Restless Legs Syndrome

What is restless legs syndrome?

As a sensory disorder restless legs syndrome (RLS) causes an uncontrollable desire to move the legs. This severe desire is caused by unpleasant sensations which are felt in the legs when an individual is at rest. People with restless legs syndrome have described these sensations as tingling, creeping and burning feelings, with sensations also being experienced in the arms. Moving the legs causes temporary respite but the feelings return after a period of time.

Effects of restless legs syndrome

Restless legs syndrome can make it difficult to go to sleep and enjoy an undisturbed night of rest, which can as a result start to affect people's energy levels and alertness throughout the day. It is common for people who have restless legs syndrome to wake up several times during the night, so that they do not get sufficient sleep. Feeling tired in the day can contribute to the following problems:

Difficulty concentrating.
Feeling irritable.
Lacking energy and motivation.
Struggling to work.
Finding it difficult to maintain an active social life.

A lack of sleep can also increase the risk of depression.

Restless legs syndrome can be mild or severe and symptoms vary according to the individual. RLS is classified according to:

The level of discomfort you experience in your legs (and sometimes arms).
How moving your legs affects you (how much respite you experience).
How often you are disturbed during sleep.
How tired you are throughout the day.
How well you are able to carry out normal daily activities.
How your performance at work is affected.
How mild or severe the symptoms are on a daily basis.
How strong the need to move your legs is.
How RLS affects your mood.
How often you experience symptoms.

Types of RLS

Two main forms of restless legs syndrome have been identified:

Primary RLS: this is the main type of restless legs syndrome, and is also known as idiopathic as the cause is unknown. Primary RLS is usually a lifelong condition that grows worse over time, this being especially true if symptoms develop during childhood. In mild cases, there can be prolonged times without any symptoms or noticeable signs may wear off quickly.
Secondary RLS: secondary RLS is brought on by another health condition or due to taking certain types of medication. Treating the primary condition or changing the medication is usually sufficient to ease symptoms associated with RLS.

Periodic limb movement disorder

The majority of people who have RLS also suffer from periodic limb movement disorder, also known as PLMD. PLMD causes the legs to move as well as twitch on a regular basis (usually every 10-60 seconds) and often occurs during sleep. PLMD results in disturbed sleep patterns which can lead to tiredness throughout the day. PLMD commonly has an effect on the legs, but it can also have an impact on the arms.

Outlook

RLS can cause discomfort and affect energy levels and mood at some point in the day. However, there are treatments and self-help techniques available to help ease symptoms. Research into treatments for RLS is ongoing.

What are the causes of restless legs syndrome?

In the majority of cases no cause is identified and this is classified as primary restless legs syndrome. There is some evidence to suggest that genetics plays a part, as primary RLS often runs in families and you have a higher risk of developing the condition if you have a close relative with RLS.

Secondary restless legs syndrome is usually caused by another health condition and can also be a consequence of taking certain types of medication. Conditions that may cause restless legs syndrome include:

Kidney failure.
Diabetes.
Iron deficiency (which may or may not cause anaemia).
Parkinson's disease.
Peripheral neuropathy (this is when the nerves in the feet or hands are damaged).
Rheumatoid arthritis.
Pregnancy: RLS is prevalent in pregnant women, especially in the final 3 months of pregnancy. Symptoms normally disappear after the baby is born, but some females continue to experience symptoms.

Medicines which may cause secondary RLS include:

Antidepressants.
Anti-sickness medication.
Anti-seizure medicines.
Some medicines for the treatment of colds and allergies.

In most cases, symptoms of RLS ease once the individual has stopped taking medication.

Some substances can trigger the onset of symptoms or make symptoms more severe. These include:

Caffeine.
Tobacco.
Alcohol.

Risk of developing restless legs syndrome

It is generally thought that the occurrence of restless legs syndrome in Northern Europe and America is 2 to 15 per cent.

Gender: RLS has an impact on both males and females, although it is more prevalent in women than men.
Age: RLS tends to affect people over the age of 40. However, it is possible for younger people to experience symptoms. Most people who have symptoms of RLS during their childhood or their twenties have a predisposition to the condition.
Race: RLS affects people of all races and ethnicities, though the disorder tends to be most common in people of Northern European origin.
Pregnancy: RLS is prevalent in pregnant women. Most women experience symptoms during the final 3 months of pregnancy and symptoms ease once the baby has been born. Although some women continue to experience symptoms following the birth of their child.

Symptoms and signs of restless legs syndrome

Restless legs syndrome causes a number of different symptoms; including:

An uncontrollable need to move the legs when resting or sitting.
Unpleasant sensations in the legs (including burning and tingling feelings).
Difficulty falling and staying asleep.
Feeling tired and lethargic in the day (as a result of disturbed sleep at night).

Urges to move

RLS is so-called because it causes an uncontrollable desire to move the legs while lying or sitting down. This urge is caused by unpleasant sensations in the legs (and sometimes the arms). Moving the legs usually causes the sensations to ease, with movements used to ease sensations including:

Pacing up and down.
Rubbing the legs up and down.
Bending and stretching the legs.
Shaking the legs.
Turning around in bed.

Unpleasant sensations

The strong desire to move the legs is usually caused by unpleasant sensations which are described as:

Burning.
Tingling.
Crawling.
Creeping.
Pulling.
Itching.
Aching.
Uncomfortable and painful.

Children with RLS often describe the sensations differently to adults.

In most cases, the unpleasant sensations develop in the lower leg (calf) but they can also have an impact on the thighs and arms. Feelings tend to be more severe when the individual is:

Sitting or lying down for a prolonged period of time.
During the night.

Unpleasant sensations make it tricky to fall and stay asleep, which can cause tiredness at some stage in the daytime. Sensations tend to ease following movement.

Duration and severity

It is common for signs of RLS to grow worse after a while, especially if symptoms first develop during childhood. They are liable to get worse more rapidly in those who develop the condition in later life. Most people who experience symptoms early in life have a predisposition to RLS, while the emergence of the condition in later life is usually the result of another illness. Some people with mild cases of RLS may only notice symptoms when they are sat or lying down for a long time; for example, on a long haul flight.

Diagnosis of restless legs syndrome

Your GP will enquire about your symptoms and take a full medical and family history. They will also carry out a physical examination and order further tests. It is important that you explain your symptoms in as much detail as possible to enable the doctor to reach an accurate diagnosis. A diagnosis of RLS is often made when a patient has the following conditions:

An uncontrollable desire to move their legs, which is caused by unpleasant sensations in the legs.
The desire to move is greater when sitting or lying down.
The desire to move with unpleasant sensations eased by moving the legs.
The desire to move is worse at night and during the evening.

Medical history

Your GP will obtain a full medical history and question you about your symptoms, which may include:

When did the symptoms first develop?
What kind of symptoms do you experience?
How often do you experience symptoms?
Are the symptoms worse at different times of the day, for example, at night?
Are symptoms interfering with your sleep pattern?

The doctor will also question you about your usual sleep habits:

When do you normally go to bed?
How long does it take you to fall asleep?
Do you wake up regularly during the night?
What do you do before you go to bed?
Do you snore?
Is there noise around you when you sleep?

They will also ask you how you feel throughout the day and whether you are:

Tired.
Irritable.
Lacking in energy and motivation.
Finding it difficult to focus and concentrate.
Finding it hard to stay awake throughout the day.

Your GP will also ask questions to determine if your symptoms are associated with an underlying health condition, such as:

Are you taking any over the counter or prescription medications?
Do you have a family history of RLS?
Do you snore?
Do you drink alcohol, smoke or consume caffeinated drinks on a regular basis?
Do you struggle for air when you sleep?

A physical examination is carried out to:

Rule out other sleep or health disorders.
Identify possible symptoms of underlying health conditions.

Your GP will also look at the nerves in your spinal cord, arms and legs, and your blood flow.

Other tests

There is no single test to confirm a diagnosis of RLS. However, blood tests may be ordered to determine the cause of secondary RLS and are used to check for:

Low iron levels.
Diabetes.
Kidney disease.
Vitamin or mineral deficiencies.

Restless legs syndrome treatment

The aims of treatment are:

To ease symptoms.
To increase the quality of sleep and reduce daytime tiredness.
To treat underlying conditions.

Treatment options include:

Medication.
Lifestyle changes.
Other non-drug treatments.

Lifestyle changes and non-drug treatments

Lifestyle changes may seem simple but they can make a huge difference. In mild cases, they may be the only treatment required. The following changes may help:

Avoid triggers or substances that make symptoms worse, including smoking, drinking alcohol and consuming a lot of caffeine. Caffeine may appear to help daytime tiredness, but it often masks or delays the symptoms and cutting down will be beneficial.
See your doctor if you experience symptoms while taking medication; some medicines including antidepressants, anti-sickness and anti-seizure medication and antihistamines can make symptoms worse.
Exercise on a regular basis (but not within three hours of your normal bed time): exercise helps to reduce stress and anxiety, facilitating good sleep patterns.
Relax during the evening and prepare for a good night's sleep; try to get into a routine and keep your bedroom a relaxing, quiet space. Try to go to bed around the same time every night and wake up at the same time each morning.
Having a bath, going for a walk, applying ice or heat packs and massaging the legs may also help to reduce symptoms.

Medicines

Medicines can reduce symptoms of RLS but are only prescribed when the individual has evident, defined symptoms that cannot be managed by lifestyle changes or other non-drug solutions.

There is no single drug to treat RLS and in many cases a number of medicines are tried to discover the best treatment for the individual. Certain medicines may not be suitable for pregnant women. If you are pregnant, talk to your doctor about treatment options. You should always discuss taking medication with your doctor, even if you are planning to take over-the-counter medication.

Specific medicines

Medicines that are commonly used to treat Parkinson's disease may also be used for patients with RLS. These medicines work by reducing movement in the legs and include:

Levodopa: this drug is most effective for mild cases and is prescribed for a short timeframe. It does not work over a long timeframe in most cases.
Dopamine agonists: these drugs are employed to treat moderate or severe cases of RLS, but they may be employed for milder cases once Levodopa has stopped working. Dopamine agonists can be employed for a long period of time.
Ropinirole: this drug was recently approved for the treatment of RLS.

Other medicines:

Narcotics (strong pain relief): usually used when there are severe symptoms present and the patient does not respond to other medicines.
Sedatives: used to aid sleep, although they may increase daytime tiredness. Sedatives are not advised for older people or those with sleep apnoea.
Epilepsy medicines: these drugs are used when dopamine agonists are unsuccessful or patients describe the sensations in their legs as painful.
Iron supplements: chosen if the patient has low levels of iron which is contributing to symptoms.

Living with restless legs syndrome

This is often a long-term condition but there are treatments that can ease symptoms and help to improve the quality of sleep. Some people only experience symptoms occasionally, while others suffer on a frequent basis. In mild cases, lifestyle changes can be sufficient to ease symptoms. However, additional treatment, usually medication, may be required for moderate and severe cases. RLS that develops during pregnancy typically eases shortly after giving birth.

Restless legs syndrome: key facts

This is a sensory disorder that causes an uncontrollable need to move the legs, the urge being caused by unpleasant sensations in the legs (and sometimes the arms).
Signs of RLS can be mild, moderate or severe, and they have a tendency to get worse after a while. It is possible for symptoms to develop during childhood but most people develop the disorder later in life.
The unpleasant sensations may be described as burning, creeping, crawling and tingling feelings.
It is common for people with RLS to have periodic limb movement disorder, which causes the legs to twitch uncontrollably every 10-60 seconds, usually during the night.
RLS makes it tricky to fall and stay asleep, which can contribute to daytime tiredness.
Two forms of RLS: primary RLS is most common and the cause is unknown; secondary RLS is caused by underlying health conditions or as a by-product of taking certain types of medication.
RLS is prevalent in pregnant women (usually at the stage of the final 3 months) but symptoms tend to ease once the baby has been born.
In many cases, lifestyle changes can reduce symptoms.
Medicines are employed to treat severe and moderate cases of RLS. Several medicines and dosages may be tried in order to find the most suitable treatment for the individual, as there is no single medicine used to treat RLS.