Restless Legs Syndrome (RLS)

Signs and symptoms of Restless Legs Syndrome (RLS)

Although the symptoms are distinctive, many people dismiss the feelings as muscle aches or restlessness, and do not suspect that they have RLS. Thus, RLS is frequently misdiagnosed and often left untreated, resulting in restlessness, insomnia, and daytime sleepiness.

Common Symptoms of Restless Legs Syndrome (RLS)
Irritating sensations	Sensations can be painful or just uncomfortable and are often described as a general urge to move the legs (or other affected limbs).
Urge to move	Getting up and moving around seems to relieve discomfort.
Evenings and nighttime are worse	Discomfort tends to increase during the evening or night.
Rest or stillness brings on the symptoms	Sitting or lying down seem to trigger the restlessness in the legs.
Visible movements in toes or feet	Your feet or toes may move slightly or jerk when you are sitting still or resting.

Children and RLS

Many people diagnosed as adults with Restless Legs Syndrome look back upon childhood hyperactivity or “growing pains” and realize that these were actually symptoms of RLS. Sometimes a child is misdiagnosed with Attention Deficit Hyperactivity Disorder, when the true diagnosis is Restless Legs Syndrome.

Causes of Restless Legs Syndrome (RLS)

Restless Legs Syndrome is a central nervous system disorder (a disorder based in the brain or spinal column). It may have a genetic basis (meaning it sometimes runs in families), or be related to an imbalance of dopamine in the brain. Levels of dopamine, a brain chemical that affects movement, naturally fall at night, which could be why RLS symptoms often get worse late in the day and at night. Additionally, iron is important to the production of dopamine, which may explain why low iron levels are often linked to RLS symptoms.

Psychiatric conditions or stress may exacerbate RLS, but they do not cause RLS.

Primary RLS

Primary RLS seems to occur without cause and often first affects people when they are young. Mild symptoms may start in early adulthood and then increase with age. After age 50, the symptoms often increase in severity and significantly disrupt sleep. Primary RLS does seem to run in families.

Secondary RLS

Secondary RLS is usually caused by or linked to other conditions, including:

• Iron poor blood (anemia)
• Kidney disease
• Parkinson’s disease
• Pregnancy (RLS often goes away after pregnancy)
• Thyroid problems
• Neurologic lesions (spinal cord tumors, peripheral nerve lesions, or spinal cord injury)
• Sleep apnea or narcolepsy
• Varicose veins or trouble with the nerves in the hands or feet
• Alcoholism

Medications including tricyclic antidepressants, anti-nausea and anti-seizure drugs, selective serotonin reuptake inhibitors (SSRIs), lithium, and some cold and allergy drugs may increase or trigger RLS symptoms. In addition, withdrawal from sedatives may trigger RLS.

Treating Restless Legs Syndrome (RLS)

Although no cure exists for Restless Legs Syndrome, different types of treatment can be used to manage the condition and relieve discomfort. If your symptoms are mild, self-help may be sufficient treatment. If your Restless Legs Syndrome is caused by an underlying condition, treatment of the underlying condition often cures the RLS.

Self-care for RLS

Your RLS symptoms may respond to changes in your daily behaviors and habits. .

Self-help tips for Restless Legs Syndrome (RLS)
During the day	At bedtime
Exercise regularly. Wrap your legs in ace bandages, or wear compression stockings or tight pantyhose. Take iron supplements for low iron levels. Be sure to get tested first. Stand up – Elevate your desk or stand at work if possible. Reduce caffeine, alcohol, and tobacco use, particularly in the evenings. These substances often increase symptoms. Keep a regular sleep schedule.	Pace, walk, or jog for a few minutes to relieve discomfort. Stretch your legs, do knee bends, or rotate your ankles. Massage your legs. Relax with meditation, yoga, or deep breathing. Apply heat or cold. Take a bath or soak your feet in hot water, briefly use a heating pad or cold compresses, or apply a hot water bottle. Lie on your side with a pillow between your knees to initiate sleep. Get up – Fighting the urge to move might make the feelings worse.

Coping with RLS can be especially difficult if you feel like others can’t relate to the problem. Sharing information with family, friends and coworkers can help them understand why you need to stand up and walk around often. It might also be helpful to find a support group and talk with others who know firsthand about RLS and who can support and encourage you in a search for a solution.

Transcutaneous Electric Nerve Stimulation (TENS)

Applying electrical stimulation to feet and legs reduces nighttime leg jerking in some patients who have severe RLS. Using a portable, bedside TENS unit, you apply electrical stimulation for 15 to 30 minutes to your legs.

Seeking medical treatment for RLS

If self-help doesn’t relieve your RLS symptoms, a doctor or sleep specialist might be helpful in exploring alternative treatments. No laboratory test can confirm a diagnosis of RLS, so the condition is often overlooked. To diagnose RLS, your doctor will request:

• A medical history
• A familial survey to see if anyone else in your family has similar symptoms
  Interview about other medical conditions you have
• A blood test for low iron levels

Keeping a sleep diary is helpful if you suspect you have RLS. Recording changes in your diet, lifestyle, sleep habits and routine might help you and your doctor make helpful changes.

Medications for Restless Legs Syndrome (RLS)

Medications are a common treatment for RLS. However, no single drug works for everyone with the condition. The medications prescribed for Restless Legs Syndrome are frequently “off-label” uses of the drugs, meaning they are not specifically intended for RLS, but have been found to help with symptoms. The dosage given for RLS is usually much less than the dosage for the intended condition.

Common medications prescribed for RLS include:

• Dopaminergic agents (Examples: Ropinirole, Pramipexole) - Often, this is the first line of treatment for RLS. Normally used to treat Parkinson’s Disease, these medications increase dopamine, a neurotransmitter that regulates muscle movements.
• Benzodiazepines - These are sleep medications, or central nervous system depressants, which also suppress muscle contractions.
• Non-benzodiazepine sedatives - Short-acting hypnotic agents, or sleeping pills. These may be helpful for mild RLS that occurs primarily at bedtime.
• Opiates / narcotics (Examples: low-potency Darvon, high-potency Percodan) - Pain-killing and relaxing drugs can suppress RLS in some people. Addictive and should be used only in low dosages.
• Anticonvulsants (Examples: Gabapentin, Neurontin) - normally used to prevent seizures, and reduce muscle contractions for some people.
• Hypertensive medications – Generally prescribed for high blood pressure.

Periodic Limb Movement Disorder (PLMD)

Periodic Limb Movement Disorder (PLMD) is very similar to RLS. While RLS is a sensation in the legs and subsequent voluntary movement to avert the sensation, PLMD is involuntary, rhythmic limb movements, either while asleep or when awake. RLS disrupts sleep by delaying sleep; PLMD can disrupt sleep because of the constant limb movements. Many people with PLMD are not even aware of their symptoms until a bed partner brings it to their attention.

Do people with RLS also have PLMD? Most people who have Restless Legs Syndrome also have PLMD. However, the reverse is not true - only some people with PLMD also have RLS. See the resources below for more information about PLMD.

PLMD can be primary (with no known cause) or secondary (caused by an underlying medical condition). Primary PLMD might be caused by an abnormal regulation of nerves traveling from the brain to the limbs. Secondary PLMD is associated with many of the same conditions as RLS, including spinal cord injuries, sleep apnea, diabetes, and iron deficiencies.

Related Links

Related links for Restless Legs Syndrome (RLS)

General information on Restless Legs Syndrome

Restless legs syndrome – An overview of RLS, plus signs and symptoms, causes, screening and diagnosis, treatment, self-care, and coping skills. (Mayo Clinic)

Restless leg syndrome (NHS Direct – UK) – Also available in different languages

Treatment for Restless Legs Syndrome

Looking for another self help/treatment page

RLS/PLMD Treatment Page: Comprehensive Review of Medications used in Treating RLS and PLMD – Comprehensive listing of treatments for Restless Legs Syndrome, including alternative treatments. (Southern California RLS Support Group)

Support for sufferers of RLS and PLMD

Support Groups: Find a group – Locate a support group for RLS in the United States or Internationally. (RLS.org)

International Guide to Movement Disorder Patient Advocacy Groups and Foundations – Links to support and advocacy organizations around the world for Restless Legs Syndrome. (WeMove.org)

Periodic Limb Movement Disorder

Periodic Limb Movements – Describes the symptoms of Periodic Limb Movement Disorder and provides guidelines for when to seek help. (SleepEducation.com, American Academy of Sleep Medicine)

Guide to Periodic Limb Movement Disorder – A comprehensive guide to PLMD. (eMedicineHealth)

Tina de Benedictis, Ph.D., Gina Kemp, M.A., and Suzanne Barston contributed to this article. Last modified: October 08.