Restless legs syndrome

Overview

Restless legs syndrome (RLS) is a condition that causes a very strong urge to move the legs. The urge to move usually is caused by an uncomfortable feeling in the legs. It typically happens in the evening or at night when sitting or lying down. Moving eases the discomfort for a short time.

Restless legs syndrome can begin at any age and tends to get worse with age. It can disrupt sleep, which interferes with daily activities. RLS also is known as Willis-Ekbom disease.

Simple self-care steps and lifestyle changes may help relieve symptoms. Medicines also help many people with RLS.

Symptoms

The chief symptom of restless legs syndrome is an urge to move the legs. It's common to experience:

• Uncomfortable sensations that begin while resting. A feeling in the legs typically begins after you've been lying down or sitting for an extended time. It might happen while sitting in a car, airplane or movie theater.
• Relief with movement. The sensation of RLS lessens with movement. Stretching, jiggling the legs, pacing or walking may improve symptoms.
• Worsening of symptoms in the evening. Symptoms occur mainly at night.
• Nighttime leg twitching. RLS may be associated with another, more common condition called periodic limb movement of sleep. This condition causes the legs to twitch and kick during sleep, possibly throughout the night.

People typically describe RLS symptoms as compelling, unpleasant feelings in the legs or feet. They usually happen on both sides of the body. Less commonly, the sensations affect the arms.

The sensations are felt within the leg rather than on the skin. They're described as:

• Crawling.
• Creeping.
• Pulling.
• Throbbing.
• Aching.
• Itching.
• Electric.

Sometimes the feelings of RLS are hard to explain. People with RLS usually don't describe the condition as a muscle cramp or numbness. They do, however, consistently describe the desire to move the legs.

It's common for symptoms to get better and worse. Sometimes symptoms disappear for periods of time, then come back.

When to see a doctor

Talk with your healthcare professional if you have symptoms of restless legs syndrome. RLS can interfere with your sleep, cause daytime drowsiness and affect your quality of life.

Causes

Often, there's no known cause for restless legs syndrome. Researchers suspect the condition may be caused by an imbalance of the brain chemical dopamine. Dopamine sends messages to control muscle movement.

Heredity

Sometimes RLS runs in families, especially if the condition starts before age 40. Researchers have identified sites on the chromosomes where genes for RLS may be present.

Pregnancy

Pregnancy or hormonal changes may worsen RLS symptoms. Some people get RLS for the first time during pregnancy, especially during the last trimester. However, symptoms usually disappear after delivery.

Risk factors

Restless legs syndrome can develop at any age, even during childhood. The condition is more common with increasing age. It's also more common in women than in men.

RLS usually isn't related to a serious underlying medical condition. However, it sometimes occurs with other conditions, such as:

• Peripheral neuropathy. This damage to the nerves in the hands and feet is sometimes due to chronic diseases such as diabetes and alcohol use disorder.
• Iron deficiency. Too little iron in the body, known as iron deficiency, can cause or worsen RLS. People who have a history of bleeding from the stomach or bowels may have iron deficiency. Deficiency also may affect people who have heavy menstrual periods or who often donate blood.
• Kidney failure. If you have kidney failure, you also may have iron deficiency, often with anemia. When kidneys don't function properly, iron stores in the blood can decrease. This and other changes in body chemistry may cause or worsen RLS.
• Spinal cord conditions. Damage or injury of the spinal cord has been linked to RLS. Having had anesthesia to the spinal cord, such as a spinal block, also increases the risk of developing RLS.
• Parkinson's disease. People who have Parkinson's disease and take medicines called dopaminergic agonists have an increased risk of developing RLS.

Complications

Restless legs syndrome symptoms can range from being mild to having a serious impact on people's lives. Many people with RLS find it hard to fall or stay asleep.

Serious symptoms of RLS can affect quality of life and result in depression. Not being able to sleep may lead to excessive daytime drowsiness, but RLS may interfere with napping.

Diagnosis

To diagnose restless legs syndrome, your healthcare professional takes your medical history and asks about your symptoms. A diagnosis of RLS is based on the following criteria, established by the International Restless Legs Syndrome Study Group:

• You have a strong, often irresistible urge to move the legs. This usually occurs with uncomfortable feelings in the legs.
• Your symptoms start or get worse when you're resting, such as sitting or lying down.
• Your symptoms are partially or temporarily relieved by activity, such as walking or stretching.
• Your symptoms are worse at night.
• Symptoms can't be explained solely by another medical or behavioral condition.

Your healthcare professional may conduct a physical and a neurological exam. Blood tests, particularly for iron deficiency, may be ordered to rule out other possible causes of your symptoms.

You may be referred to a sleep specialist. This may involve an overnight stay and a study at a sleep clinic if another sleep condition such as sleep apnea is suspected. However, a diagnosis of RLS usually doesn't require a sleep study.

Treatment

Symptoms of restless legs syndrome sometimes go away after treating an underlying condition, such as iron deficiency. Correcting an iron deficiency may involve taking an iron supplement by mouth. Or you may be given an iron supplement through a vein in your arm. Take iron supplements only with medical supervision and after having your blood-iron level checked.

If you have RLS without an associated condition, treatment focuses on lifestyle changes. If those aren't effective, your healthcare professional may prescribe medicines.

Medications

Several prescription medicines are available to reduce the restlessness in the legs. Many of the medicines were developed to treat other diseases, but they may help with RLS. Medicines include:

• Medicines that increase dopamine in the brain. These medicines affect levels of the chemical messenger dopamine in the brain. Rotigotine (Neupro), pramipexole (Mirapex ER) and ropinirole are approved by the Food and Drug Administration for the treatment of moderate to severe RLS.

  Short-term side effects of these medicines are usually mild and include nausea, lightheadedness and fatigue. However, they also can cause issues with impulse control, such as compulsive gambling. They also can cause daytime sleepiness.

  Sometimes dopamine medicines that have worked for a while to relieve RLS stop working. Or you may notice your symptoms return earlier in the day or involve your arms. This is called augmentation. If this happens, your healthcare professional may substitute another medicine.

  People who have occasional RLS symptoms may be prescribed carbidopa-levodopa (Duopa, Rytary, others) to take as needed. But healthcare professionals don't recommend taking this medicine daily or near daily. Daily use of this medicine can cause augmentation.

• Medicines affecting calcium channels. Medicines such as gabapentin (Neurontin, Gralise), gabapentin enacarbil (Horizant) and pregabalin (Lyrica), work for some people with RLS.
• Muscle relaxants and sleep medicines. These medicines help you sleep better at night, but they don't eliminate the leg sensations. They also may cause daytime drowsiness. These medicines may only be used if no other treatment provides relief.
• Opioids. These medicines are used mainly to relieve serious symptoms, but they may be addicting if used in high doses. Some examples include tramadol (ConZip, Qdolo), codeine, oxycodone (Oxycontin, Roxicodone, others) and hydrocodone (Hysingla ER).

It may take several trials to find the right medicine or combination of medicines that work best for you.

Most medicines prescribed to treat RLS aren't recommended during pregnancy. Instead, self-care techniques may be recommended to relieve symptoms. But if symptoms are bothersome during your last trimester, your healthcare professional may approve the use of certain medicines.

And some medicines may worsen symptoms of RLS. These include some antidepressants, some antipsychotic medicines, some anti-nausea medicines, and some cold and allergy medicines. Your healthcare professional may recommend that you don't take these medicines, if possible. However, if you need to take them, talk about treatments to help manage RLS.

Lifestyle and home remedies

Making simple lifestyle changes can help alleviate symptoms of restless legs syndrome:

• Try baths and massages. Soaking in a warm bath and massaging the legs can relax the muscles.
• Apply warm or cool packs. Use of heat or cold, or alternating use of the two, may lessen the leg sensations.
• Establish good sleep hygiene. Fatigue tends to worsen symptoms of RLS, so it's important that you practice good sleep hygiene. Create a cool, quiet, comfortable sleeping environment. Go to bed and rise at the same time daily. Get at least seven hours of sleep nightly.
• Exercise. Moderate, regular exercise may relieve symptoms of RLS. But overdoing it or working out too late in the day may make symptoms worse.
• Avoid caffeine. Sometimes cutting back on caffeine may help restless legs. Try to avoid caffeine-containing products for a few weeks to see if this helps. This includes cutting out chocolate, coffee, tea and soda.
• Consider using a foot wrap or a vibrating pad. A foot wrap specially designed for people with RLS puts pressure under the foot and may help relieve your symptoms. You also may find relief using a pad that vibrates on the back of the legs.

Coping and support

Restless legs syndrome is most often a lifelong condition. It may help you to develop coping strategies that work for you, such as:

• Tell others about your condition. Sharing information about RLS helps your family, friends and coworkers better understand what you're going through. It can help explain why you might pace the halls or stand at the back of the theater. It may help coworkers better understand if they see you walk to the water cooler many times during the day.
• Don't resist your need for movement. If you attempt to suppress the urge to move, you may find that your symptoms worsen.
• Keep a sleep diary. Keep track of the medicines and strategies that help symptoms. Also note what makes symptoms worse. Share this information with your healthcare professional.
• Stretch and massage. Begin and end your day with stretching exercises or gentle massage.
• Seek help. Support groups bring together family members and people with RLS. By participating in a group, your insights not only can help you but also may help someone else.

Preparing for an appointment

If you have symptoms of restless legs syndrome, make an appointment with your healthcare professional. You may be referred to a doctor who specializes in conditions affecting the nervous system, known as a neurologist, or a sleep specialist.

Here's some information to help you get ready for your appointment.

What you can do

• Write down your symptoms, including when they started and when they tend to occur.
• Write down key medical information, including other conditions you have. Also include medicines you take, including prescription, those you get without a prescription, vitamins and supplements. And note whether there's a history of RLS in your family.
• Take a family member or friend along. Someone who accompanies you may remember information you missed or forgot.
• Write down questions to ask.

Some basic questions to ask about RLS include:

• What is the most likely cause of my symptoms?
• Are there other possible causes?
• What tests do I need?
• What treatment options are available for this condition?
• I have other health conditions. How can I best manage them together?
• What self-care steps might improve my symptoms?
• Do you have educational materials I can have? What websites do you recommend?
• Where can I find a support group for people with RLS?

What to expect from your doctor

Your healthcare professional is likely to ask you a number of questions, including:

• Do you get an irresistible urge to move your legs?
• What words describe your symptoms?
• Do your symptoms start while you're sitting or lying down?
• Are your symptoms worse at night?
• Does movement make you feel better?
• Have you been told that you kick, shake or otherwise move your legs while sleeping?
• Do you often have trouble falling or staying asleep?
• Are you tired during the day?
• Does anyone else in your family have restless legs?
• How much caffeine do you have daily?
• What is your typical exercise program?
• Are you at risk of low iron due to limiting meat in your diet, donating blood frequently or blood loss from a recent surgery?

What you can do in the meantime

To ease your symptoms, try:

• Cutting back on or eliminating caffeine, alcohol and tobacco.
• Massaging your legs while soaking in a warm bath.