Restless legs syndrome is also known as Willis-Ekbom disease. If you’ve never heard of it, you’re not alone. Although the first description of restless legs syndrome appeared in 1672, no diagnostic criteria existed until 1995.
As the name suggests, the primary symptom of restless legs syndrome is a desire to move the legs. It is relatively common – around 10% of the population may experience it to some degree. However, it is still not completely understood and occasionally misdiagnosed. Many people are not sure how to recognize the condition, or what they can do about it.
Today, we’re going to look in-depth at restless legs syndrome. We’ll find out what it is, what the symptoms are, and what can cause it. We’ll also look at how doctors diagnose it, and what treatments there are. Finally, we’ll find out whether there’s anything you can do at home to relieve the symptoms.
What is Restless Leg Syndrome?
It is a neurological disorder which causes, among other symptoms, a strong desire to move the legs. For some people, the symptoms also occur in other areas of the body, such as the arms, chest, and face.
According to Sleep Medicine Reviews, between 5% and 15% of the population have restless legs syndrome. It’s a spectrum disorder, meaning that its severity varies from person to person. Some people experience RLS as a mild inconvenience. For others, RLS significantly affects their day-to-day lives.
There are two main types of RLS:
- Primary (idiopathic) RLS begins before the age of 40, sometimes as early as childhood. Idiopathic means that the cause is unknown; however, there may be a genetic component in some cases. Usually, people with Primary RLS find that their symptoms come on slowly, and gradually worsen over time.
- Secondary RLS usually begins after age 45, as a result of an extraneous factor (such as another condition, or medication). It usually starts very suddenly. It can be more severe, but the symptoms typically remain static over time, rather than worsening.
Scientists don’t yet understand exactly how RLS works. However, research in the Sleep Medicine journal suggests that it may be something to do with a dopamine deficiency. Dopamine is a neurotransmitter (natural chemical) that has various functions, including controlling movement. People with RLS tend to have less dopamine in their cerebrospinal fluid.
What Are the Symptoms of Restless Leg Syndrome?
There are four primary symptoms of RLS. For a doctor to diagnose you with RLS, all of the following symptoms must be present to some degree.
- A strong or uncontrollable urge to move the legs. Usually, the feeling affects both legs at the same time. Most people with RLS also experience a strange, unpleasant sensation in the legs, occurring alongside the desire to move. Some people describe the feeling as burning, tingling, creeping, crawling, itching or pulling. It can also feel like mild electric shocks.
- Worsening of symptoms during inactivity. Most people find the symptoms get worse when relaxing. The symptoms can be felt when sitting or lying down.
- Worsening of symptoms in the evening or at night. Some people experience the symptoms at night, before falling asleep.
- Relief with movement. The above symptoms almost always subside upon moving the affected limbs. Walking is usually the best way of relieving the symptoms. The symptoms can also improve when jiggling, bending or stretching the legs. Sometimes, massaging the legs can also help.
As RLS is a spectrum disorder, the severity of its symptoms can range from mild to incapacitating. The symptoms may occur every day, or only occasionally. For some people with RLS, the symptoms also occur in other parts of the body, such as the arms.
A study in the Movement Disorders journal found that over 80% of people with RLS also experience Periodic Limb Movement Disorder (PLMD). This is a condition causing the limbs to repetitively and uncontrollably move during sleep. It’s possible to have PLMS without having restless legs syndrome. RLS can also exist alongside ADHD (attention deficit hyperactivity disorder). Around 44% of people with ADHD also have RLS.
What Are the Causes of Restless Leg Syndrome?
Many different factors can contribute to the onset of restless legs syndrome. In most cases, it’s difficult to determine what triggered it. However, some common conditions may play a role in RLS.
- According to a Postgraduate Medical Journal study, around 60% of people with RLS also have a close family member with the disorder. For people who first develop symptoms under age 20, the figure increases to 80%. Most cases of Primary RLS are thought to be hereditary.
- Iron Deficiency. Iron and dopamine are closely linked. If your blood iron levels are low, this can cause your brain to produce less dopamine, leading to RLS. According to American Family Physician, iron deficiency could account for up to 20% of RLS cases.
- Medications. Some medications may cause RLS to develop, or make it worse. These may include antidepressants, antihistamines (allergy medications) and antipsychotics. Withdrawal from certain medications, such as opioids and sleeping pills, can also trigger RLS.
- Chronic Health Problems. Secondary RLS often occurs as a complication of another health condition. Examples include diabetes, Parkinson’s disease, hypothyroidism, rheumatoid arthritis, fibromyalgia and chronic kidney disease.
In most cases of RLS, however, the cause is unknown. Some people develop it for seemingly no reason, despite having no genetic connection or any other observable cause.
Who Does RLS Affect?
Restless legs syndrome can affect anyone, in any part of the world. However, certain populations may be more at risk of developing RLS than others.
There are four main demographic factors to consider:
- Age: Although RLS can develop at any age, including childhood, there are two main ages at which onset is likely. According to research Sleep Medicine, primary RLS usually occurs around 20 years of age. Secondary RLS, on the other hand, tends to develop in the mid-40s.
- Gender: According to the Archives of Internal Medicine, RLS affects women around twice as often as men. The more children a woman gives birth to, the more likely she is to develop RLS.
- Pregnancy: Pregnant women have a much higher chance of developing RLS than the general population. According to research in Neuro Endocrinology Letters, around 30% of pregnant women may develop RLS to some degree. RLS which develops during pregnancy usually disappears once the baby is born.
- Race: A study in the medical journal Chest found that Caucasians are twice as likely to develop RLS as African-Americans. Among the Asian population, the prevalence may be even lower. Scientists don’t currently understand why this is.
It is important to bear in mind that anyone can develop RLS, even if they’re not part of the above demographic. For instance, children can develop RLS even though it typically begins later in life. RLS in children is often misdiagnosed as growing pains.
What Are the Complications of Restless Leg Syndrome?
As restless legs syndrome is a spectrum disorder, many instances of the condition are quite mild. Some people with RLS can live relatively typical lives, without their disorder causing any significant issues. However, severe cases of RLS can negatively affect mental and physical health in many ways.
Here are some of the ways that you can be affected:
- Chronic Pain: For the majority of people with RLS, the symptoms are not painful; they are merely uncomfortable and irritating. However, there are some exceptions. According to a study published in Lancet Neurology, severe cases of RLS are often accompanied by significant bodily pain.
- Insomnia: The symptoms of restless legs syndrome are often worse in the evening and at night. This leads to many people with RLS developing insomnia. The uncomfortable sensations only subside with movement, making it difficult to fall asleep. According to Frontiers in Aging Neuroscience, insomnia is the most common reason that people with RLS visit a doctor.
- Lowered Quality of Life: A study carried out in 2004, published in Clinical Therapeutics, evaluated RLS patients’ quality of life. They measured this using metrics such as physical functioning, mental health, general health, and vitality. The researchers found that people with RLS scored considerably lower than the general population. They even scored significantly lower than people with other conditions such as hypotension and arthritis.
- Mood Disorders: A study in the Journal of Clinical Psychiatry found that people with RLS are likely to develop mood disorders. Mood disorders are a type of mental health condition which includes depression, anxiety and panic disorder, among others. This may be a result of insomnia and poor quality of life experienced by those with RLS.
Fortunately, RLS does not lead to the development of other neurological or physical disorders. However, people with other neurological and physical problems can be more likely to develop RLS.
What Checks Do Doctors Perform for RLS?
If you recognize the symptoms of restless legs syndrome, you may consider visiting a doctor for a diagnosis.
A doctor will ask you about your symptoms. The four critical symptoms of RLS, discussed above, must all be present for the doctor to diagnose it. If they aren’t, it’s possible the symptoms you’re experiencing are a result of a different issue.
Secondly, they assess to what extent your symptoms are affecting you. They’ll ask you about your sleep, and whether you’re experiencing insomnia. They’ll also evaluate whether your symptoms or insomnia are affecting your day-to-day life.
If your doctor suspects that you may have RLS, they will then try to determine what may be causing it. There is no specific test for RLS, so your doctor may use a combination of the following.
1) Physical Examination and Medical History
Conducting a physical examination will allow the doctor to check your overall health. Although RLS is invisible from the outside, it can sometimes be a sign that you have another health condition. There are also some conditions which have similar symptoms to RLS which the doctor will check for.
The doctor may also ask you about your medical history. They’ll want to know if you’ve ever been diagnosed with diabetes, angina or another potentially triggering condition.
2) Family History
Primary (idiopathic) restless legs syndrome is hereditary, more often than not. Your doctor may ask you if you know of any relatives with the condition. If you do, this will help the doctor to diagnose you with Primary RLS.
If you know of no family members with RLS, you may have Secondary RLS. Alternatively, you may not have RLS at all, but a different condition.
3) Medication Review
Sometimes, restless legs syndrome can occur as a reaction or side-effect of certain medications. Your doctor may ask you whether you’re on any medications, and what they are. If there’s a chance that your medication may be causing RLS, your doctor may suggest switching to a different type.
RLS can also occur when withdrawing from medication. So, your doctor may also ask if you’ve stopped taking anything recently.
4) Blood Sampling
Iron deficiency anemia is one of the most common culprits of restless legs syndrome. To determine whether this is causing yours, your doctor may take a blood sample. This will also create the opportunity to check your blood for any other issues. For example, kidney disease and diabetes can also contribute to RLS symptoms. A blood test is a great way to check for both of those.
5) Sleep Study
There’s a chance your doctor may recommend that you undergo a sleep study. A sleep study involves you staying overnight in a hospital or center. While you sleep, medical staff monitor your sleep patterns. This won’t necessarily help to diagnose RLS, but it will ascertain whether your symptoms are affecting your sleep.
Sleep studies may also be able to determine whether you have Periodic Limb Movement Disorder. This disorder often goes hand-in-hand with RLS.
6) Nerve Test
Sometimes, symptoms which seem like restless legs syndrome can be caused by other muscle and nerve issues. Examples include over-sensitive nerves and damage to muscle or nerve tissue. Conducting muscle and nerve tests will help your doctor rule these conditions out.
Because there are so many tests to undergo, it may take a while to achieve a RLS diagnosis. However, you can still start looking into treatments and lifestyle changes before you have an official diagnosis.
What Are the Options for Restless Leg Syndrome Treatment?
Unfortunately, there is currently no cure for restless legs syndrome. This is because scientists are still not sure of the precise mechanism of RLS inside the body. New research is published regularly on the matter, so it may not remain incurable forever.
However, fortunately, there are still some treatment options. Some medications have been shown to help with the symptoms of restless legs syndrome. There is no guarantee that they’ll work, as every case is different. Some people find that medication only slightly eases the symptoms whereas, for others, the symptoms almost entirely vanish.
If your doctor determines that an underlying condition is causing your RLS, they will first aim to treat that. For example, if your RLS is due to an iron deficiency, your doctor may prescribe an iron supplement.
If your RLS has no obvious cause, your doctor may prescribe one of the following medications:
1) Dopamine Agonists
Dopamine agonists are medicines that stimulate the dopamine receptors in your brain. A study published in Clinical Therapeutics found that they are significantly effective at treating RLS. This may be because RLS is associated with a lack of dopamine, according to current research. Dopamine agonists also used to treat other disorders associated with dopamine insufficiency, such as Parkinson’s disease.
2) Seizure Medications (Anticonvulsants)
Some medications used to treat seizures can also be effective for RLS. One such medication is called gabapentin. Gabapentin works by changing the messages that your nerves send to your brain. A study in Neurology found that gabapentin reduces RLS symptoms, and improves sleep quality. It’s especially effective for people who experience pain as one of their symptoms.
Opioids are powerful pain medications. They are usually used to treat cases of severe and chronic pain. They work by completely blocking the pain messages that your body sends to your brain. They also cause a large release of dopamine. According to a study in Sleep Medicine, opioids can relieve the symptoms of RLS and help with sleep. However, they are usually only prescribed as a last resort. This is because opioids can be addictive, and cause withdrawal symptoms when you stop taking them.
Benzodiazepines are powerful sedatives. They help to induce and maintain sleep. For this reason, they are sometimes recommended for cases of RLS that severely affect sleep. However, they don’t treat any of the other symptoms of RLS. According to the Cochrane Database of Systematic Reviews, the effectiveness of benzodiazepines in treating RLS is currently unknown. Doctors usually prescribe them alongside other treatments, rather than alone.
Can I Treat Restless Leg Syndrome at Home?
Medication is not the only option for treating restless legs syndrome. There are many ways in which you can ease the symptoms yourself, at home. Lifestyle changes can have a massive impact on the symptoms of restless legs syndrome.
To help ease the symptoms of RLS at home, try the following:
- Warm baths. Some people with RLS find that a soothing, warm bath can help relax the muscles. This may reduce the strength of the symptoms. A heating pack, or a cooling pack, may also help.
- Adjusting your sleep routine. Try going to bed earlier or later than usual, as this may offset the symptoms. Also, prepare your mind and body to rest by creating a relaxing bedtime routine and sticking to it every night.
- Leg massage. Massaging your legs before bed may help alleviate the symptoms long enough for you to fall asleep.
- Lose weight, if you are overweight. According to a study in Neurology, obesity and RLS are linked. If you are overweight or obese, losing weight could help reduce the frequency of symptoms.
- Quit smoking. People with RLS are more likely to smoke than people who do not have RLS. This means that smoking may be a contributing factor.
- Exercise regularly. According to the American Academy of Sleep Medicine, implementing a regular daytime exercise program may improve RLS symptoms. As a bonus, exercising regularly may also help you to fall asleep more quickly.
- Avoid alcohol and caffeine in the evenings. Consuming these substances too close to bedtime will make it even harder to achieve quality sleep.
Does Restless Leg Syndrome Ever Go Away?
By now, you should be familiar with the main aspects of restless legs syndrome. You’ve learned what it is, how to recognize the symptoms and its potential treatments. You should also have a good idea of how to cope better with the condition at home.
Many people with restless legs syndrome wonder whether it will be permanent. Unfortunately, RLS is unlikely to ever abate without intervention. According to RLS UK, there are some reported cases of spontaneous remission, but they are rare.
However, it’s possible that your RLS may subside – or at least significantly improve – if it’s treatable. For example, if your RLS is related to an iron deficiency, taking iron supplements could cure it. If your RLS began in pregnancy, it’s likely that it will go away once the baby is born.
Milder cases of RLS may respond well to lifestyle changes and medications. Setting up a sleep routine, exercising regularly and losing weight may reduce the symptoms to the point that they’re barely noticeable. However, it all depends on your case.
If you haven’t yet seen a doctor, the next step is to make an appointment. Every case of RLS is unique, so your doctor will be able to give you personalized recommendations. If you ever feel that you aren’t receiving adequate help, don’t be afraid to seek a second opinion.