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Restless Legs

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What is it?

Restless legs syndrome (RLS) is when you have a strong urge to move your legs. This urge is very hard to resist. It often comes with other uneasy feelings deep inside the legs. You can have a very hard time trying to explain what this feels like. The sensation might be like burning, prickling, itching or tingling. It can even be more extreme and feel painful. These feelings, along with the urge to move, are made worse by rest. Lying or sitting still can be very hard. Temporary relief is found when you walk or move the legs. This relief tends to come right away.

The urge to move the legs grows worse at night and eases in the morning. RLS makes it very hard for you to rest or go to sleep. People with severe RLS may get less than five hours of sleep each night. This total sleep time is lower than with almost any other sleep disorder. Milder RLS will not disturb your sleep as much. People with RLS feel very tired and have less energy during the day. They are also more likely to suffer from depression or anxiety.

A related problem is that your leg muscles might tighten or flex while you are still. These movements can be out of your control. In extreme cases, they can take the form of periodic limb movements. These simple, repetitive muscle movements can occur when you are awake (periodic limb movements of wakefulness or PLMW). This can make it even harder for you to go to sleep. They can also occur while you sleep (periodic limb movements of sleep or PLMS). This can wake you up and make it harder for you to fall asleep again. Eighty to 90% of patients with RLS also have PLMS.

Mild RLS may show up for only a short period of time. It may also return after being gone for a long while. Symptoms tend to become more intense and last longer over time. It normally starts in the legs but may progress to more of the body. It will occasionally start in the ankles or feet. How bad it feels can vary from day to day. It is made worse when you are not active for a long period of time. This could be due to sitting in a theater, working at a desk, or taking a long plane or car ride.

Who gets it?

RLS occurs between 1.5 and two times more often in women than in men. Studies show that adults in the U.S. and Northern Europe have it at a rate of 5% to 10%. Studies also show that fewer people seem to have it in Asia.

It can occur at any age, from early childhood to late adult life. In children, RLS can be wrongly called “growing pains.” Some think that RLS in children may be related to attention-deficit/hyperactivity disorder. This idea has not yet been proven.

Secondary RLS is caused by other disorders or medical conditions. It is resolved when the other conditions are treated. It has clearly been shown to be associated with the following:

  • Pregnancy
  • End-stage renal (kidney) disease
  • Iron deficiency and all conditions that produce low iron
  • Peripheral neuropathy (a disease or abnormality of the nervous system)
  • Some medications
    • Most antidepressants (one antidepressant that does not trigger RLS is buproprion)
    • Sedating antihistamines
    • Virtually all centrally active dopamine-receptor antagonists, including anti-nausea medications

Primary RLS is not directly caused by another sleep disorder or medical condition.

There may be a link between some sleep related eating disorders and RLS. This idea needs to be studied further.

RLS has an “early onset” when it starts before the age of 45. Signs of it may show up very slowly over time. Daily feelings of uneasiness in the legs do not always start right away. But these feelings usually occur on a daily basis after the patient is 40 to 65 years old. Late-onset RLS occurs more quickly and more often. Sometimes, it will occur daily from the time that it starts.

More than 50% of people with primary RLS report a pattern of it in their family. The risk of RLS is about three to six times greater when an immediate relative has it. Early onset of RLS points to a higher rate of RLS in the family.

How do I know if I have it?

1. Do you have an urge to move your legs or uncomfortable sensations?

2. Is this urge worse when you are at rest?

3. Do your legs seem to feel better when you walk, stretch or make other movements?

4. Are these feelings worse, or do they only occur, in the evening or at night?

If your answer to each of these questions is yes, then you might have RLS.

It is also important to know if there is something else that is causing your sleep problems. They may be a result of one of the following:

  • Another sleep disorder
  • A medical condition
  • Medication use
  • A mental health disorder
  • Substance abuse

The feelings related to RLS can be very hard to describe. This can also make it hard to know for sure if someone has it. This is true for adults, but even more so for children. They often don’t have the words to tell someone what is wrong. This makes it more important to know if the child’s parent or other relative has RLS.

Do I need to see a sleep specialist?

Mild RLS may not bother you enough to seek medical help. You will want to see a sleep specialist if you think you may have a more severe case of RLS. It can greatly disturb your sleep. This can hinder you at work and at home by making you very tired during the day. It can also play a part in causing depression or anxiety. Your overall quality of life can suffer greatly.

What will the doctor need to know?

You should complete a sleep diary for two weeks. This will give the doctor clues as to what might be causing you problems. You can also rate your sleep with the Epworth Sleepiness Scale. This will help show how your sleep is affecting your daily life. The doctor will need to know your complete medical history. Be sure to inform him of any past or present drug and medication use. Also tell him if you or a relative have ever had a sleep disorder.

Will I need to take any tests?

Your doctor may have you do an overnight sleep study (polysomnogram), but this is not usually needed to detect restless legs. The polysomnogram charts your brain waves, heart beat, and breathing as you sleep. It also records how your arms and legs move. The best sleep study will also record your sleep on video. This will help show in clear detail how your legs move during the night.

Your doctor may order blood tests, including measuring iron.

How is it treated?

A regular exercise program may help restless legs. Reducing caffeinated drinks, alcohol use or smoking may also help. You may also reduce RLS by keeping mentally active while you are sitting down. When restless legs occurs, any of the following activities may help:

  • Walking
  • Riding an exercise bike
  • Massaging the legs
  • Soaking in a hot tub

Many medications are available to treat restless legs. The most commonly used ones are drugs that replace a chemical in the brain called dopamine.These drugs are also used to treat Parkinson disease. However, if you have restless legs, you are not at an increased risk of getting Parkinson disease. Other medications used include the following:

  • Sleeping tablets
  • Some anti-seizure medications
  • Narcotic pain killers

If you are shown to have iron deficiency, your doctor may recommend iron treatment. However, you should not take iron without a doctor’s advice. This is due to the fact that too much iron can be harmful to the liver.

Reviewed by Donald R. Townsend, PhD
Updated May 16, 2006

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