Restless Legs Syndrome
What is restless legs syndrome?
Restless legs syndrome (also known as Willis-Ekbom disease) is a nervous system disorder that can affect your sleep. Restless legs syndrome (RLS) causes an overwhelming urge to move your legs. This sensation is worse in the evening and while you’re resting.
For many people it starts when lying down and resting before sleep, but it can also happen when you are sitting still.
People of all ages can get it, but it often worsens with age. RLS can happen for a variety of reasons, including genetics and other medical conditions. RLS is treatable with coping techniques, exercise, lifestyle modifications, and medications.
Most common symptoms
RLS is a hard problem for friends and family to understand because they can’t “see” anything wrong with you. But studies have shown that at least 3% and possibly as many as 14% of the population have RLS symptoms. What you are feeling is a real sensation and you are not alone. —Dr. Farrah Daly
RLS causes discomfort in your legs (and less commonly your arms) that leads to an irresistible urge to move them. The discomfort is worse when you are not moving. RLS makes it difficult to fall asleep and stay asleep. You can become tired during the day from the frequent wakings.
- Uncomfortable sensations in the legs and arms that lead to an irresistible urge to move them.
- Burning, throbbing, crawling, electric, and itching sensations.
- Sensations that are worse in the evening or when you are resting.
- Sensations go away when you move your legs and arms.
- Trouble falling asleep or going back to sleep if you wake up during the night.
- Difficulty staying awake throughout the day because of poor sleep.
- Lack of focus when working on tasks during the day because of poor sleep.
Restless legs syndrome causes
The cause of RLS is not known. It is believed to be a combination of genetics, environment, and other illnesses that cause it. RLS can run in families.
It is sometimes related to iron deficiency or kidney disease. Some research suggests that issues with the transmission of the brain chemical dopamine contributes to the problem. People with other diseases that have problems with dopamine, such as Parkinson's disease, may have a higher risk of RLS.
People often think that RLS is “just anxiety.” Anxiety can make the symptoms worse, but RLS is its own condition. Many people who have RLS are not anxious. —Dr. Daly
RLS is more common in women and in adults. Several factors can increase your risk of developing RLS:
- Genetics: There are several different genes linked to RLS. If you have familial RLS, you can pass it down to your children.
- Medical conditions can raise your risk of RLS, especially iron deficiency and kidney disease.
- Medications to treat depression, nausea, or psychosis can stimulate RLS.
- Pregnancy can also trigger RLS. Most women with pregnancy-related RLS improve within a month after delivery, but it can return later in life.
If you are experiencing symptoms that may be RLS, make an appointment with your doctor. Symptoms of RLS can be confused with other disorders that cause leg discomfort, such as diseases of the nerves or blood vessels. RLS may be a symptom of a more complex problem that should be addressed.
Go to the ER or call 911 if you notice the following symptoms, as you may have a more serious condition than RLS:
- Unable to control your urination or your bowel movements.
- Numbness in your hips or genital area associated with the sensations in your legs.
How do you stop restless leg syndrome fast?
Patients with RLS may have a hard time describing in words what the discomfort feels like. They describe feeling “uncomfortable” and the feeling goes away if they move around. They can’t get into a position where they can just rest. —Dr. Daly
There are a number of lifestyle changes that you can try before you take any medications.
- Get regular exercise. Exercise in the morning rather than before bedtime.
- Practice healthy sleep behaviors: Avoid looking at electronics (phone, computer, TV) before going to sleep.
- Avoid caffeine and alcohol before bed.
- Try warm baths, gentle stretching, and massage before bed.
- Review your medication list with your doctor to see if anything you’re taking might be contributing to RLS. Some medications used to treat depression, nausea, or psychosis can worsen the problem.
If your symptoms continue after trying these strategies, ask your doctor if they can recommend medications.
Your doctor may recommend the following supplements or medications to help manage your RLS symptoms:
- Daily iron supplements if you have low iron levels.
- Dopamine agonists, including ropinirole (Requip) and pramipexole (Mirapex). These help with dopamine activity.
- Nerve medications, including gabapentin (Neurontin), pregabalin (Lyrica), and gabapentin enacarbil (Horizant), which change neurotransmitter activity.
Dr. Dasani is a resident physician at Penn and Brigham and Women's Hospitals. She graduated from Columbia University in 2013 with a BA in Neuroscience and Behavior. Upon graduation, she served as a Fulbright scholar on the island, Bangka, Indonesia. After her Fulbright, she pursued a MD/MBA at Penn during which she worked on various health care consulting projects solving problems across multiple sectors of the health care system. She is currently a medicine resident physician at Penn and is planning to continue her anesthesia training at Harvard starting in July 2020. She is primarily interested in increasing the efficiency of health systems delivery with attention to patient safety, specifically within the perioperative realm.