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Restless legs syndrome (RLS) is a sleep
disorder in which a person has unpleasant feelings or
sensations in the legs. These feelings are described as creeping,
crawling, tingling, pulling, or painful. While these sensations
happen most often in the calf or lower leg area, they can be felt
anywhere from the ankle to the upper thigh. RLS symptoms can occur
in one or both legs and can also be felt in the arms. These symptoms
occur most often when lying down, but can also occur when sitting
for long periods of time, such as at a desk, riding in a car, or
watching a movie. People with RLS talk about having an irresistible
urge to move the legs. Moving the legs, walking, rubbing or
massaging the legs, or doing knee bends can bring relief, at least
for a short time.
Unlike other conditions, RLS symptoms get
worse when relaxing or lessening activity, particularly during the
evening and nighttime sleeping hours. Many people with RLS have
trouble falling asleep and staying asleep. If not treated, RLS can
cause extreme tiredness and daytime fatigue. A person's job,
personal life and daily activities can be strongly affected due to
exhaustion. A person can lose their ability to focus and have memory
loss.
Many people with RLS also have a related sleep
disorder called periodic limb movements in sleep (PLMS).
With PLMS, a person jerks or bends their legs unintentionally during
sleep. These movements can happen every 10 to 60 seconds, or
hundreds of times, during the night. They can wake a person, disturb
sleep, and wake bed partners. People who have both RLS and PLMS have
trouble falling and staying asleep and can have extreme sleepiness
during the day.
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RLS affects about 2 to 15 percent of
Americans. But, it may actually affect more people. Some people with
RLS do not seek treatment because they fear they won't be taken
seriously, their symptoms are too mild, or that the condition can't
be treated. Health care providers sometimes think the symptoms of RLS are caused by something else, like nervousness, insomnia (not
being able to sleep), stress, arthritis, muscle cramps, or aging.
RLS is thought to affect women more often than
men. It can start at any age, even in young children, but most
people with RLS are middle-aged or older. And, older people with RLS
have symptoms more often and for longer periods of time. Young
people who have RLS are sometimes thought to have "growing pains" or
may be considered "hyperactive" because they cannot sit still in
school.
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RLS symptoms are not the same for every
person. They range from uncomfortable to painful and can vary in
frequency. A person can have periods when RLS does not cause
problems, but the symptoms usually return. Another person can have
severe symptoms every day.
Common symptoms of RLS include:
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Unpleasant or uncomfortable feelings or
sensations in the legs often described as creeping, crawling,
tingling, pulling or painful, often producing an irresistible
urge to move the legs. These feelings most often occur deep
inside the leg, between the knee and ankle. While rare, they can
also occur in the feet, thighs, arms, and hands. Most of these
feelings involve both sides of the body, although they can
happen on just one side of the body.
-
Leg discomfort that occurs and gets worse
when lying down or sitting for long periods of time. Long car
trips, sitting in the movies, long-distance flights, and having
a cast on can trigger RLS.
-
Symptoms that happen and are worse later
in the day, evening, and during the night.
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The need for constant movement of the legs
(or other affected body parts) to lessen discomfort. People may
pace the floor, move their legs when sitting, and toss and turn
in bed.
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Having leg and sometimes arm movements
when sleeping that you can't control.
-
Trouble falling asleep or staying asleep.
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Sleepiness or tiredness during the day.
Certain medications, such as drugs for nausea,
seizures, and psychosis, as well as some cold and allergy medicines,
may make symptoms worse. Talk with your health care provider if you
are taking any prescription or over-the-counter medicines.
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In most cases, the cause of RLS is not known.
For about half of all RLS cases, there is a family history of the
condition. People who have RLS in the family tend to be younger when
symptoms start and develop symptoms slowly.
RLS is thought to be related to the following
factors or conditions:
-
Some women get RLS during pregnancy,
especially in the last 3 months. But the symptoms usually go
away about 4 weeks after having the baby.
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People with anemia (low iron
levels) may be more likely to get RLS. Once low iron levels or
anemia is corrected, symptoms can lessen.
-
Chronic diseases such as kidney
failure, diabetes, Parkinson's disease,
and
peripheral neuropathy
(loss of feeling or numbness in the hands and feet) may be
linked to RLS.
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There are no tests for RLS. It can be hard to
diagnose and is easily confused with other conditions. When someone
with RLS goes to see a doctor, there is often nothing wrong that the
doctor can see or detect with a physical exam. Diagnosis therefore
depends on what a person describes to the doctor. To help make a
diagnosis, the doctor may ask about all current and past medical
problems, family history, and current medications. A complete
physical and neurological exam may help identify other conditions
that may be linked with RLS, such as nerve damage (neuropathy or a
pinched nerve) or abnormalities in the blood vessels. Basic lab
tests may be done to assess overall health and to rule out anemia.
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There is no cure for RLS. Sometimes RLS can be
controlled by diagnosing and treating an underlying condition, such
as peripheral neuropathy or
diabetes. Treating the underlying disease can relieve many
of the symptoms of RLS.
For people who have RLS with no diagnosed
cause (like an underlying disease), treatment is focused on symptom
relief. For those with mild to moderate symptoms, lifestyle changes
are often suggested including:
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reducing or stopping use of caffeine,
alcohol, and tobacco products;
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taking supplements to increase iron,
folate, and magnesium in the body;
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developing and keeping a regular sleep
schedule;
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getting moderate exercise;
-
taking hot or cold baths, rubbing or
massaging the legs or other affected body parts, or using a
heating pad or ice pack.
Health care providers may prescribe drugs for
symptom relief. The following three types of drugs are most often
prescribed (all of which may have serious side effects):
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Benzodiazepines - these drugs depress the
central nervous system and allow people to sleep more, despite
the RLS symptoms. They should not be used by people with
sleep apnea (a person stops breathing on and off during the
night).
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Dopaminergic agents - are drugs used to
treat Parkinson's disease. They have been shown to reduce RLS
symptoms and nighttime leg movements.
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Opiods - are painkillers and relaxing
drugs that can sometimes help people with severe RLS symptoms.
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This
information was abstracted from fact sheets developed by the
National Heart, Lung, and Blood Institute, including
Facts About Restless Legs Syndrome, and the National
Institute of Neurological Diseases and Stroke
Restless Legs Syndrome Fact Sheet.
Thank you to the Office on Women's Health
in the Department of
Health and Human Services for providing this information.
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