04/11/2022
Restless legs syndrome.
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(RLS) is a condition that causes an uncontrollable urge to move your legs, usually because of an uncomfortable sensation. It typically happens in the evening or nighttime hours when you're sitting or lying down. Moving eases the unpleasant feeling temporarily.
What triggers restless leg syndrome?
In most cases, the cause of RLS is unknown (called primary RLS). However, RLS has a genetic component and can be found in families where the onset of symptoms is before age 40. Specific gene variants have been associated with RLS. Evidence indicates that low levels of iron in the brain also may be responsible for RLS.
What causes restless legs syndrome (RLS)?
Low levels of iron (iron deficiency).
Uremia (a condition associated with worsening kidney function).
Hypothyroidism.
Depression.
Fibromyalgia.
Parkinson's disease.
Kidney disease.
Diabetes.
Restless legs syndrome typically causes an overwhelming urge to move your legs and an uncomfortable sensation in your legs.
The sensation may also affect your arms, chest and face.
It's been described as:
tingling, burning, itching or throbbing
a "creepy-crawly" feeling
feeling like fizzy water is inside the blood vessels in the legs
a painful cramping sensation in the legs, particularly in the calves
These unpleasant sensations can range from mild to unbearable, and are usually worse in the evening and during the night. They can often be relieved by moving or rubbing your legs.
Some people experience symptoms occasionally, while others have them every day.
There's no single test for diagnosing restless legs syndrome.
A diagnosis will be based on your symptoms, medical and family history, a physical examination, and test results.
Your GP should be able to diagnose restless legs syndrome, but they may refer you to a neurologist if there's any uncertainty.
There are 4 main criteria your GP or specialist will look for to confirm a diagnosis.
These are:
an overwhelming urge to move your legs, usually with an uncomfortable sensation, such as itching or tingling
your symptoms occur or get worse when you're resting or inactive
your symptoms are relieved by moving your legs or rubbing them
your symptoms are worse during the evening or at night
Assessing your symptoms
Your GP or specialist will ask you about the pattern of your symptoms to help assess their severity.
For example, they may ask you:
how often you have symptoms
how unpleasant you find your symptoms
whether your symptoms cause significant distress
whether your sleep is disrupted, making you tired during the day
Keeping a sleep diary may help your doctor assess your symptoms.
You can use the diary to record your daily sleeping habits, such as the time you go to bed, how long it takes you to fall asleep, how often you wake during the night, and episodes of tiredness during the day.
Mild symptoms of restless legs syndrome can usually be treated by making lifestyle changes.
For example:
establishing a regular sleeping pattern
avoiding stimulants, such as caffeine, alcohol or to***co, in the evening
If your symptoms are more severe, you may need medication to bring them under control.
Read more about treating restless leg syndrome.
Blood tests
Your GP may refer you for blood tests to confirm or rule out possible underlying causes of restless legs syndrome.
For example, you may have blood tests to rule out conditions such as anaemia, diabetes and kidney function problems.
It's particularly important to find out the levels of iron in your blood because low iron levels can sometimes cause secondary restless legs syndrome.
Low iron levels can be treated with iron tablets.
Sleep tests
If you have restless legs syndrome and your sleep is being severely disrupted, sleep tests, such as a suggested immobilisation test, may be recommended.
The test involves lying on a bed for a set period of time without moving your legs while any involuntary leg movements are monitored.
Occasionally, polysomnography may be recommended. This is a test that measures your breathing rate, brain waves and heartbeat throughout the course of a night.
Treatment
Mild restless legs syndrome that isn't linked to an underlying health condition can be managed with just a few lifestyle changes.
If symptoms are more severe, medication may be needed.
Restless legs syndrome caused by an underlying health condition can often be cured by treating that condition.
For example, iron deficiency anaemia can be treated by taking iron supplements.
If it's associated with pregnancy, it usually disappears on its own within 4 weeks of the birth.
Lifestyle changes
A number of lifestyle changes may be enough to ease the symptoms of restless legs syndrome.
avoiding stimulants in the evening (such as caffeine, to***co and alcohol)
not smoking (read more about quitting smoking)
regular daily exercise (but avoid exercising close to bedtime)
good sleep habits (for example, going to bed and getting up at the same time every day, not napping during the day, taking time to relax before going to bed, and avoiding caffeine close to bedtime)
avoiding medicines that trigger the symptoms or make them worse (if you think medication is causing your symptoms, continue to take it and make an appointment to see your GP)
During an episode of restless legs syndrome, the following measures may help relieve your symptoms:
massaging your legs
taking a hot bath in the evening
applying a hot or cold compress to your leg muscles
doing activities that distract your mind, such as reading or watching television
relaxation exercises, such as yoga or tai chi
walking and stretching
Medication
Dopamine agonists
Dopamine agonists may be recommended if you're experiencing frequent symptoms of restless legs syndrome.
They work by increasing dopamine levels, which are often low.
Dopamine agonists that may be recommended include:
ropinirole
pramipexole
rotigotine skin patch
These medications can occasionally make you feel sleepy, so you should be cautious when driving or using tools or machinery after taking them.
Other possible side effects can include nausea, dizziness and headaches.
If you experience nausea while taking a dopamine agonist, you may be given medication to help with this (antiemitic medication).
Impulse control disorder (ICD) is a less common side effect sometimes associated with dopamine agonists.
People with ICD are unable to resist the urge to do something harmful to themselves or others.
For example, this could be an addiction to alcohol, drugs, gambling, shopping or s*x (hypers*xuality).
But the urges associated with ICD will subside once treatment with the dopamine agonist is stopped.
Painkillers
A mild opiate-based painkiller, such as codeine, may be prescribed to relieve pain associated with restless legs syndrome.
Gabapentin and pregabalin are also sometimes prescribed to help relieve painful symptoms of restless legs syndrome.
Side effects of these medications include dizziness, tiredness and headaches.
Aiding sleep
If restless legs syndrome is disrupting your sleep, a short-term course of medication may be recommended to help you sleep.
These types of medication are known as hypnotics, and include temazepam and loprazolam.
Hypnotics are usually only recommended for short-term use (typically no longer than a week).
You may find you still feel sleepy or "hungover" the morning after taking your medication.
Cardiovascular diseases
Recent research found people with restless legs syndrome may be more likely to develop cardiovascular disease, such as coronary heart disease or stroke, compared with people who don't have the syndrome.
This risk is thought to be greatest in people with frequent or severe symptoms of restless legs syndrome.
The exact reason for the increased risk is unclear, but it may be that the rapid leg movements are associated with an increased heart rate and blood pressure.
Sleep problems have also been linked to cardiovascular disease.
To reduce this risk, you should exercise regularly, maintain a healthy weight, give up smoking if you smoke, and eat a healthy, balanced diet.
Physiotherapy
A physical therapist has a vital role in calming the symptoms of restless leg syndrome to help patients get relief. With regular treatments, individuals can regain good sleep patterns, feel more relaxed when they are at rest, and experience better quality of life overall.
