What is Restless Legs Syndrome (RLS)?
Restless leg syndrome (RLS) is a chronic condition characterized by uncomfortable sensations while lying down and a strong urge to move the legs. Leg movement relieves the unpleasant sensations temporarily, often resulting in poor quality sleep. RLS is common, affecting up to one in 10 people in the U.S. [1,2].
Symptoms primarily include an uncontrollable urge to move the legs and sometimes the arms while at rest. The sensations experienced can be described in a variety of ways, but are mainly uncomfortable.
Treatment options vary depending on the severity of your RLS and will likely continue for the rest of your life. Certain lifestyle adjustments, medications, and supplements may help to alleviate symptoms.
You should see a doctor if these symptoms continue or begin to get worse
How common is Restless Legs Syndrome (RLS)?
Symptoms that always occur with Restless Legs Syndrome (RLS):
- Restless legs
Restless Legs Syndrome (RLS) is also known as
- Restless legs syndrome
- Willis-Ekbom Disease
- Ekbom's Syndrome
Restless Legs Syndrome (RLS) Symptoms
Restless leg syndrome is characterized by an uncontrollable urge to move the legs (akathisia) in which symptoms are temporarily relieved by activity, such as walking and stretching, often leading to frequent tossing and turning during sleep. Symptoms typically become more frequent and severe over time. RLS is not explained solely by another medical condition.
Timing of symptoms
Sensations begin at rest and are felt after laying or sitting for an extended period of time, such as during an airplane ride or movie.
- Present later in the day: Sensations are typically absent in the morning, worse in the late afternoon, and become most severe at night.
- Inconsistent: The condition is relapsing and remitting, sometimes becoming severe for a period of time before remitting entirely for several weeks or months.
Areas of the body affected
The legs and feet are affected most often, usually on both sides of the body, sometimes alternating between sides. This condition may also sometimes affect the arms.
How sensations can be described
The uncomfortable sensations in RLS can be difficult to explain. They are not muscle cramps, but rather may be described as:
- Creepy crawling
- "Like ants marching"
- "Like soda water in my veins"
- Electric shocks
Periodic limb movement of sleep
A majority of people with RLS (80 percent) also develop periodic limb movement of sleep (PLMS), a disorder that involves involuntary leg and arm twitching and jerking during sleep .
Poor quality sleep caused by RLS can lead to:
- Daytime sleepiness, irritability, and impaired concentration: However, daytime sleepiness has often been found to be less than expected for the amount of sleep lost.
- Difficulty completing tasks: This leads to a 20 percent decrease in work productivity .
- Professional and social difficulties: Impaired job performance and difficulty with relationships often results in worsening mood and, in some cases, depression.
Restless Legs Syndrome (RLS) Causes
RLS is classified as a sleep disorder, since symptoms occur mostly during sleep, as a movement disorder since leg movement is integral to the disease, and as a neurologic sensory disorder, with symptoms thought to originate in the brain.
Although RLS can be brought on by other conditions, two main causes include genetics and a dysfunction in dopamine, a neurotransmitter.
- Genetics: RLS can run in families, especially in cases with symptom-onset prior to age 40 . More than 70 percent of children with RLS have at least one parent with the condition, suggesting a strong genetic link. However, the condition only affects about two percent of children overall .
- Neurobiology: RLS seems to stem from dysfunction in a part of the brain that typically enables smooth and purposeful movement (the basal ganglia) via the neurotransmitter dopamine. Dysfunction of the basal ganglia has been associated with various movement disorders, including Parkinson's Disease.
Conditions that may worsen RLS
Conditions that have been found related to RLS include varicose veins, as well as those described below. Other conditions include:
- Pregnancy: For some people, RLS occurs exclusively during the third trimester of pregnancy, remitting within one month after delivery, likely due to hormonal changes during pregnancy.
- Peripheral neuropathy: Damage to the nerves in the hands and feet can be caused by a variety of conditions, including diabetes, alcoholism, treatment for cancer, and some infections (such as HIV, Lyme disease, and Hepatitis C).
- Iron deficiency: Low body iron stores have been found associated with RLS. Iron deficiency most commonly results from blood loss, such as heavy menstrual periods, gastric ulcers, colon polyps, or other gastrointestinal bleeding.
- Spinal cord conditions: Injuries or diseases of the spinal cord have been related to RLS.
Medications that may worsen RLS
Beyond caffeine, alcohol, and nicotine, medications that affect dopamine, serotonin, and histamine can worsen RLS, including:
- Some anti-nausea medications: Such as metoclopramide or prochlorperazine
- Antidepressants: SSRIs such as fluoxetine and sertraline
- Allergy medications: Such as diphenhydramine (Benadryl)
Other medications that can worsen RLS also include:
- Beta-blockers: Such as propranolol or metoprolol
- Antiepileptic medications
Treatment Options and Prevention
Treatment will depend on the severity of your RLS and your specific concerns. Symptoms can be managed but the condition is unfortunately chronic and not preventable . However, many resources for support are available in addition to the various methods of treatment described below .
In some cases, RLS is made worse by iron deficiency. Iron deficiency has been identified in about 15 percent of people with RLS . If your blood work is consistent with iron deficiency, your physician may recommend iron supplementation, either orally or intravenously.
These are often the first-line treatment and are preferred in most cases of RLS during pregnancy. These may include:
- Taking warm baths
- Massaging your leg muscles
- Applying warm or cool packs
- Exercising: Regular exercise in moderation may relieve symptoms
RLS affects your life most when it results in poor quality sleep, therefore, you should practice good sleep hygiene.Try to do everything you can to ensure restful sleep, such as:
- Avoiding caffeine
- Avoid viewing screens: This includes viewing a smartphone or related device in the hour prior to bedtime.
- Establishing a consistent bedtime
- Creating a calm and soothing sleep environment: This should be within a cool, dark, quiet room.
The FDA has also approved medical devices that may help relieve RLS symptoms . These include:
- A foot wrap: This will place pressure on the bottom of the foot.
- A vibration pad: This stimulatesthe back of the legs.
When first-line treatments and lifestyle modifications are not enough, various medications may be an option, such as the following.
- Dopamine agonists: Medications such asropinirole, rotigotine, and pramipexole, predominantly used to treat Parkinson's Disease, work by activating dopamine receptors in the brain. They have been shown to reduce symptoms in RLS and are approved by the FDA for the condition . Over time, they can become ineffective, leading to worsening of symptoms.
- Gabapentinoids: Medications such as gabapentin (Neurontin) and pregabalin (Lyrica) that affect the voltage-gated calcium channels in nerves have also been found effective at reducing the sensory symptoms.
- Opioids: Pain medications such as oxycodone, Percocet, or Vicodin, which contain oxycodone or hydrocodone can relieve symptoms, but can lead to dependency .
- Benzodiazepines: Medications such as clonazepam (Klonopin) cause drowsiness and relax muscles. They can help people with RLS sleep better, but do not prevent unpleasant leg sensations. Due to concerns about causing dependency and daytime drowsiness, they are often reserved for use when the previously mentioned treatments are not effective. Their overall efficacy for treating RLS is still considered unknown .
When to Seek Further Consultation
If your RLS symptoms interfere with sleep quality so much that your mood becomes more depressed or you are too sleepy to engage with work and social activities, seek further consultation from your physician.
If your symptoms initially responded to medications but have now returned
Sometimes medications work initially for RLS but eventually lose their effectiveness. If this occurs, your physician may be able to switch you to another medication.
If you are taking a lot of medications for other conditions and have RLS
A number of medications have been identified as contributing to RLS. Ask your physician or pharmacist if any of your medications could be worsening your RLS symptoms and if alternative therapies are available.
- Restless legs syndrome fact sheet. National Institute of Neurological Disorders and Stroke. Published May 2017. NINDS Link
- Restless legs syndrome. Mayo Clinic. Published July 17, 2018. Mayo Clinic Link
- Restless legs syndrome (RLS) and sleep. National Sleep Foundation. National Sleep Foundation Link
- Restless leg syndrome. American Academy of Family Physicians: FamilyDoctor.org. Updated July 25, 2018. FamilyDoctor.org Link
- Helpful links. Restless Legs Syndrome Foundation, Inc. RLS Foundation Link
- Causes of restless legs syndrome. Johns Hopkins Medicine. John Hopkins Medicine Link
- Mitchell UH. Medical devices for restless legs syndrome - clinical utility of the relaxis pad. Therapeutics and Clinical Risk Management. 2015;11:1789-1794. NCBI Link
- Scholz H, Trenkwalder C, Kohnen R, Kriston L, Riemann D, Hornyak M. Dopamine agonists for restless legs syndrome. Cochrane Database of Systematic Reviews. 2011;3. NCBI Link
- Silber MH, Becker PM, Buchfuhrer MJ, et al. The appropriate use of opioids in the treatment of refractory restless legs syndrome. Mayo Clinic Proceedings. 2018;93(1):59-67. Mayo Clinic Link
- Carlos K, Prado GF, Teixeira CD, et al. Benzodiazepines for restless legs syndrome. Cochrane Database of Systematic Reviews. 2017;3:CD006939. NCBI Link