Restless Leg Syndrome: The Complete Guide for 2021

If you experience the urge to move your legs at night due to uncomfortable or painful sensations, you may have restless leg syndrome (RLS).

Approximately 7-10% of people in the US suffer from RLS, and while the sleep disorder affects both men and women, it’s more prevalent in women (particularly women with children).

Continue reading to find out the signs and symptoms of restless leg syndrome as well as the causes, treatments, and how to get a diagnosis.

Table of Contents

What is restless leg syndrome?

Restless leg syndrome (RLS), or ‘Willis-Ekbom disease’, is a neurological sensory disorder that causes painful or uncomfortable sensations in the legs, which can usually only be relieved by movement. 

The sensations experienced by RLS sufferers are associated with resting, which is why symptoms usually arise while relaxing in the evening or throughout the night.

Individuals with RLS may also experience sensations during long periods of inactivity, e.g. on a flight.

While difficult to describe, and unlike anything people without the disorder will have experienced, RLS sufferers often describe the sensations as:

  • Tingling, burning, aching, itching, or throbbing
  • A cramping sensation (especially in the calves)
  • Insects crawling inside the legs
  • Legs wanting to move on their own

Because RLS sensations can only be relieved by movement, individuals with the disorder often end up getting out of bed multiple times throughout the night to relieve the sensations. This frequent awakening can result in a lack of sleep, meaning daytime symptoms associated with insomnia, such as excessive sleepiness, often arise.

Types of restless leg syndrome

Restless leg syndrome can be categorized as:

  • Primary: Not associated with another medical condition
  • Secondary: As a result of another medical condition
  • Early-onset: Seen in individuals younger than 45 years old (often genetic, with slow-progressing symptoms)
  • Late-onset: Seen in individuals older than 45 years old (more common with secondary RLS, with symptoms developing more quickly)
  • Intermittent/moderate: RLS symptoms less than twice a week for the past year
  • Chronic persistent/severe: RLS symptoms at least twice a week for the past year

Symptoms of restless leg syndrome

The symptoms of RLS include:

  • A strong urge to move legs due to uncomfortable or painful sensations – often relieved by stretching, walking, or massaging the area
  • Periodic limb movements in sleep (PLMS): uncontrollable jerking or twitching of legs that can occur every 15 to 40 seconds – usually while asleep, but also while awake and resting
  • Worsening symptoms in the evening or at night
  • Difficulty sitting for long periods

While the sensations most often occur below the knee, some RLS sufferers may also experience similar sensations in the arms, chest, and face.

Certain daytime symptoms associated with a lack of sleep can also occur. 

These include:

  • Daytime sleepiness and fatigue
  • Mood disturbances (e.g. irritability)
  • Impaired functioning and concentration
  • Decreased productivity

Prevalence of symptoms 

RLS symptoms can begin at any age and typically worsen as sufferers get older. Those who are most affected are middle-aged or older, with symptoms becoming more frequent and longer-lasting with age.

It’s also normal for symptoms to come and go and fluctuate in severity during early stages of the disorder. However, over time symptoms generally become more severe.

Primary and secondary RLS

In people with primary RLS, the development of the disorder tends to be relatively slow (especially if onset began at an early age), often with years passing before symptoms become a regular occurrence. However, individuals with secondary RLS tend to develop more severe symptoms more quickly.

Causes of restless leg syndrome

While the cause of restless leg syndrome is often unknown in many patients, the disorder has been linked to the following risk factors:

Dopamine imbalance

Evidence suggests that RLS may be caused by a dysfunction in the part of the brain called the basal ganglia, which uses the chemical dopamine as a messenger to help control muscle movement. When this pathway is damaged, dopamine levels in the brain fall, which can result in the involuntary movements experienced with RLS. Because the body’s dopamine levels naturally fall towards the end of the day, it’s thought this could be why RLS symptoms worsen at night.

Kidney disease

Studies have shown that end-stage renal disease (kidney function failure) can increase the risk of RLS. Individuals with kidney failure may also have an iron deficiency which can cause RLS.

Iron deficiency

Another cause of secondary RLS is iron deficiency. Low levels of iron in the blood can cause dopamine levels to drop, therefore provoking RLS. Many women develop iron deficiencies during pregnancy which is why pregnancy is also a risk factor for RLS.

Research also shows that RLS can be triggered by low iron levels in the brain – even when blood iron levels are normal.

Pregnancy

Many women with RLS experience symptoms for the first time during pregnancy – particularly in the third trimester. One study found that 26% of pregnant women suffered from RLS during pregnancy, with symptoms often disappearing a few weeks after giving birth.

Age and Gender

Research shows that women are twice as likely to suffer from RLS than men and that the prevalence of the disorder increases in those aged 60-70 years old. The disorder doesn’t affect children as strongly, with around 2% of children experiencing pediatric RLS.

Underlying health condition

Some research has identified a link between RLS symptoms in patients with cardiovascular disease, arterial hypertension, diabetes, migraine, and Parkinson’s disease. However, research is ongoing as it’s thought that previous studies lacked strong methodologies.

Genetics

Many RLS sufferers are genetically predisposed to the disorder. Studies have shown that up to 63% of individuals with RLS have at least one first-degree relative with the disorder – particularly early-onset RLS.

Medications

Some medications have been found to provoke or exacerbate RLS symptoms, including certain types of antihistamines, antidepressants, neuroleptics, and dopamine-receptor blockers.

Alcohol, caffeine, and nicotine

The use of alcohol, caffeine, and nicotine can trigger or exacerbate RLS in some patients.

Sleep deprivation

Sleep deprivation and other sleep disorders, such as sleep apnea, can exacerbate or bring on RLS symptoms.

Treatment for restless leg syndrome

Various treatment options can help alleviate restless leg syndrome symptoms. However, the recommended treatment will depend on the cause of the RLS.

Lifestyle factors

As with many sleep disorders, addressing certain lifestyle factors can ease RLS symptoms. These include things like:

  • Sticking to a consistent sleep schedule
  • Limiting alcohol and caffeine intake
  • Stopping smoking
  • Doing regular exercise, such as lower body training 
  • Massaging and/or stretching legs before bed
  • Taking a warm bath in the evening
  • Practicing yoga or meditation
  • Using a heating pad or ice pack to alleviate symptoms

Treat underlying health conditions

With secondary RLS, treatment of the underlying health condition (e.g. iron deficiency) or discontinuing the use of certain medications will usually alleviate RLS symptoms. 

Medication and supplements

Depending on the cause of the RLS symptoms, certain medications and supplements have been found to treat symptoms. These include:

  • Iron supplements
  • Dopamine agonists
  • Benzodiazepines
  • Opioids

 

Most RLS medications aren’t recommended during pregnancy, but may be allowed in certain circumstances. 

Note: Be sure to speak to your doctor before taking any kind of medication to treat RLS, as determining whether there is an underlying cause is vital.

Getting a restless leg syndrome diagnosis

If you think you have restless leg syndrome and it’s beginning to affect your daily life, be sure to speak to your healthcare provider.

To reach an RLS diagnosis, you must experience all of the below symptoms, as set out by the International Restless Legs Syndrome Study Group (IRLSSG):

  • An urge to move the legs usually but not always accompanied by, or felt to be caused by, uncomfortable and unpleasant sensations in the legs.
  • The urge to move the legs and unpleasant sensations begin or worsen during periods of rest or inactivity, such as lying down or sitting.
  • The urge to move the legs and unpleasant sensations are partially or totally relieved by movement, such as walking or stretching, at least as long as the activity continues. 
  • The urge to move the legs and any accompanying unpleasant sensations during rest or inactivity only occur or are worse in the evening or night than during the day. 
  • The occurrence of the above features is not solely accounted for as symptoms primary to another medical or a behavioral condition (e.g., myalgia, venous stasis, leg edema, arthritis, leg cramps, positional discomfort, habitual foot tapping).

Your doctor will ask about the frequency, duration, and intensity of symptoms and may also:

  • Ask about any medications you take to rule out a link
  • Carry out a physical examination
  • Arrange blood tests to check iron levels 
  • Refer you to a sleep specialist

Because of the varying symptoms of RLS, it’s often left undiagnosed (or misdiagnosed), meaning many individuals suffer in silence. But with sleep deprivation being the biggest concern, RLS shouldn’t be ignored. 

If you can relate to the symptoms mentioned throughout this guide, be sure to speak with your healthcare provider to reach a diagnosis and explore the best treatment options for you.

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