Restless Legs Syndrome

Restless Legs Syndrome

Topic Overview

What is restless legs syndrome?

Restless legs
syndrome (RLS) is a disorder related to sensation and movement. People with
restless legs syndrome have an unpleasant feeling or sensation in parts of their bodies
when they lie down to sleep. Most people also have a very strong urge to move, and moving sometimes makes them feel better. But all this
movement makes it hard or impossible to get enough sleep.

Restless legs syndrome usually affects the legs. But it can cause unpleasant feelings in the arms, torso, or even a phantom limb (the part of a limb that has been amputated).

When you
don't get enough sleep, you may start to have problems getting things done
during the day because you're so tired. You may also be sleepy or have trouble
concentrating. So it's important to see your doctor and get help to manage your
symptoms.

What causes restless legs syndrome?

Usually there
isn't a clear reason for restless legs. The problem often runs in families.
Sometimes there is a clear cause, like not getting enough iron. If that's the
case, treating the cause may solve the problem.

Women sometimes
get restless legs while they are pregnant.

Other problems that are sometimes linked to
restless legs syndrome include kidney failure,
rheumatoid arthritis,
diabetes, nerve damage, anemia, and
Parkinson's disease. But most people who seek
treatment do not have any of these other problems.

What are the symptoms?

Restless legs syndrome
makes you feel like you must move a part of your body, usually your legs. These feelings are often described
as tingling, "pins and needles," prickling, pulling, or crawling.

Moving will usually make you feel better, at least for a
short time. This problem usually happens at night when you are trying to relax
or go to sleep.

After you fall asleep, your legs or arms may begin to jerk
or move. These movements are called periodic limb movements. They can wake you
from sleep, which adds to your being overtired. Although periodic limb movement
is considered a separate condition, it often happens to people who have
restless legs syndrome.

How is restless legs syndrome diagnosed?

One of
the hardest things about having restless legs syndrome is getting to the diagnosis.
Often doctors don't ask about sleep or don't ask about the symptoms of restless
legs. If you're not sleeping well, or if you think you may have restless legs
syndrome, tell your doctor.

Your doctor will talk with you about
your symptoms to make sure that the feelings you describe are
typical of restless legs syndrome and are not caused by some other problem.

You may have blood tests to rule out other problems that could be causing
your symptoms. In some cases, the doctor may order tests of your nerves to be
sure there is no nerve damage. Your doctor may also order a sleep study called
a
polysomnography. This test records how often your legs
jerk or move while you sleep.

How is it treated?

If your symptoms are mild, a
few lifestyle changes may be enough to control your symptoms. Some changes that
may help:

  • Avoid tobacco, alcohol, and
    caffeine.
  • Keep your bedroom cool, quiet, and comfortable, and use
    it only for sleeping, not for watching TV.
  • Get regular
    exercise.
  • Massage the leg or the arm, or use heat or ice
    packs.

When symptoms are more severe, medicines may help control
the urge to move and help you sleep. There are different types of medicine,
and you may have to try a few to find the one that works best.

Frequently Asked Questions

Learning about restless legs syndrome:

Being diagnosed:

Getting treatment:

Ongoing concerns:

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Symptoms

The main symptom of
restless legs syndrome (RLS) is an irresistible urge
to move because of uncomfortable and sometimes painful sensations
deep within a part of your body. The feelings usually affect the legs but can also affect the arms, torso, or a phantom limb (the part of a limb that has been amputated). Some people describe the sensations as aching, creeping,
crawling, or prickling. Symptoms usually begin about 15 minutes after you lie
down to sleep or to relax or when you have not moved for long periods, such as
when traveling in a car or airplane. Symptoms that occur frequently can result
in significant sleep loss, fatigue, and problems with daily
functioning.

After they are asleep, most people with RLS also
have involuntary or jerking leg movements called
periodic limb movements. These movements can interrupt
your sleep, which adds to problems with fatigue. Periodic limb movements may
also occur during the day, although most people move around after their legs
begin to bother them. As a result, the periodic limb movements that people have
when they are awake may not be noticed except under unusual
circumstances.

Restless legs syndrome and periodic limb movements
also often disturb the sleep of a bed partner. This can cause fatigue for both
people and can strain the relationship.

Symptoms may start during
infancy or any time during your life. At first, your symptoms may be mild and
occur only once in awhile. Typically, symptoms get worse with age. After age
50, many people with this condition have daily symptoms and suffer from
significant sleep loss. Severe
insomnia,
fatigue,
anxiety,
depression, and lack of social activity can become a
problem and cause a decline in quality of life.

Restless legs
syndrome may start or become worse during pregnancy, especially after week 20.

Exams and Tests

A doctor diagnoses
restless legs syndrome by asking questions about your
symptoms. A physical exam may be done to look for other possible problems that
could be causing your symptoms.

Restless legs syndrome is
diagnosed by your doctor based on the following four criteria:

  • You have an urge to move a part of your body, usually
    because of uncomfortable sensations such as tingling, "pins and needles,"
    prickling, crawling, or pain. In some cases, you may not feel any unpleasant
    sensations but still feel the urge to move your legs or your
    arms.
  • The sensations and the urge to move begin or get
    worse during periods of rest or inactivity, such as when you are sitting or
    lying down.
  • The sensations and the urge to move are
    partially or totally relieved by movement. But relief may be temporary and only
    last while you are walking, stretching, or moving.
  • The
    urge to move and the sensations are worse in the evening or at night.
    But some people may have severe sensations and urges to move throughout the day and night.

Other factors that may support a diagnosis include:

  • Having a family history (in a parent or
    sibling) of restless legs syndrome.
  • Having
    periodic limb movements—involuntary jerking or
    movement of your legs—while you are awake or asleep.
  • Showing
    improvement when the medicine
    dopamine is used.

A sleep study called a
polysomnography may be done to help your doctor
diagnose restless legs syndrome or rule out other sleep disorders. This test
records the electrical activity of your brain, eye movements, muscle activity,
heart rate, breathing, air flow through your nose and mouth, and blood oxygen
levels.

Although this test is not essential, it provides details
of limb movement symptoms. These details may help evaluate the severity of your
symptoms. The severity ranges from people who have restless legs syndrome
occasionally, with only mild difficulty falling asleep, to those who have it
frequently, with repeated interruptions of sleep. Serious sleep problems can
greatly affect your ability to function during the day.

Common problems with diagnosing restless legs syndrome

Many cases go undiagnosed because:

  • Many people do not seek a doctor's help when
    they have symptoms.
  • Most people visit a doctor during the day, when
    symptoms are not present or are only mild.
  • Some doctors do not
    recognize the condition and may believe that the symptoms are caused by other
    conditions, such as insomnia, stress, muscle cramps, or arthritis.

Restless legs syndrome does occur in children but it is
hard to diagnose for the same reasons. Children often are not able to
describe their symptoms. A parent's observations of the child's behavior and
sleep may be helpful. Knowing that a parent or other close relative has
restless legs syndrome can also help the doctor make a diagnosis of restless
legs syndrome in the child.

Other conditions to consider

Polysomnography and
related sleep study tests may also be done to help identify problems that can
interfere with sleep. You may be evaluated for
other conditions with symptoms similar to restless legs syndrome. These
conditions include
varicose veins,
arthritis, or
intermittent claudication (a tight, aching, or
squeezing pain in the calf, foot, thigh, or buttock that occurs during
exercise).

You also may be asked about behaviors, habits, and
physical traits that may be related, such as:

  • Smoking.
  • Lack of regular,
    moderate exercise.
  • Being overweight and having a high
    body mass index.

You may also have tests to check for
other diseases or health conditions—such as
diabetes,
peripheral neuropathy, pregnancy, kidney problems, or
iron deficiency anemia—that can cause your symptoms.
Tests will vary depending on what your doctor identifies as likely problems.

Treatment Overview

Treatment for
restless legs syndrome is based on the type of
symptoms you have and how bad your symptoms are. Getting regular exercise and
enough sleep may relieve mild symptoms. Medicines may be tried when symptoms
are severe and interfere with sleep and daily functioning. If your symptoms are
being caused by another medical condition (such as
iron deficiency anemia), that condition can be treated
first.

Initial treatment

Changing your daily routine is
sometimes enough to control your symptoms. Stretching, walking, exercising
regularly, taking a hot or cold bath, using massage, losing weight if you are overweight, and avoiding smoking, alcohol, and
caffeine may reduce or control your symptoms.

If your symptoms are
caused by
another medical condition such as
diabetes or
iron deficiency anemia, you will be treated for that
condition first. For example, if iron deficiency is causing restless legs
syndrome, you will be prescribed iron supplements.

For restless legs syndrome that starts during pregnancy, your
doctor may recommend conservative treatment, such as regular exercise and
stretching, to relieve symptoms. Your condition may be reevaluated if it
doesn't go away after you have given birth.

Children who have restless
legs syndrome are not usually treated with drugs right away. First regular,
moderate exercise and regular sleep routines are tried. If this treatment
is not effective, the doctor may prescribe medicine.

Ongoing treatment

If your symptoms do not improve,
drugs may be used to control the urge to move and help you sleep, such
as:

  • Dopamine agonists, such as ropinirole
    (for example, Requip).
  • Anticonvulsants, such as gabapentin
    (for example, Neurontin) or gabapentin enacarbil (Horizant).

In some cases, your doctor may recommend an opioid pain medicine.

If
your doctor recommends medicine, make sure that you discuss expectations and
understand the potential benefits and risks of the drug. Let your doctor know
about all of the other drugs you are taking. Drugs taken for other conditions
sometimes contribute to restless legs syndrome. For example, antidepressants
improve restless legs syndrome in some people but make it worse in
others.

Treatment if the condition gets worse

Over time, treatment of RLS with a dopamine medicine may not work as well as it did at first. This is called augmentation.

You might notice that your symptoms:

  • Begin earlier in the day.
  • Become more intense.
  • Spread to another part of your body.

If you are taking a dopamine medicine for RLS and your symptoms change, tell your doctor. Do not stop taking your medicine without talking to your doctor first. You can work with your doctor to decide what treatment is the best one for you.

If you
continue to have symptoms even though you are receiving treatment with drugs
and are exercising regularly, eating right, and not smoking, drinking alcohol, or using caffeine,
your symptoms may need to be reevaluated. Many other conditions can cause the
sensations found in
restless legs syndrome, including several vitamin and
mineral deficiencies.

Your doctor may recommend different drugs or
a combination of drugs. Follow up with your doctor if your symptoms do not
improve.

Other treatment

Your doctor may have you try other treatments. Examples are:

  • A pneumatic compression device, which pumps air in and out of sleeves to make them tight and loose around your legs while you are resting.
  • Vibrating pads (Relaxis), which send vibrations to your legs as you lie in bed. The vibrations have been shown to improve sleep for some people with RLS.

Home Treatment

There are ways to improve your symptoms
of
restless legs syndrome at home.

Try:

  • Exercise. Regular,
    moderate exercise may reduce symptoms. Avoid long periods between activity
    and avoid sudden bursts of intense activity. Talk to
    your doctor before you start an exercise program.
  • Heat or cold. Your symptoms may be relieved by bathing in hot or
    cold water. Or try a heating pad, hot water bottle, or ice bag. Keep a cloth between the heating pad, hot water bottle, or ice bag and your skin. Do not use a heating pad with children.
  • Changing your sleep schedule.
    Fatigue can make your symptoms worse. Because symptoms
    typically improve around 4 a.m. to 6 a.m., try going to bed later than usual or
    allowing extra time for sleeping in to help you get the rest you need.

  • Stretching and massage.
    You may be able to control your symptoms by gently stretching and massaging
    your limbs before bed or as discomfort begins.

Avoid:

  • Caffeine, tobacco, and alcohol.
    These may make your symptoms worse.
  • Certain medicines. Some prescription and
    over-the-counter (OTC) medicines (such as cold and
    sinus medicines) can make symptoms of RLS worse. If you think your symptoms get
    worse after you take a certain medicine, talk to your doctor.
  • Being confined for long periods. Try to plan for
    times when you will need to remain seated for long stretches. For
    example, if you are traveling by car, plan to make some stops so you can get
    out and walk around.
  • Excessive exercise.
    Although moderate exercise may help relieve symptoms, unusually intense
    workouts may make them worse. Try to figure out at what level exercise helps and
    at what point it triggers restless legs syndrome.

See your doctor if your symptoms do not improve, if they
become worse, or if they significantly interfere with your sleep and daily
functioning.

Other Places To Get Help

Organizations

American Academy of Sleep Medicine: Yoursleep
http://yoursleep.aasmnet.org

National Institute of Neurological Disorders and Stroke (U.S.)
www.ninds.nih.gov

References

Other Works Consulted

  • American Academy of Sleep Medicine (2005). Restless legs syndrome. In International Classification of Sleep Disorders, Diagnostic Coding Manual, 2nd ed., pp. 178–181. Westchester, IL: American Academy of Sleep Medicine.
  • Aurora RN, et al. (2012). The treatment of restless legs syndrome and periodic limb movement disorder in adults—An update for 2012: Practice parameters with an evidence-based systematic review and meta-analyses. Sleep, 35(8): 1039–1062. Also available online: http://www.aasmnet.org/practiceparameters.aspx?cid=119.
  • Esteves AM, et al. (2009). Effect of acute and chronic physical exercise on patients with periodic leg movements. Medicine and Science in Sports and Exercise, 41(1): 237–242.
  • Garcia-Borreguero D, et al. (2010). Treatment of restless legs syndrome with pregabalin: A double-blind, placebo-controlled study. Neurology, 74(23): 1897–1904.
  • Pack AM (2010). Neurologic disease during pregnancy. In LP Rowland, TA Pedley, eds., Merritt's Neurology, 12th ed., pp. 1043–1050. Philadelphia: Lippincott Williams and Wilkins.
  • Reite M, Weissberg M (2014). Sleep-wake disorders. In RE Hales et al., eds., American Psychiatric Publishing Textbook of Psychiatry, 6th ed., pp. 607–644. Washington, DC: American Psychiatric Publishing.
  • Voon V, et al. (2011). Frequency of impulse control behaviours associated with dopaminergic therapy in restless legs syndrome. BMC Neurology. Published online: September 28, 2011. (doi: 10.1186/1471-2377-11-117). Available online: http://www.biomedcentral.com/1471-2377/11/117.
  • Weintraub D, et al. (2010). Impulse control disorders in Parkinson disease. Archives of Neurology, 67(5): 589–595.
  • Winkelman JW, et al. (2016). Practice guideline summary: Treatment of restless leg syndrome in adults. Neurology, 87: 2585–2593. DOI: http://dx.doi.org/10.1212/WNL.0000000000003388. Accessed February 23, 2017.

Credits

ByHealthwise StaffPrimary Medical Reviewer Anne C. Poinier, MD - Internal Medicine E. Gregory Thompson, MD - Internal Medicine Adam Husney, MD - Family Medicine Martin J. Gabica, MD - Family Medicine Kathleen Romito, MD - Family Medicine Specialist Medical Reviewer Karin M. Lindholm, DO - Neurology

Current as ofFebruary 22, 2018

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