What is Restless Legs Syndrome?

Restless legs syndrome (RLS) is a disorder in which a person experiences an uncontrollable urge to move the legs especially in the evening and during sleep. Restless leg syndrome (RLS) is also known as Willis-Ekbom disease (WED) and impacts any age. RLS typically worsens over time.

While similar to a disorder called Periodic Limb Movement (PLMD), the two are different in that RLS happens prior to sleep and delays the onset of sleep, whereas PLMD occurs during sleep and you may never know you have it.

Signs and Symptoms

The most common symptom of Restless Legs Syndrome is the urge to move the legs. Other symptoms of RLS include:

• Leg twitching
• Sensation of skin crawling or itching
• Sleep interruption or discomfort

Symptoms are most common at rest (usually in the evening) and can affect your ability to get comfortable enough to fall asleep.

Causes

Hereditary

There is oftentimes no known cause for Restless Legs Syndrome and is linked to certain genes, making it hereditary. The imbalance of a chemical in the brain, dopamine, has been suspected to cause RLS as it is partly responsible for muscle control. This imbalance causes the brain to send mixed messages to the muscles in the legs, giving the person that urge to move the legs when unnecessary.

Pregnancy

Pregnancy can cause a temporary urge to move the legs that is similar to RLS even though the condition has not previously existed and may go away after delivery. This typically happens later in the pregnancy and is attributed to hormonal shifts.

Risk Factors

Restless leg syndrome (RLS) is usually associated with other medical conditions. Other conditions associated with RLS are:

• Iron deficiency: People deficient in iron are the most common reason for RLS diagnoses
• Pregnancy: Pregnancy can worsen symptoms of RLS especially in late stages of pregnancy
• End-stage renal disease: End-stage renal disease often contributes to iron deficiencies
• Parkinson's disease: Damage to nerves can increase the risk for RLS
• Rheumatoid arthritis: Restless leg syndrome is common in patients with arthritis

RLS can occur in childhood and are often associated with attention deficit/hyperactivity disorder (ADHD). Forty percent of adults with RLS had an onset before age 21. RLS affects more women than men and your chances for developing the disorder increase with age.

Diagnosis

Usually a diagnosis can be made from the symptoms you describe to your doctor in addition to a medical history and a physical exam. Your doctor may want to run some blood tests to check for an iron deficiency and to rule out any other disorders. If necessary, your doctor may refer you to a sleep specialist at Baptist Health to take part in a sleep study in the lab or in your home.

Treatment

Current treatment methods for Restless Legs Syndrome are through medication and lifestyle changes.

Medical Treatments

There are several types of medications used to treat RLS or an underlying condition that may help alleviate the symptoms. The most common types of medications used are:

• Dopamine increasing medications like Ropinirole (Requip), rotigotine (Neupro) and pramipexole (Mirapex).
• Sleep medications such as clonazepam (Klonopin), eszopiclone (Lunesta), temazepam (Restoril), zaleplon (Sonata) and zolpidem (Ambien). While these medications help patients sleep, they do not have an effect on the leg symptoms.
• Narcotic medications such as codeine, oxycodone (Oxycontin, Roxicodone), combined oxycodone with acetaminophen (Percocet, Roxicet) and combined hydrocodone and acetaminophen (Norco).
• Nerve channels can be treated with medications such as gabapentin (Neurontin) and pregabalin (Lyrica).
• Iron stores can be replenished with an iron supplement to treat an underlying anemia condition that may be attributing to the symptoms of RLS.

It is important to note that certain medications work better for some people and not for others so your doctor may need to prescribe one and see how it works for you before trying another. Over time these medications may lose their effectiveness but your doctor can also prescribe something to help regain the effectiveness if that happens.

Non-Medical Treatment

In addition to medications you can also take steps to alleviate symptoms by:

• Practicing good sleep habits: going to bed and waking at the same time each day.
• Exercise regularly but at a moderate level. Walking is a good exercise that is not too strenuous as overdoing it may increase symptoms.
• Avoid caffeinated drinks and foods that contain caffeine.
• Relaxation techniques such as breathing, meditation and massages before sleep or during the evening.
• Warm baths and heat packs can help reduce symptoms.

Appointments can be made to speak with any of our physicians by calling the sleep center, however you may need a referral to have a study or other tests performed, which can be obtained from your primary care physician.

Prevention

While there is no prevention for Restless Legs Syndrome you can take steps to alleviate symptoms.

Prognosis

Maintaining a normal life with restless legs syndrome is possible with the help of medication and lifestyle changes but it also important to maintain a strong support system as sleep deprivation or a lack of sleep from this disorder may wear on you over time. To help you find the support you can try the following:

• Join a support group. If none exist in your area specifically for RLS, try finding one that is for chronic pain/disorders or seek out a group online. You may be able to make a connection with someone close to you who also has this disorder and understands your condition but technology can connect you to those suffering even if they aren’t near you.
• Keep a diary. Writing can be a release of the emotions and feeling associated with a chronic condition but can also be useful when speaking to your doctor and recalling how you are feeling on a new medicine, etc.
• Stretch, walk, massage your limbs or use hot/cold compresses to relieve your symptoms. When you feel the urge to move, do so, then try to rest again once you’ve given in to the urge.