Restless Leg Syndrome 101
We’ve all had those long, restless nights where we just can’t seem to fall asleep. For many, this annoyance only happens once in a while. But for7 to 11 percent of the population in western countries, uncomfortable sensations in the legs and an urge to move are a constant burden. The cause? A sleep disorder called restless legs syndrome (RLS). This condition may seem like no big deal, but it can seriously impact people’s quality of life and causes sleep disorders like insomnia.
So what is RLS? And how do you get diagnosed? Today we’re giving you an overview of the symptoms, causes, and common treatments for the often overlooked condition of restless legs syndrome.
What is Restless Legs Syndrome?
Restless legs syndrome, occasionally called Willis-Ekbom disease, is a chronic neurological disorder defined by PubMed Central as “a condition characterized by discomfort at rest and urge to move focused on the legs.” People with restless legs syndrome (RLS) will experience uncomfortable sensations in their legs that can feel like crawling, pulling, or prickling. The only way for people to relieve symptoms of RLS is to move around, and because RLS usually occurs at night, it can lead to insomnia.
RLS is more likely to affect adults and women, but men and kids can also develop restless legs syndrome. 1 in 5 pregnant women will even experience RLS symptoms during the last 3 months of their pregnancy. 80 percent of people with RLS also have a related condition called periodic limb movement of sleep (PLMS), which can also contribute to poor sleep.
Restless Legs Syndrome Causes
Most of the time, the cause of RLS is unknown. This is referred to as idiopathic or primary restless legs syndrome, and it is a condition that runs in families. Research has narrowed down three factors that play a significant role in RLS:
Brain Concentration of Iron
One potential cause of restless legs syndrome is an imbalance in the brain’s concentration of iron. Iron plays a crucial role in the production of dopamine, a neurotransmitter that helps regulate movement and control. In individuals with restless legs syndrome, there may be a deficiency of iron in certain areas of the brain, leading to less dopamine production and therefore greater discomfort and involuntary movements in the legs.
Additionally, iron deficiencies can also lead to nerve damage and reduced nerve function, further contributing to restless legs syndrome symptoms. Finding out your blood’s iron levels is particularly crucial because low iron levels can occasionally lead to secondary restless legs syndrome. Taking iron supplements or increasing dietary intake of iron-rich foods may help correct this imbalance and alleviate restless legs syndrome symptoms.
Brain Dopamine Concentration
One of the causes of restless legs syndrome is a lack of dopamine in the brain. Dopamine is a chemical that helps regulate movement and emotions. When there is not enough dopamine present, individuals may experience uncomfortable sensations in their legs and an urge to move them in order to relieve those sensations. Studies have shown that individuals with RLS also tend to have lower levels of dopamine in their brains.
There are a few possible explanations for this link between low dopamine levels and RLS. Some research suggests that a genetic predisposition can lead to lower levels of dopamine being produced in the brain, which may then lead to the development of RLS. In addition, certain medications such as antidepressants and anti-nausea drugs can also decrease dopamine levels and potentially contribute to RLS symptoms.
While there is currently no cure for RLS, treatment options do exist that can help increase dopamine levels in the brain and alleviate symptoms. These include medications such as levodopa and pramipexole, as well as lifestyle changes such as regular exercise and managing stress levels.
According to the National Institute of Neurological Disorders and Stroke, genetics may play a role in causing restless legs syndrome. Several genes have been identified as possibly contributing to the development of RLS, including MEIS1, BTBD9, MAP2K5/SKOR1, and PTPRD. These genes have been found to be more common in individuals with RLS compared to those without the condition. Additionally, researchers have observed that RLS tends to run in families, suggesting a genetic component.
However, it is important to note that having one or more of these genes does not necessarily mean an individual will develop RLS. Environmental factors also likely play a role in the development of the condition. More research is needed to fully understand the interplay between genes and other factors in causing RLS. Research has shown that between 40 to 90 percent of peoplewith RLS have a relative with the condition, which may be caused by genetics.
RLS has also been linked to other medical conditions like:
Late-stage Kidney Disease
Late-stage kidney disease, also known as end-stage renal disease (ESRD), can lead to restless legs syndrome. ESRD occurs when the kidneys are no longer able to filter waste and excess fluids from the blood, leading to a buildup of toxins in the body. This can result in nerve damage, causing symptoms such as muscle cramps, twitching, and discomfort in the legs.
In addition, people with ESRD often experience anemia, or low levels of red blood cells, which can also contribute to restless legs syndrome symptoms. Treatment for ESRD typically involves dialysis or a kidney transplant. However, managing the underlying condition may not always fully alleviate restless legs syndrome symptoms and medication may still be necessary.
One of the potential causes of restless legs syndrome is multiple sclerosis, a neurological disorder in which the body’s immune system attacks and damages the protective sheath (called myelin) that covers nerve cells. In some cases, this results in abnormal nerve signalling, causing symptoms such as muscle weakness or spasms, vision problems, and cognitive difficulties.
In individuals with multiple sclerosis, these disruptions in nerve signaling can also affect the nerves and muscles in the legs, leading to symptoms similar to those experienced in restless legs syndrome. Research suggests that up to 60% of people with multiple sclerosis also have restless legs syndrome, particularly during periods of disease activity or relapse.
Treatment for multiple sclerosis typically involves medications to manage symptoms and slow disease progression. In cases where restless legs syndrome is present alongside multiple sclerosis, treatment may also include specific medications for managing restless legs syndrome symptoms.
Pregnancy is a common cause of restless legs syndrome, as hormonal changes and an increase in weight can put pressure on the nerves and blood vessels in the legs. Additionally, pregnancy can lead to iron deficiency, which has also been linked to RLS. While the symptoms often improve after giving birth, some women may continue to experience RLS postpartum.
Treatment options for pregnant women include non-drug methods such as massage and exercise, though medication may be necessary in severe cases. It is important for pregnant women to discuss any symptoms of RLS with their healthcare provider.
Certain medications, such as antipsychotics and antidepressants, can cause restless legs syndrome as a side effect. These medications alter the balance of neurotransmitters in the brain, which can lead to abnormal sensations and movements in the legs. In some cases, simply changing the medication or adjusting the dosage can stop the symptoms of restless legs syndrome.
However, it is important to consult with a doctor before making any changes to medication regimens. In some cases, the benefits of the medication may outweigh the discomfort of restless legs syndrome. It is also possible for certain over-the-counter drugs, like cold and allergy medicines, to contribute to restless legs syndrome. Again, consulting with a doctor is necessary before making any changes to medication use.
Symptoms of Restless Legs Syndrome
The most apparent symptom of RLS is an uncomfortable sensation in your legs. But people have also described having this feeling in their arms, chest, and face. According to the NHS, this is what RLS feels like:
Tingling, Itching, Throbbing Sensation
One symptom of restless legs syndrome is a tingling, itching, or throbbing sensation in the legs. These unpleasant sensations or symptoms occur when the person is sitting or lying down and can be temporarily relieved by moving or rubbing the affected limb. This uncomfortable feeling can range from mild to severe and can greatly impact a person’s ability to relax or fall asleep.
In severe cases, this sensation may even interrupt daily activities and cause difficulty concentrating. It is believed that these sensations occur due to imbalances in brain chemistry and nerve function in the legs.
Another common symptom of restless legs syndrome is a creepy-crawly feeling in the legs. This feeling typically occurs when the person is resting or trying to sleep, causing them to feel the urge to move their legs to find relief. This sensation can range in intensity from mild to unbearable and may be accompanied by throbbing or pulling sensations.
It is important to note that while this feeling can occur in other conditions, such as nerve damage or varicose veins, it is typically only accompanied by an overwhelming urge to move when it is a symptom of RLS. Additionally, RLS symptoms tend to worsen at night and improve with movement, while other conditions may not have this same pattern. If you are experiencing these symptoms, it is important to speak with your healthcare provider about potential causes and treatment options.
Painful Cramping Sensation
This feeling can range from mild discomfort to severe pain and often becomes worse with rest or inactivity. It may also be accompanied by an irresistible urge to move the affected limb in order to temporarily relieve the discomfort. These sensations can interrupt sleep and make it difficult for individuals with RLS to get enough rest, leading to fatigue and impaired daily functioning.
Involuntary Jerking of Legs During Sleep
Involuntary jerking or movement of the legs during sleep is a common symptom of restless legs syndrome. This is known as periodic limb movement disorder, and it can occur throughout the night and interrupt a person’s sleep. The movements can range from small twitches to more forceful jerks, and they usually happen in cycles lasting about every 20-40 seconds. These movements can also involve the arms, hips, and torso.
Like any condition, symptoms and their severity vary from person to person. Some experience RLS symptoms daily, while others will only have them once every couple of weeks. Usually, they get worse at night.
How to Diagnose Restless Legs Syndrome
RLS can’t be measured or tested for, making diagnosing the condition difficult. Doctors have to go off a patient’s subjective experience to see if they meet the criteria for RLS. According to the Sleep Foundation, doctors will look for the following criteria when making a diagnosis.
Urges and Sensations Triggered When Resting
One of the main diagnostic criteria for restless legs syndrome is a strong urge or sensation to move the legs, often accompanied by uncomfortable sensations in the legs. These urges and sensations occur primarily when the person is resting or lying down and can be temporarily relieved by movement, such as walking or stretching.
Doctors may also look for patterns in a person’s symptoms, particularly their response to certain medications used to treat restless legs syndrome. This can help confirm a diagnosis of restless legs syndrome.
Sensations Only Occurring or Worsening at Night
One of the diagnostic criteria for restless legs syndrome is the presence of sensations that only occur or worsen at night. These sensations, often described as creeping, crawling, pulling, or painful, typically occur in the legs but can also occur in the arms or other parts of the body. As these sensations often disrupt sleep, they can lead to daytime fatigue and decrease quality of life.
Additionally, these nighttime sensations often improve with movement such as walking or stretching. This urge to move can also lead to sleep disruption and difficulty falling or staying asleep. Restless legs syndrome is typically a chronic condition and symptoms may fluctuate in severity over time.
It is important to note that while nighttime sensations are a key symptom of restless legs syndrome, they can also be present in other conditions such as peripheral neuropathy or arthritis. Therefore, a thorough medical evaluation and appropriate testing should be completed to ensure correct diagnosis and treatment of these symptoms.
Symptoms Aren’t a Symptom of Another Condition Like Leg Cramps
Symptoms of restless leg syndrome often mimic those of other conditions, such as leg cramps. However, there are key differences in the way these symptoms present themselves that can help with diagnosis.
For example, restless legs syndrome is characterized by an urge to move the legs, which often improves temporarily with movement. In contrast, leg cramps typically involve sudden and painful muscle contractions that do not improve with movement.
Restless legs syndrome also often worsens in the evening or at night, while leg cramps tend to happen during physical activity or while resting. Additionally, restless legs syndrome can cause sensation changes or discomfort in the arms as well as the legs, while leg cramps usually affect only one muscle group at a time.
These distinctions can help healthcare professionals accurately diagnose and treat restless legs syndrome rather than mistakenly attributing symptoms to another condition like leg cramps.
Things like iron deficiency, anemia, kidney failure, and pregnancy can also worsen RLS symptoms. Your doctor may test you for these and other underlying sleeping conditions to help you better manage your pain.
How Do You Know RLS Isn’t Some Other Condition with the Same Symptoms?
Conditions like akathisia, nocturnal leg cramps, peripheral neuropathy, and peripheral vascular disease have symptoms similar to RLS but have some distinct differences. To rule out other possible causes of your pain, doctors will usually give you a differential diagnosis.
A differential diagnosis is a list of possible conditions you could have given the symptoms you’re experiencing. Then, the doctor can test for those other conditions with the right follow-up tests (like physical exams, questions about your health history, lab tests, etc.).
Managing Restless Legs Syndrome
There are various medications and treatments your doctor may prescribe you to help with your RLS. But it depends on your specific medical history and overall health. People have also found that certain lifestyle changes can help treat RLS. These include:
Maintaining a Healthy Diet
Maintaining a healthy diet can play an important role in managing restless legs syndrome. Some research has shown that iron deficiency and low vitamin D levels may contribute to the development of RLS symptoms. Eating a balanced diet rich in fruits, vegetables, lean protein, and whole grains can help ensure adequate intake of these key nutrients. It is also important to stay hydrated by drinking plenty of water throughout the day.
Limiting Your Caffeine and Alcohol Intake
Limiting your intake of caffeine and alcohol can help manage restless legs syndrome. Caffeine and alcohol are known to aggravate symptoms of RLS, so reducing or eliminating their consumption may decrease the frequency and severity of symptoms. It is also important to note that caffeine and alcohol can disrupt sleep patterns, which can make RLS symptoms worse.
Exercising regularly can be a useful tool in managing restless legs syndrome. Not only does it release endorphins that can improve mood and overall wellbeing, it can also improve circulation and reduce muscle tension throughout the body, both of which may lessen symptoms of RLS.
However, it is important to note that exercise should not be done right before bed, as it may actually increase symptoms and make it harder to fall asleep. Instead, incorporating regular exercise throughout the day can lead to long-term benefits for managing RLS.
One way to manage restless legs syndrome is through stress management. Chronic stress can contribute to the symptoms of RLS, so finding ways to reduce and cope with stress can have a positive impact on symptoms. This can include incorporating relaxation techniques into daily life, such as deep breathing exercises or mindfulness meditation. Seeking support from a therapist or joining a support group may also be helpful in managing the stress and emotional aspects of living with RLS.
There are several types of medications that can be used to manage restless legs syndrome, including sleep medicine, dopamine agonists, anticonvulsants, and opioid pain medications. Dopamine agonists work by mimicking the effects of dopamine in the brain, which can help relieve RLS symptoms. Anticonvulsants, typically used to treat seizures, have also been found to alleviate severe symptoms of RLS.
Opioid pain medications may provide temporary relief, but they can also lead to dependence and should be used cautiously. It is important to work with a healthcare professional to determine the best course of treatment for your specific situation.
How Does Restless Legs Syndrome Impact the Quality of Life for Those Who Suffer from It?
The impact of RLS on quality of life can be significant. The constant urge to move the legs and discomfort can lead to difficulties with daily activities and concentration. In addition, the disruption of sleep can result in fatigue and difficulty functioning during the day. RLS can also lead to anxiety and depression due to the negative impact on daily life and lack of control over symptoms.
How Can Family Members and Friends Help Those Who Suffer from Restless Legs Syndrome?
One way family members and friends can help those with restless legs syndrome is by educating themselves about the condition and its symptoms. This will allow them to better understand and support their loved one when they are experiencing discomfort or distress related to RLS. Additionally, they can assist in finding appropriate medical treatment and therapies, as well as helping to create a relaxing bedtime routine that can alleviate some of the symptoms at night.
Another way to help is by being understanding and accommodating of any changes in plans or activities due to RLS flare-ups, as well as offering emotional support during difficult times. It is also important for family members and friends to encourage their loved one with RLS to take care of themselves, including getting enough sleep, engaging in regular exercise, and reducing stress levels.
What to Do if You Think You Have Restless Legs Syndrome
If you suspect that you may have restless leg syndrome, it is important to see a doctor for a proper diagnosis. Your doctor may ask about your symptoms and perform a physical examination. They may also order tests, such as a blood test or nerve conduction study, to rule out other possible causes of your symptoms.
In addition to seeking medical treatment, there are some steps you can take at home to manage your symptoms. These include practicing relaxation techniques, massaging or stretching affected muscles, taking hot baths or using heating pads, and keeping a regular sleep schedule. It is also helpful to keep a diary of your symptoms in order to track any patterns and inform discussions with your healthcare provider.
Restless legs syndrome can be a frustrating and disruptive condition, but there are ways to manage it. Making lifestyle changes such as exercising regularly, avoiding caffeine and alcohol, and practicing good sleep hygiene can help alleviate symptoms. Medications may also be prescribed by a doctor to address the underlying causes of RLS. It is important to seek treatment for RLS as it can significantly impact daily life.
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