Restless Legs Syndrome

Condition Basics

What is restless legs syndrome (RLS)?

Restless legs syndrome is a disorder related to sensation and movement. People with RLS 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.

RLS usually affects the legs. But it can cause unpleasant feelings in the arms, torso, or even a phantom limb. A phantom limb is 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 it?

Usually there isn't a clear reason for restless legs. The problem often runs in families. Sometimes pregnant women get it, or people who don't get enough iron. And it can be linked to other health problems, such as kidney failure, rheumatoid arthritis, and diabetes.

What are the symptoms?

The main symptom of RLS is uncomfortable or painful sensations that happen after you lie down to sleep. The sensations are described as aching, creeping, crawling, or prickling. Often, the uncomfortable feelings make you want to move, instead of sleep. Sometimes, RLS also causes jerking movements.

How is it diagnosed?

If you think you have RLS, your doctor will review your symptoms and will look for any other causes of your symptoms. You may get tested for other conditions. And your doctor may recommend a sleep study.

How is RLS treated?

If your RLS symptoms are mild, a few lifestyle changes may be enough to control them. You may find it helpful to:

• Avoid tobacco, alcohol, and caffeine.
• Keep your bedroom cool, quiet, and comfortable. 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.

Cause

Usually there isn't a clear reason for restless legs. The problem often runs in families. Sometimes there's 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 RLS include kidney failure, rheumatoid arthritis, diabetes, nerve damage, anemia, and Parkinson's disease. But most people who seek treatment don't have any of these other problems.

Symptoms

The main symptom of RLS is a strong urge to move because of uncomfortable and sometimes painful sensations. The feelings usually affect the legs. But they 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 start about 15 minutes after you lie down to sleep or to relax. They can also occur when you haven't moved for long periods, such as when riding in a car or airplane. If you have symptoms a lot, it can lead to sleep loss and fatigue. And that can make it hard to do your daily activities.

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, and make you more tired. Periodic limb movements may also occur during the day. But they're harder to notice then, and most people move around after their legs start to bother them.

RLS 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 when you are an infant or at any time during your life. At first, your symptoms may be mild and occur only once in awhile. But symptoms usually get worse with age. After age 50, many people have daily symptoms and suffer from significant sleep loss. Severe insomnia, fatigue, anxiety, depression, and lack of social activity can affect your quality of life.

RLS may start or become worse during pregnancy, especially after week 20.

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When to Call a Doctor

Watch closely for changes in your health, and be sure to contact your doctor if:

• You are still not getting enough sleep.
• Your symptoms become more severe or happen more often.

Exams and Tests

One of the hardest things about having RLS 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 RLS, tell your doctor.

Your doctor will talk with you about your symptoms to make sure that the feelings you describe are typical of RLS and aren't 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.

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Treatment Overview

Treatment for RLS is based on the type of symptoms you have and how bad they are. Getting regular exercise and enough sleep may be enough for mild symptoms. But if your symptoms get in the way of how well you can function, you may need medicines.

First treatments

Changing your daily routine is sometimes enough. It may help if you do things like stretch, walk, exercise regularly, get a massage, or take a hot or cold bath. Losing weight and avoiding smoking, alcohol, and caffeine can also help.

If your symptoms are caused by another medical problem like diabetes or iron deficiency anemia, you will be treated for that problem first. For example, you'll take iron supplements if you aren't getting enough iron.

If RLS starts during pregnancy, your doctor may just recommend exercise and stretching.

For children, regular exercise and sleep routines are usually tried first. If those don't work, the doctor may prescribe medicine.

Medicines

If your symptoms don't improve, you may try medicines. These include:

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

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

If your doctor recommends medicine, be sure to talk about the possible benefits and risks. Let your doctor know about all of the other medicines you take. Medicines for other conditions sometimes help cause RLS. For example, antidepressants may improve symptoms. Or they may make them worse.

Ongoing treatment

Over time, a dopamine medicine may not work as well.

You may also notice that your symptoms start earlier in the day. Or they may be more intense. Or they may spread to another part of your body.

If you're taking a dopamine medicine and your symptoms change, tell your doctor. Don't stop taking your medicine without talking to your doctor first. You can work with your doctor to find the best treatment for you.

If you make lifestyle changes, and you still have symptoms, you may need a doctor to reevaluate your symptoms. Many other health problems have similar symptoms. These include several vitamin and mineral deficiencies.

Your doctor may recommend different medicines. Or your doctor may recommend a combination of medicines. Follow up with your doctor if your symptoms don't improve.

Other treatment

Your doctor may have you try other treatments. These include:

• A pneumatic compression device. This machine pumps air in and out of sleeves to make them tight and loose around your legs while you are resting.
• Vibrating pads (Relaxis). The pads send vibrations to your legs. They may improve sleep for some people with RLS.

Self-Care

There are ways to improve your symptoms of restless legs syndrome at home. Here are some things to consider.

• Try regular, moderate exercise.

  Avoid long periods between activity and avoid sudden bursts of intense activity. Talk to your doctor before you start an exercise program.

• Try heat or cold.

  Your symptoms may be relieved by bathing in hot or cold water. Or try a heating pad set on low, hot water bottle, or ice bag. Keep a cloth between the heating pad, hot water bottle, or ice bag and your skin.

• Keep good sleeping habits.

  Fatigue can make your symptoms worse. So it is important to keep good sleep habits. Keep your bedroom cool, quiet, and comfortable. Use it only for sleeping, not for watching TV. Try to go to bed and get up at the same time every day.

• Try 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.

• Limit 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.

• Avoid 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.

• Avoid 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.

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