Restless Legs Syndrome

Restless legs syndrome (RLS) is a sleep-related movement disorder that causes a strong, nearly irresistible urge to move your legs. Symptoms are usually worse when you’re at rest in the evening or at night.

You may also have uncomfortable sensations in your legs, like throbbing or aching. The urge to constantly move can disrupt your ability to relax or fall asleep.

This condition can affect anyone, including children and adults. But it’s more common in people over 50. Some people call it restless leg syndrome or Willis-Ekbom disease.

Types of this condition

There are two main types of RLS. Healthcare providers describe them in a few different ways:

• Early-onset, primary or idiopathic: Symptoms start before age 45. It usually runs in your biological family and has no other known cause. The condition progresses slowly.
• Late-onset or secondary: Symptoms start after age 45. It progresses more quickly. It’s connected to an underlying condition, like multiple sclerosis or kidney disease.

Symptoms of restless legs syndrome

Symptoms of restless legs syndrome can range from mild to severe in intensity. They include:

• Uncomfortable sensations in your legs that make you want to move them
• Worsening symptoms when you’re resting
• Relief of discomfort (at least temporarily) when you move your legs

About 8 to 9 in 10 people with RLS also have periodic limb movements of sleep (PLMS). So, you may also have repetitive leg and/or arm movements during sleep.

What does restless legs syndrome feel like?

Restless legs syndrome causes sensations that make you want to move your legs. These sensations most often happen in your legs. But they can also affect your arms or your entire body. You may experience the following feelings:

• Crawling
• Itching
• Aching
• Burning
• Throbbing
• Pulling
• Tugging

Sensations can happen on one side of your body. But they more commonly affect both sides equally, like both legs.

Restless legs syndrome causes

Researchers don’t know the exact cause of restless legs syndrome. They think it likely involves many factors, including:

• Issues with how your body uses iron: Researchers have found low brain iron levels in people with RLS. This can happen even if your blood iron levels are normal. It may be due to an issue with your blood-brain barrier.
• Genetics: About half of people with idiopathic RLS have a first-degree relative (biological sibling or parent) with it. Specific genes may be linked to RLS, including ones that play roles in nervous system development and your body’s iron balance.
• Dysfunctional dopamine pathways in your brain: Dopamine is a neurotransmitter that’s important for things like movement and sleep.

Other factors may contribute to this condition. Researchers are still studying it. There’s no way to prevent RLS.

Risk factors

Factors that increase your risk of developing RLS include:

• Being female
• Being age 50 or older
• Having biological relatives with RLS
• Using certain medications, like antihistamines, SSRIs and dopamine antagonists

Late-onset or secondary RLS is associated with several conditions. You’re more likely to have it if you also have:

• Opioid withdrawal
• Multiple sclerosis
• End-stage kidney disease
• Iron-deficiency anemia
• Pregnancy (your risk increases with each trimester)
• Peripheral neuropathy
• Parkinson’s disease
• Obstructive sleep apnea

Complications

The main complication of RLS is disrupted sleep. You may find it hard to fall or stay asleep. A lack of quality sleep may cause:

• Fatigue or daytime sleepiness
• Behavior or mood changes, like depression or anxiety
• Difficulty with memory or concentration

How doctors diagnose this condition

There isn’t a test to diagnose RLS. A healthcare provider will do a physical exam and review your symptoms and medical history to diagnose it.

To confirm a diagnosis of RLS, your provider will look for the following criteria:

• You have the urge to move your legs, usually occurring with uncomfortable sensations, like aching or pulling.
• The symptoms worsen in the evenings and at night. They also appear during periods of rest or inactivity.
• You have partial or total relief when stretching, walking or exercising the affected muscles.
• Another medical condition didn’t cause your symptoms.

Your provider may suggest a neurological exam and blood tests to rule out other conditions. They may also recommend an overnight sleep study to check for other sleep conditions.

Is restless legs syndrome hard to diagnose in children?

Yes, it’s sometimes difficult for healthcare providers to diagnose RLS in children. Your child may not be able to describe their symptoms or what they feel. RLS in children may look like attention-deficit/hyperactivity disorder (ADHD) or growing pains.

How is it treated?

There’s no cure for restless legs syndrome. But certain treatment options can help manage symptoms. Treatment varies, too. Treatment depends on the severity of RLS and if an underlying condition is causing it.

For example, if you have low blood iron levels, taking an iron supplement or getting an iron infusion may help. If end-stage kidney disease is the cause, a kidney transplant may make RLS go away.

Your healthcare provider will also check if medications you take may be the culprit, like SSRIs and dopamine antagonists. They may adjust your medications if so.

After these initial treatment approaches, you and your healthcare provider will discuss other options. It may include at-home therapies, medications and/or nerve stimulation.

At-home therapies

If you have mild RLS symptoms, your provider may recommend these at-home therapies to help:

• Regular daytime exercise that involves your legs, like walking or lower-body resistance training
• Stretching before bedtime, especially your legs
• Soaking your legs in warm water before bedtime
• Good sleep hygiene, like consistent sleep and wake times
• Avoiding caffeine, such as drinking coffee, before bedtime
• Avoiding or limiting alcohol, which can make symptoms worse

Medication

Certain medications can help relieve RLS symptoms. The first-line choice is a gabapentinoid, like gabapentin or pregabalin. Your provider may prescribe one of these if you have bothersome RLS symptoms that disrupt your sleep.

If other forms of treatment don’t help, your provider may recommend a low-dose opioid. At a small dose, the risk for opioid misuse and dependence is low. But it’s important to tell your provider if you have risk factors for substance use disorders.

If you have occasional symptoms, your provider may suggest levodopa or a dopamine agonist. You’ll need careful monitoring if you take a dopamine agonist. It can worsen your symptoms over time (augmentation syndrome).

Peroneal nerve stimulation

Your provider may recommend peroneal nerve stimulation if medications alone don’t help your symptoms. You wear a device on your lower legs that sends electrical impulses to your muscles. You use it 30 to 60 minutes before going to bed.

This is a newer therapy that researchers are still studying.

What can I expect if I have this condition?

Each case of RLS is different. Medication and iron supplements help reduce symptoms for many people with RLS. But the symptoms can persist, causing difficulty falling and staying asleep.

Restless legs syndrome doesn’t affect your life expectancy. But it can affect your overall wellness. Your healthcare provider will be your guide to help curb symptoms. Reach out to a mental health professional if RLS causes distress.