What Is Restless Legs Syndrome?

Restless legs syndrome (RLS) is a neurological disorder that causes an uncontrollable urge to move your legs. Also known as Willis-Ekbom disease, RLS symptoms typically arise in the evenings or at night when you’re seated or lying down, and it often affects sleep. Moving the legs or walking provide temporary relief.

RLS affects 7% to 10% of people and is more common and severe among people over age 45 and those assigned female at birth.

This article provides an overview of restless legs syndrome, including its symptoms, diagnosis, treatment, and prognosis.     

Types of Restless Legs Syndrome

RLS is categorized based on cause and age of onset. Here’s a breakdown:

• Idiopathic RLS arises without any known cause.
• Secondary RLS occurs alongside other diseases or conditions, such as pregnancy, iron deficiency, neurological disorders, Parkinson’s disease, peripheral neuropathy, kidney failure, and others.
• Early-onset RLS arises in people under age 45. In these cases, the symptoms gradually worsen over time.
• Late-onset RLS occurs in people who first experience symptoms at 45 years old or older. With the later onset, the disease tends to progress more rapidly.
  

Restless Legs Syndrome Symptoms

RLS causes an uncomfortable sensation in the legs, leading to an overwhelming urge to move them. People with RLS describe this feeling as:

• Aching
• Throbbing
• Itching
• Pulling
• Crawling
• Creeping

Two or more episodes of RLS a week is considered severe and includes other characteristics, such as:

• Arising at rest: Symptoms arise when you’re at rest or lying down for more extended periods.
• Helped by movement: The discomfort reduces when you move your legs, as in walking, tapping, or shaking while seated.
• Nocturnal pattern: Symptoms are worse in the evenings or at night, while early mornings are generally symptom-free.
• Sleeping problems: The symptoms of RLS can make falling asleep and getting enough sleep difficult, and it is associated with sleep disorders.

Complications

Living with RLS can cause several other complications due to its impact on sleep, which includes:

• Exhaustion and an inability to stay awake during the day
• Shifts in mood
• Difficulty concentrating
• Memory problems
• Decreased productivity and performance at work or school
• Depression and anxiety

Periodic Limb Movement Disorder

Periodic limb movement disorder is a different but often co-occurring condition with RLS, characterized by involuntary movements of the limbs and torso during sleep or while awake. Unlike RLS, there’s no uncomfortable sensation, and people with the condition are typically unaware that they’re moving.

This condition occurs in 80% of people with restless legs syndrome. However, most people with periodic limb movement disorder don’t experience RLS.

Causes

There are several theories about the causes of restless legs syndrome. Depending on whether you have primary or secondary RLS, factors may arise independently (primary) or from other neurological conditions (secondary). While the exact cause varies, the following play a role in the development of RLS:

• Low iron levels
• Dopamine production problems
• Genetics

Though the exact relationship is unknown, RLS is associated with insufficient iron levels in the brain. This can affect many processes, including oxygen transportation, cellular communication, and the metabolism of neurotransmitters (the brain’s chemical messengers). As a result, there’s less dopamine production and fewer receptors, which can affect motor function.

Low dopamine levels may be at the root of RLS symptoms. Dysfunction among dopamine-producing cells in the midbrain and thalamus brain region, a part of the limbic system (which regulates emotions and survival responses), may contribute to RLS. This affects the body’s pain system, leading to the discomfort associated with RLS.

A family history of RLS dramatically increases your chances of developing primary and secondary forms, indicating a strong genetic component. In one study, about 77% of cases were linked to heredity. Mutations in several genes have been linked to higher risk. These reduce iron metabolism and dopamine production, which can lead to symptoms.

Risk Factors

The risk of developing RLS is higher among certain groups and those living with certain diseases. These risk factors include:

• Family history of RLS
• End-stage kidney disease
• Hemodialysis, a medical treatment for kidney disease that cleans water and waste from the blood
• Sleep deprivation or sleep disorders (especially sleep apnea, or nighttime snoring)
• Pregnancy, especially in the third-trimester, or changes in hormone levels
• Alcohol, nicotine, or caffeine use

Diagnosis

There is no specific test for restless legs syndrome, so diagnosis is based on medical and family histories, current health status, and symptoms. Questionnaires and neurological tests may be performed to look for signs of the condition, such as a growing urge to move the legs at rest, a reduction in discomfort with leg movements, increased frequency of symptoms at night, and an absence of other causes.

In addition, you may be given blood tests to catch causes of secondary RLS or rule out other factors. These can identify health factors that lead to the condition, including kidney failure, low iron levels, and pregnancy.     

Treatment

While RLS doesn't have a cure, some treatments can help. A provider will tailor therapies specific to individual needs, including a combination of lifestyle changes and medications. Lifestyle modifications include:

• Going to bed and getting up at the same times every day
• Aiming for seven to eight hours of rest a night
• Regular moderate—but not excessive—exercise 
• Avoiding caffeine 
• Stopping the use of certain antidepressants and antinausea drugs, under a medical providers approval and direction

If you have secondary RLS, therapies focus on managing the underlying cause. In primary cases, or if symptoms persist in secondary cases, several classes of drugs may help ease symptoms, such as:

• Dopamine precursors: Levodopa or L-dopa, Cinemet (combination of levodopa and carbidopa)
• Dopamine agonists: Requip (ropinirole), Mirapex (pramipexole), Neupro (rotigotine)
• Calcium-channel ligands: Neurontin (gabapentin), Lyrica (pregabalin), Horizant (gabapentin enacarbil)
• Opioids: Xtampza ZR (oxycodone)
• Benzodiazepines: Klonopin (clonazepam), Restoril (temazepam)

If you have low levels of iron alongside RLS, you may also need to take iron supplements.

Prognosis

RLS doesn’t have a cure and is a lifelong condition. It typically worsens over time and can significantly impact mental health. As many as 39% of people with RLS experience psychiatric comorbidities, especially depression and anxiety.

Medications and therapeutic approaches can help ease the impact of the symptoms, increase periods of remission, and improve sleep. Seeking out timely therapy and diagnosis is critical for managing this condition.

Coping

Since RLS can significantly affect the quality of life, people with RLS may need extra support. Strategies to help cope with the impact of this disorder include:

• Social support: If you’ve been diagnosed, talk to family, friends, and loved ones about your condition. Don’t be afraid to ask for help when needed; seek out those you trust and can confide in.
• Counseling: Individual or group counseling can also help, especially if RLS makes you feel depressed, stigmatized, or anxious. Your healthcare provider may be able to recommend a therapist or counselor who can help.
• Help online: Online forums and social media groups devoted to RLS can also be helpful. They connect you with others in your position and can help share information and experiences.
• Advocacy organizations: Nonprofit organizations, such as the Restless Legs Syndrome Foundation, among others, can be excellent sources of information and support. These groups also promote awareness and research on therapies.

Summary

Restless legs syndrome (RLS) is a neurological disorder characterized by an uncontrollable urge to move your legs when at rest. Often affecting sleep, RLS symptoms tend to arise at night and are most often seen in adults 45 or older, though people of all ages can be affected. Therapies for this incurable and chronic disorder include lifestyle changes and taking certain medications.