Restless legs syndrome

Overview

Restless legs syndrome (RLS) is a condition that causes a very strong urge to move the legs. The need to move usually is caused by aching or an uncomfortable feeling in the legs. It typically happens in the evening or at night when sitting or lying down. Moving eases the feeling for a short time.

Restless legs syndrome can begin at any age and tends to get worse with age. It can make it hard to sleep, which affects daily activities. RLS also is known as Willis-Ekbom disease.

Simple self-care steps and lifestyle changes may help relieve symptoms. Medicines also help many people with RLS.

Symptoms

The main symptom of restless legs syndrome (RLS) is an urge to move the legs. It's common to experience:

• Leg discomfort that begins while resting. RLS symptoms typically begin after you've been lying down or sitting. This might happen while sitting in a car, airplane or movie theater.
• Relief with movement. RLS lessens with movement. Stretching, jiggling the legs, pacing or walking may improve symptoms.
• Worsening symptoms in the evening. Symptoms occur mainly at night.
• Nighttime leg twitching. RLS may be linked with another, more common condition called periodic limb movement of sleep. This condition causes the legs to twitch and kick during sleep, possibly throughout the night.

RLS leg symptoms usually happen on both sides of the body. They're described as feelings within the legs rather than on the skin. Less commonly, the condition affects the arms. The sensations are described as:

• Crawling.
• Creeping.
• Pulling.
• Throbbing.
• Aching.
• Itching.
• Electric.

Sometimes the symptoms of RLS are hard to explain. People with the condition usually don't describe the symptoms as muscle cramps or numbness. They do, however, describe the desire to move their legs.

It's common for symptoms to get better and worse. Sometimes symptoms disappear for periods of time, then come back.

When to see a doctor

Talk with your healthcare professional if you have symptoms of restless legs syndrome. RLS can interfere with your sleep, cause daytime drowsiness and affect your quality of life.

Causes

Often, there's no known cause for restless legs syndrome (RLS). Researchers suspect the condition may be due to an imbalance of the brain chemical dopamine. Dopamine sends messages that regulate muscle movement.

Heredity

Sometimes RLS runs in families, especially if the condition starts before age 40. Researchers have found sites on the chromosomes where genes linked to RLS may be present.

Pregnancy

Pregnancy or hormonal changes may worsen RLS symptoms. Some people get RLS for the first time during pregnancy, especially during the last trimester. However, in that case, symptoms usually disappear after delivery.

Risk factors

Restless legs syndrome (RLS) can develop at any age, even during childhood. The condition is more common as people get older. It's also more common in women than in men.

RLS usually isn't related to a serious medical condition. However, it sometimes occurs with other conditions, such as:

• Peripheral neuropathy. This damage to the nerves in the hands and feet is sometimes due to chronic diseases such as diabetes and alcohol use disorder.
• Too little iron in the body, known as iron deficiency. This can cause or worsen RLS. Iron deficiency can be caused by heavy menstrual periods, donating blood often, or bleeding from the stomach or bowels.
• Kidney failure. People with kidney failure also may have iron deficiency. When kidneys don't function properly, iron levels in the blood can go down. This and other changes in body chemistry may cause or worsen RLS.
• Spinal cord conditions. Damage or injury of the spinal cord has been linked to RLS.
• Parkinson's disease. People who have Parkinson's disease may have a higher risk of developing RLS.

Complications

Restless legs syndrome (RLS) symptoms can range from mild to serious. Many people with the condition find it hard to fall asleep or stay asleep, which may affect their quality of life. This can cause depression in some people. Not being able to sleep also may lead to excessive daytime drowsiness. RLS can even interfere with napping.

Diagnosis

To diagnose restless legs syndrome (RLS), your healthcare professional takes your medical history and asks about your symptoms. A diagnosis of RLS is based on the following criteria from the International Restless Legs Syndrome Study Group:

• You have a strong urge to move your legs that's hard to resist. This usually occurs with discomfort in your legs.
• Your symptoms start or get worse when you're resting, such as sitting or lying down.
• Your symptoms are relieved by activity, such as walking or stretching.
• Your symptoms are worse at night.
• Your symptoms can't be explained by another condition.

Your healthcare professional also may give you a physical and a neurological exam. Blood tests, especially of your iron level, can help look for possible causes of your symptoms and guide your treatment.

You may be referred to a sleep specialist. This may involve an overnight stay at a sleep clinic for a sleep study if another condition, such as sleep apnea, is suspected. However, a diagnosis of RLS usually doesn't require a sleep study.

Treatment

Symptoms of restless legs syndrome (RLS) sometimes go away after treating an underlying condition, such as iron deficiency. This may involve taking an iron supplement by mouth or through a vein in your arm. Only take iron supplements after having your blood-iron level checked and while being monitored by your healthcare professional.

If you have RLS that's not directly caused by another condition, treatment focuses on lifestyle changes. If those aren't effective, your healthcare professional may prescribe medicines.

There's also a device that delivers electrical stimulation to a nerve on the side of your knee that may help RLS symptoms. This device requires a prescription from your healthcare professional. It's often used with medicines.

Medicines

A number of prescription medicines are available to reduce the restlessness in the legs. Many of the medicines were developed to treat other diseases, but they may help with RLS. These medicines include:

• Medicines affecting calcium channels. Medicines such as gabapentin (Neurontin, Gralise, Gabarone), gabapentin enacarbil (Horizant) and pregabalin (Lyrica) are the first line of treatment for most people with RLS. These medicines can cause side effects such as dizziness, trouble with balance, mental fog or weight gain.

• Medicines that increase dopamine in the brain. These medicines affect levels of the chemical messenger dopamine in the brain. Rotigotine (Neupro), pramipexole (Mirapex ER) and ropinirole work for a short time. But in many people taking these medicines, RLS will get worse over time. The medicines may cause symptoms to return earlier in the day. Some people taking these medicines find that symptoms spread to the arms. The medicines also can cause issues with impulse management, such as compulsive gambling. Because of these risks, these medicines may not be recommended by your healthcare professional. They're only used if medicines affecting calcium channels don't work or cause side effects.

  People who have occasional RLS symptoms may be prescribed carbidopa-levodopa (Sinemet, Rytary, others) to take as needed. But healthcare professionals don't recommend taking this medicine daily or near daily. Daily use of this medicine can cause a worsening of symptoms.

• Opioids. These medicines are used in low doses to treat RLS when other medicines haven't worked or have caused side effects. Some examples include oxycodone (Oxycontin, Roxicodone, others), hydrocodone (Hysingla ER) and buprenorphine (Belbuca, Butrans). Most people taking opioids don't have major side effects, and these medicines are effective in managing RLS symptoms. In low doses, misuse is rare.

It may take a number of trials to find the right medicine or combination of medicines that work best for you.

Some other medicines may worsen symptoms of RLS. These include some antidepressants, some antipsychotic medicines, some anti-nausea medicines, and some cold and allergy medicines. Your healthcare professional may recommend that you don't take these medicines, if possible. If you need to take them, talk to your healthcare professional about treatments to help manage RLS.

Most medicines prescribed to treat RLS aren't recommended during pregnancy. Instead, self-care techniques and iron supplements may be recommended to relieve symptoms. But if symptoms bother you during your last trimester, your healthcare professional may recommend certain RLS medicines.

Lifestyle and home remedies

Restless legs syndrome (RLS) might be relieved by making simple lifestyle changes:

• Try baths and massages. Soaking in a warm bath and massaging the legs can relax the muscles.
• Apply warm or cool packs. Use of heat or cold, or alternating use of the two, may lessen the uncomfortable feelings in your legs.
• Establish good sleep hygiene. Fatigue tends to worsen symptoms of RLS, but good sleep hygiene may help lessen fatigue. Create a cool, quiet, comfortable sleeping environment. Go to bed and rise at the same time every day. Get at least seven hours of sleep every night.
• Exercise. Moderate, regular exercise may relieve symptoms of RLS. But overdoing it or working out too late in the day may make symptoms worse.
• Avoid caffeine. Sometimes cutting back on caffeine may help restless legs. Try to avoid caffeine-containing products for a few weeks to see if this helps. This includes cutting out chocolate, coffee, tea and soda.
• Consider using a foot wrap or a vibrating pad. A foot wrap specially designed for people with RLS puts pressure under the foot and may help relieve your symptoms. You also may find relief using a pad that vibrates on the back of your legs.

Coping and support

Restless legs syndrome (RLS) is most often a lifelong condition. It may help you to develop coping strategies, such as:

• Tell others about your condition. Sharing information about RLS helps your family, friends and co-workers better understand what you're going through. It can help explain why you might pace the halls or stand at the back of the theater. It may help co-workers better understand if they see you walk to the water cooler many times during the day.
• Don't resist your need for movement. If you try to ignore the urge to move, you may find that your symptoms worsen.
• Keep a diary. Keep track of your sleep and the medicines and strategies that help symptoms. Also note what makes symptoms worse. Share this information with your healthcare professional.
• Stretch and massage. Begin and end your day with stretching exercises or gentle massage.
• Seek support. Support groups bring together family members and people with RLS. By taking part in a group, your insights can not only help you but also may help someone else.

Preparing for an appointment

If you have symptoms of restless legs syndrome (RLS), make an appointment with your healthcare professional. You may be referred to a doctor who specializes in conditions affecting the nervous system, known as a neurologist, or to a sleep specialist.

Here's some information to help you get ready for your appointment.

What you can do

• Write down your symptoms, including when they started and when they tend to occur.
• Write down key medical information, including other conditions you have. Also include medicines you take, including prescriptions and those you get without a prescription, as well as vitamins and supplements. And note whether there's a history of RLS in your family.
• Take a family member or friend along. Someone who comes with you may remember information you missed or forgot.
• Write down questions to ask.

Some basic questions to ask your healthcare professional about RLS include:

• What is the most likely cause of my symptoms?
• Are there other possible causes?
• What tests do I need?
• What treatment options are available for this condition?
• I have other health conditions. How can I best manage them together?
• What self-care steps might improve my symptoms?
• Do you have educational materials I can have? What websites do you recommend?
• Where can I find a support group for people with RLS?

What to expect from your doctor

Your healthcare professional is likely to ask you questions, including:

• Do you get a strong urge to move your legs?
• What words describe your symptoms?
• Do your symptoms start while you're sitting or lying down?
• Are your symptoms worse at night?
• Does movement make you feel better?
• Have you been told that you kick, shake or otherwise move your legs while sleeping?
• Do you often have trouble falling or staying asleep?
• Are you tired during the day?
• Does anyone else in your family have restless legs?
• How much caffeine do you have daily?
• What is your typical exercise program?
• Are you at risk of low iron due to limiting meat in your diet, donating blood often or blood loss from a recent surgery?
• What medicines have you used for RLS? Were they effective?

What you can do in the meantime

To ease your symptoms:

• Cut back on or eliminate caffeine, alcohol and tobacco.
• Massage your legs while soaking in a warm bath.