Parkinson’s disease. It has been proven to reduce symptoms of RLS when taken at night. However, dopaminergic agents, when taken for a long time, can lead to worsening of the symptoms. Aside from that, it can also develop impulsive or obsessive behaviors on people.
People with more severe symptoms of RLS who did not respond well to medications are often prescribed with drugs like methadone, codeine, hydrocodone, or oxycodone for treatment. However, these drugs may have side effects like dizziness, constipation, sleep apnea, nausea, and the risk of addiction.
If you cannot get proper sleep because of RLS, these drugs can help you obtain more restful sleep. However, even if it’s only taken at bedtime, it can still cause daytime sleepiness sometimes which can reduce your energy and affect concentration.
If a person’s RLS symptoms are only mild, do not produce significant daytime discomfort, and do not affect his or her ability to fall asleep, then there’s no need to do treatments. And before doing any treatments to RLS, make sure that you consult with a doctor first.
We hope the information we shared helped you in further understanding what restless legs syndrome is. If you’re curious about other sleep disorders, you may check out our post on the Overview of the Different Types of Major Sleep Disorders for more information.