An Overview of Restless Legs Syndrome (RLS)

Willis-Ekbom Disease is restless legs syndrome

Restless legs syndrome (RLS) symptoms can make it hard to stay in bed, but causes can be addressed and effective treatments exist after diagnosis is made
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Restless legs syndrome (RLS), also known as Willis-Ekbom disease, is a movement disorder characterized by unpleasant sensations and involuntary leg movements during sleep.

This condition may leave you kicking your legs as you fall asleep. The continued nighttime movements can prevent you from getting restorative sleep—making you sleepy during the day. There are many medical issues that can cause RLS, and it can also be idiopathic (without a known cause). If you meet the diagnostic criteria for RLS, you can be treated with medications. Lifestyle strategies —like not smoking—can help diminish the symptoms of RLS too.

Symptoms

RLS is a movement disorder that is characterized by paresthesias (unpleasant feelings), usually in the legs. Often, these sensations are associated with a conscious or subconscious need to move the affected area or areas of the body. Movement may provide a temporary sense of relief.

These symptoms typically come on during periods of rest, usually within 15 to 30 minutes of resting. They are especially severe at night and at bedtime.

The pattern of movements with RLS is intermittent throughout the night. You might or might not notice your symptoms, but bed partners tend to notice the excessive movements.

Sensations associated with RLS include:

  • Aches
  • Pulling
  • Itching
  • A feeling of bugs crawling under the skin
  • Tingling
  • Tightness
  • Electrical or jolting sensations

The sensations and movements that occur with restless leg syndrome may make it hard to fall asleep or stay asleep, resulting in insomnia. Some people are so bothered by the symptoms at night that they will get out of bed.

Daytime sleepiness can occur due to a lack of restorative nighttime sleep.

Movements

In very severe cases, the effects of RLS may occur whenever you are seated—such as in meetings, at church, or in a movie theater. Your symptoms may be worsened on long flights or during prolonged car rides. This may lead to fidgeting, constant movement, or the need to kick or massage your legs to relieve the symptoms.

When you have RLS, you are likely to experience periodic limb movements of sleep (PLMS). This consists of rhythmic jerking leg movements such as flexion and extension at the ankle or knee.

Leg cramps are not the same as the paresthesias of RLS. Leg cramps are common and are described as sudden muscle contractions that cause pain, stiffness, or discomfort.

Causes

Mild symptoms associated with RLS affect 5 to 15 percent of the population. The incidence increases with advancing age and occurs more commonly in women than in men.

There are two types of RLS, described as primary and secondary RLS. Primary RLS is also called idiopathic RLS. The primary type has no clear cause and tends to run in families.

Secondary RLS occurs in association with predisposing conditions, including:

  • Iron deficiency
  • End-stage kidney disease
  • Diabetes
  • Multiple sclerosis (MS)
  • Parkinson's disease
  • Peripheral neuropathy
  • Varicose veins
  • Thyroid disease
  • Medication side effect

Pregnancy is associated with an increase in RLS symptoms. It is not clear why it occurs during pregnancy and the symptoms of RLS generally resolve after delivery.

How RLS Develops

There are several mechanisms that cause RLS. It has been associated with changes in the brain as well as changes in the sensation of the legs. Experts suggest that the condition can develop through either of these problems, but sometimes it develops even without any neuropathic pain or known changes in the brain.

  • Issues that increase the predisposition to neuropathic pain—including peripheral neuropathy and diabetes—may cause a type of discomfort in the legs that is temporarily relieved by movements.
  • The substantia nigra, an area of the brain, can be impaired in RLS. In iron-deficiency anemia, the substantia nigra may be low in iron content. This brain region is known to have a major role in mediating muscle movement and in regulating dopamine, a neurotransmitter. Several of the treatments that reduce the symptoms of RLS work by interacting with dopamine receptors in the brain.

There is still a great deal that is not understood about the cause of RLS.

Diagnosis

RLS is diagnosed based on your medical history and diagnostic testing. If you share a bed with someone, their description of your nighttime movements can provide valuable insight into your condition as well.

There are four features that are used to diagnose RLS:

  1. An urge to move the legs, usually accompanied or caused by uncomfortable and unpleasant sensations in the legs.
  2. The urge to move or unpleasant sensations begin or worsen during periods of rest or inactivity such as lying or sitting.
  3. Sensations that are relieved by movement, such as walking or stretching, as long as the activity continues.
  4. Sensations that are worse during the evening or night.

RLS is typically diagnosed when all four of these criteria are met. However, you still may need additional testing to rule out another cause of your symptoms or to identify a cause of your RLS (such as iron deficiency or peripheral neuropathy).

Diagnostic Tests

An overnight diagnostic sleep study, also described as a polysomnogram, can be used to evaluate your sleeping pattern. A polysomnogram includes tests of brain activity, muscle movements, and oxygenation during sleep. This test is usually performed at a sleep center.

Other tests that you may need include blood tests, which can identify an iron deficiency, kidney disease, thyroid disease, and diabetes. In some instances, imaging tests such as a brain magnetic resonance imaging (MRI) test, can help identify structural issues such as MS.

Treatment

Your RLS can be managed with a variety of treatment strategies. Lifestyle modifications include avoiding caffeine and alcohol and avoiding smoking. If your RLS developed as a medication side effect, then your doctor will change your prescription.

Secondary RLS, which is caused by a medical illness, requires treatment of the causative condition (such as iron replacement) to help alleviate the secondary RLS symptoms.

Managing Daytime Symptoms

If you are self-conscious about your RLS symptoms during meetings or during social events, you might adopt habits such as periodically getting up and walking to prevent the sensations and leg movements from occurring.

Some people who have RLS do not experience symptoms during periods of mental activity or concentration—keeping your mind and body occupied with actions such as taking notes may help prevent the symptoms during "boring" events.

Medications

There are prescription medications used to reduce the symptoms of RLS, and you may benefit from taking medication for your RLS in addition to utilizing lifestyle strategies and getting treatment for the underlying cause.

Medications used in the treatment of RLS include:

Augmentation

Several medications used for the treatment of RLS act on the dopaminergic system (levodopa, Mirapex, and Requip). These dopaminergic medications may cause a side effect described as augmentation. This side effect manifests with symptoms of restless legs that occur during the day, and the movements can involve the arms as well.

If you experience augmentation, your doctor may change your medication dose or prescribe a different medication for the treatment of your RLS.

A Word From Verywell

RLS typically occurs at night, but it can lead to sleeplessness that has effects during the day. While the symptoms typically involve the legs and occur at night, they can occur during waking hours and may affect the arms as well. And the leg movements of RLS can be distressing for the person who shares a bed with you. Be sure to talk to your doctor if you have symptoms of RLS because there are effective lifestyle strategies and medical treatments that can help reduce the symptoms of this condition.

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