Restless Legs Syndrome (RLS), also known as Willis-Ekbom Disease, affects millions of people worldwide. It is characterised by uncomfortable sensations in the legs and a compelling urge to move them, especially during rest or inactivity.
This condition can be incredibly disruptive, particularly at night, interfering with sleep and overall quality of life. While RLS has no cure, various treatments can help manage the symptoms and improve daily functioning.
We will discuss the types, causes, symptoms, treatment options, and lifestyle changes that can help ease the discomfort of restless leg syndrome.
What is restless legs syndrome?
Restless Legs Syndrome (RLS) is a chronic neurological disorder that causes an irresistible need to move the legs. It is often accompanied by crawling, tingling, itching, or aching sensations. Symptoms typically worsen in the evening or night, especially at rest, making sleep difficult.
Movement—stretching, walking, or repositioning—provides only brief relief. Prolonged inactivity can lead to severe sleep disturbances, fatigue, mood changes, and cognitive issues. Unlike cramps or numbness, RLS is characterised by a relentless need to move, with symptoms fluctuating over time.
Though not life-threatening, RLS can significantly impact well-being. Research links it to dopamine imbalances, iron deficiency, and genetic factors. Conditions such as kidney disease, pregnancy, or neuropathy may also trigger it. Treatment options include lifestyle changes, iron supplementation, and medications to regulate dopamine, helping improve sleep and quality of life.
Types of restless legs syndrome
There are two primary types of RLS:
- Early-onset RLS: This type typically develops before age 45 and progresses slowly over time. It is often linked to a family history of the condition.
- Late Onset RLS: This type develops after age 45 and tends to progress more quickly. It may be associated with other medical conditions.
Understanding the nature of RLS leads us to explore the different types of this condition, but this is not enough. Identifying its underlying causes provides a better understanding of what triggers this condition.
Causes of restless legs syndrome
The exact cause of RLS is often unknown, but several factors have been identified as potential triggers or contributors:
- Genetics: RLS can be inherited, meaning a parent may pass down the condition through an autosomal dominant gene. This means it’s inherited equally by males and females.
- Iron Deficiency: Low iron levels, especially in the brain, are strongly linked to Restless Legs Syndrome (RLS). Iron is essential for a healthy nervous system and is key in producing dopamine—a neurotransmitter that regulates muscle movement. When iron levels are low, dopamine function can be disrupted, potentially triggering the involuntary urges and discomfort that define RLS.
- Pregnancy: RLS can develop or worsen during pregnancy, especially in the third trimester. However, symptoms typically subside after childbirth.
- Kidney Failure: RLS is more common in individuals with chronic kidney disease, especially those undergoing dialysis.
- Diabetes: People with diabetes are at higher risk due to peripheral neuropathy (nerve damage) caused by the disease.
- Parkinson’s Disease and Multiple Sclerosis (MS): Both conditions are associated with dysfunction in the brain’s movement control systems, which may increase the risk of developing RLS.
- Medications: Certain drugs, such as antihistamines, antidepressants, and anti-nausea medications, can worsen RLS symptoms.
Common symptoms of restless legs syndrome
Individuals with RLS often experience the following symptoms:
- Urge to Move: The primary symptom of Restless Legs Syndrome (RLS) is an irresistible urge to move the legs, often paired with unsettling sensations like tingling, crawling, or aching. This discomfort typically worsens during rest, making staying still or falling asleep challenging.
- Uncomfortable Sensations: These sensations can include aching, crawling, pulling, itching, or throbbing. They primarily affect the legs but sometimes extend to the arms, chest, or head.
- Disruption of Sleep: The discomfort and urge to move in Restless Legs Syndrome (RLS) make it hard to fall or stay asleep, leading to fatigue and daytime drowsiness.
- Mood and Cognitive Effects: Chronic Restless Legs Syndrome (RLS) can take a toll on mental well-being, leading to mood swings, anxiety, and depression. It can also impair cognitive functions like focus, memory, and decision-making, making daily tasks more challenging.
Periodic limb movement of sleep (PLMS) and RLS
Many individuals with RLS also experience Periodic Limb Movements of Sleep (PLMS). During sleep, PLMS involves involuntary jerking or twitching of the legs (and sometimes the arms), typically occurring every 15 to 60 seconds. While RLS and PLMS are related, they are not the same.
Most people with PLMS do not experience the uncomfortable sensations associated with RLS during wakefulness. However, both conditions often occur together, and the repetitive movements of PLMS can disrupt sleep, leading to similar daytime fatigue.
Though distinct, these conditions frequently overlap, further disrupting sleep.
Diagnosis of restless legs syndrome
Restless Leg Syndrome (RLS) is diagnosed based on a patient’s symptoms; no specific test can confirm the condition. A healthcare provider will conduct a physical examination and review the patient’s personal and family medical history to assess potential risk factors. Since RLS symptoms can be similar to other conditions, further tests may be required.
Key diagnostic steps:
- Medical and Neurological Examination: A doctor evaluates symptoms, focusing on the urge to move the legs, discomfort at rest, and relief with movement.
- Blood Tests: These check for iron deficiency and other underlying conditions that may contribute to RLS.
- Sleep Study (Polysomnography): In some cases, an overnight sleep study may be recommended to monitor periodic limb movements and rule out other sleep disorders.
- Nerve Tests: Electromyography (EMG) and Nerve Conduction Studies (NCS) may be used to detect peripheral neuropathy, which can increase the risk of RLS.
Diagnostic criteria for RLS:
- A strong urge to move the legs, often with discomfort.
- Symptoms worsen at rest and improve with movement.
- Symptoms are more severe in the evening or night.
- No other medical or behavioural condition explains the symptoms.
Diagnosing RLS in children can be difficult as their symptoms may resemble ADHD or growing pains. Early detection is crucial for proper treatment, including iron supplementation or medications for severe cases.
In some cases, a sleep study may be recommended to observe limb movements during sleep and determine whether an underlying sleep disorder, such as obstructive sleep apnoea, contributes to the symptoms.
Treatment options for restless legs syndrome
Here’s an overview of medication options, lifestyle changes, and at-home remedies for treating and managing RLS:
Medication treatments
Medications commonly treat moderate to severe Restless Legs Syndrome (RLS), particularly when symptoms significantly interfere with daily activities or sleep quality. Healthcare providers may prescribe specific medications tailored to the severity and nature of the condition.
- Iron Supplements: Iron is crucial in producing dopamine, a neurotransmitter linked to RLS. Supplements, often paired with vitamin C for better absorption, are recommended after blood tests determine the appropriate type and dosage. Severe cases may require iron infusions to replenish brain iron levels.
- Dopaminergic Medicines: These medications boost dopamine levels, effectively reducing involuntary leg movements. Common medications include pramipexole, ropinirole, and rotigotine (skin patch). While generally effective, they can cause side effects like nausea, dizziness, and drowsiness.
- Antiseizure Medications: Gabapentin and pregabalin effectively manage nerve-related discomfort in RLS. However, side effects like dizziness, fatigue, and headaches may occur. These medications are often prescribed when other treatments are insufficient or contraindicated.
- Hypnotics and Benzodiazepines: For sleep disruptions caused by RLS, short-term use of hypnotics (e.g., zolpidem) or benzodiazepines (e.g., clonazepam) may be recommended. These medications promote relaxation but are used cautiously due to risks of dependency and potential side effects.
- Opioids (Severe Cases): In rare and severe RLS cases, opioids like methadone or buprenorphine may be prescribed. These medications are reserved for intractable symptoms and are used under strict medical supervision due to their potential for side effects and dependency risks.
Note on Dopamine Augmentation: While dopamine-enhancing medications are effective, they can sometimes exacerbate symptoms over time, a phenomenon known as augmentation. Regular monitoring by a healthcare provider is essential to manage this risk and adjust treatment as needed.
Lifestyle modifications for RLS management
If you have mild RLS symptoms, a healthcare provider may suggest specific lifestyle changes to help manage the condition effectively. These modifications can complement medical treatments and improve overall comfort and sleep quality.
- Regular Exercise: To alleviate RLS symptoms, engage in moderate activities like walking, cycling, or swimming. Avoid intense workouts close to bedtime to prevent disrupting your sleep routine.
- Sleep Hygiene: Maintain consistent sleep and wake times. Develop a calming bedtime routine, avoiding screens or stimulating activities at least an hour before sleep for improved relaxation and better rest.
- Limit Stimulants: Reduce or avoid caffeine, tobacco, and alcohol consumption in the evening, as these stimulants can worsen RLS symptoms and interfere with restful sleep.
- Stress Management: Chronic stress can intensify RLS symptoms. To reduce stress and improve overall well-being, practice relaxation techniques such as yoga, meditation, or deep breathing exercises.
At-home therapies
- Heat and Cold Therapy: Applying heating pads or cold compresses to the legs can provide immediate relief by soothing muscle discomfort and improving circulation.
- Leg Massages: Regular massages help improve blood flow and reduce muscle tension, offering significant comfort during RLS episodes.
- Warm Baths: Soaking your legs in a warm bath before bedtime can relax the muscles and provide temporary relief, promoting better sleep quality.
- Distracting Activities: Engage in calming activities like reading or watching television during RLS episodes. These distractions help shift your focus from discomfort and make symptoms more manageable.
Considerations during pregnancy
RLS is common during pregnancy, particularly in the third trimester. Non-pharmacological approaches, including lifestyle modifications and pneumatic compression devices, are preferred during this period. Healthcare providers may consider iron supplementation or other treatments if symptoms are severe, carefully evaluating the benefits and risks.
Complementary and alternative therapies
Some individuals find relief through complementary approaches such as acupuncture, massage therapy, or transcutaneous electrical nerve stimulation (TENS). While research on these treatments is ongoing, they may offer additional support when used alongside conventional methods.
How Manse Medical can help you manage RLS
At Manse Medical, we are dedicated to helping you achieve better sleep and overall well-being. Our expert team is here to assist you if you’re experiencing Restless Legs Syndrome (RLS) or related conditions like periodic limb movement disorder (PLMD).
We begin with a thorough evaluation, including assessments of iron levels and medications that may worsen your symptoms. Addressing iron deficiencies and adjusting medications can often bring significant relief.
Additionally, we provide overnight and home sleep tests to measure limb movements during sleep. An overnight sleep study tracks any abnormal limb movements, which can help specialists diagnose RLS or PLMD. This data is crucial in forming an accurate diagnosis, allowing us to develop a tailored treatment plan to address your needs.
This also helps us determine if another sleep disorder, such as obstructive sleep apnoea, causes the limb movements.
Book an appointment with our team today to explore tailored treatment options and regain restful nights. Your journey to better sleep and improved health starts here.
FAQs
Q1. What foods should you avoid with restless leg syndrome?
Avoid foods high in caffeine, sugar, and processed ingredients, such as coffee, energy drinks, soda, and sugary snacks, as they may aggravate symptoms. Limit alcohol and foods high in refined carbs. A balanced diet rich in iron, magnesium, and vitamins may help manage restless leg syndrome.
Q2. Is restless legs syndrome serious?
While RLS isn’t life-threatening, it can significantly affect quality of life. Severe cases may cause chronic sleep disruption, fatigue, and emotional distress. Proper diagnosis and management, including medications or lifestyle changes, can minimise its impact and improve overall well-being. Consulting a healthcare professional is essential for effective treatment.
Q3. Can restless legs syndrome be prevented?
RLS cannot always be prevented, but maintaining a healthy lifestyle helps reduce symptoms. Regular exercise, avoiding stimulants like caffeine and alcohol, managing stress, and addressing underlying conditions, such as iron deficiency, may prevent the onset or worsening of symptoms. Early diagnosis and tailored management improve outcomes and quality of life.
Q4. What age group does restless legs syndrome affect?
Restless Leg Syndrome (RLS) can affect people of all ages, but it is most commonly diagnosed in middle-aged and older adults. Though less frequently, it can also occur in children. Symptoms may worsen with age.
Q5. Why is it difficult for healthcare providers to diagnose RLS in children?
Diagnosing Restless Legs Syndrome (RLS) in children can be challenging because they may have difficulty describing their symptoms or articulating the sensations they experience. The condition often presents in a way that can be confused with other issues, such as attention-deficit/hyperactivity disorder (ADHD) or growing pains. As a result, healthcare providers may need to rely on observing behaviour and considering other potential causes for the child’s discomfort.
Q6. When should I see a healthcare provider for RLS?
You should see a healthcare provider for Restless Legs Syndrome (RLS) if your symptoms are frequent, persistent, or significantly affect your quality of life, especially if they disrupt your sleep or daily activities. It’s also important to seek medical attention if over-the-counter treatments or lifestyle changes don’t provide relief if your symptoms worsen over time. Early diagnosis and treatment can help manage symptoms effectively and prevent them from becoming more severe.
