Restless Leg Syndrome (RLS)

Characterized by prickling, pulling, tingling, and itching in the legs, restless leg syndrome (RLS) creates an overwhelming urge to move the legs. Unless the patient moves his or her legs, he or she keeps feeling the symptoms.

And although moving the legs may provide temporary relief, the symptoms return as soon as the patient relaxes his or her legs.

Affecting 5-10 percent of adults in the United States, RLS can affect people of all ages: from children to old people.

restless leg syndrome

Symptoms of Restless Legs Syndrome

Although different from the sensations that normal people feel, RLS symptoms are defined by patients as:

Restlessness
Twitching
Bruning
Creeping
Crawling
Ithing
Tingling

These symptoms occur mostly when the person is rested or inactive. When the person with RLS moves his or her legs, the symptoms temporarily resolve.

Because of its onset during the resting phase, many people with RLS develop insomnia, as they lose the ability to fall asleep quickly.

In fact, a study concluded that 88 percent of individuals with RLS report at least one sleep related symptom. This can further lead to:

Depression
Irritability
Mood swings
Other physical and mental health issues.

If the RLS is caused because of a certain drug or substance, then stopping it will resolve the issue. However, if RLS is primary or idiopathic (has no known symptoms), then the symptoms may worsen over time.

Types of RLS

RLS may be primary/idiopathic or secondary. While primary RLS has no known symptoms, secondary RLS results from an underlying medical condition or medication.

Primary or idiopathic RLS

Idiopathic means that the pathology has no known cause. It can be especially difficult to treat because of the absence of an underlying medical condition.

Idiopathic RLS is quite common in people:

Age 40 or above
Who are genetically predisposed to the condition

Primary or idiopathic RLS generally lasts for the entire lifetime, but sometimes the symptoms disappear for a long time.

Secondary RLS

Secondary RLS may result from the following medical conditions:

Iron deficiency
Pregnancy
Neuropathy
Kidney failure
Rheumatoid arthritis
Parkinson's disease

Although the cause hasn’t been identified yet, experts hypothesise that neurotransmitters play an important role and that basal ganglia, a region in the brain that uses dopamine to control muscle activity, may be involved.

Excess dopamine in the brain damages nerve cells, leading to involuntary movements.

So when dopamine levels fall at the end of the day, the symptoms of RLS get worse. This is why people with RLS should avoid melatonin supplements, which lower the amount of dopamine in the brain.

There are a few triggers that can cause restless leg syndrome or exacerbate the symptoms. Here are the triggers for RLS:

SSRI antidepressants (selective serotonin reuptake inhibitor)
Antipsychotics
Calcium channel blockers
Antihistamines
Lithium

Periodic Limb Movement Disorder

People with RLS generally have period limb movement disorder, which causes the limbs to jerk and twitch while the person is asleep.

As the movements occur during sleep, the person is mostly unaware of this symptom. However, these movements can sometimes be severe enough to wake up the person.

Diagnosis of RLS

Generally, your GP can diagnose RLS on the basis of test results, family history, medical history, and physical examination. Here are a few things that your doctor may look for:

Overwhelming urge to move legs because of uncomfortable sensations
Symptoms resolve on moving the legs
Symptoms occur or get worse when inactive
Symptoms get worse during the night

Assessment of RLS

It’s essential to look for patterns when it comes to RLS. You need to take note of:

How often do the symptoms occur?
What type of sensations do you feel?
If your sleep is disrupted, then how often?
How much distress do the symptoms cause?

Your doctor may advise you to keep a sleep diary, which maintains a record of:

Daily sleep habits
Time of sleep per day
Number of times you wake up during the night
Excessive daytime sleepiness

If your symptoms are severe, your doctor may prescribe you a few medicines to relieve the symptoms and to help you fall asleep faster.

Tests for RLS

Your doctor may conduct a few blood and sleep tests.

Blood tests may include tests for:

Diabetes
Kidney function problem
Anemia

Blood tests can ascertain any underlying issues that may lead to secondary restless legs syndrome. Primarily, your doctor looks at the levels of iron in your body.

As RLS may disrupt sleep and cause insomnia, your doctor may recommend polysomnography (sleep tests), which measure your brain wave, oxygen levels, breathing rate, etc while you sleep.

Treatment for RLS

By making a few lifestyle changes, you can easily manage mild to moderate symptoms of restless legs syndrome.

Lifestyle changes that you can make include:

Sleeping at a specific time each day
Avoiding caffeine and alcohol
Quitting smoking
Regular exercise, but not close to bedtime
Following good sleep hygiene
Avoiding medications that exacerbate your symptoms

Apart from these changes, you can practice relaxation techniques that may calm your anxiety:

Take a hot bath before heading to bed
Massage your legs
Stretch out your muscles
Use the 4-7-8 breathing technique to calm your nerves
Practice mindfulness to learn not to judge your thoughts

Medication

For severe restless legs syndrome, your doctor may prescribe the following medicines:

Dopamine agonists

If you frequently experience symptoms of RLS, your doctor may prescribe dopamine agonists, which increase the levels of dopamine in the brain.

Since low levels of dopamine have been linked to increased symptoms of RLS, dopamine agonists may provide relief.

Painkillers

Opioids, such as codeine, may be prescribed to relieve chronic pain, which is sometimes accompanied by RLS.

Gabapentanoids, such as gabapentin and pregabalin, may be prescribed to provide relief from restlessness and tingling sensations. They work as painkillers as well.

Home remedies for RLS

People with RLS sometimes find relief from home remedies. Here are some of these remedies that you can try:

Magnesium supplements

Consuming magnesium may provide some relief from restless legs, as magnesium is a natural muscle relaxant. Further, our body requires magnesium to make melatonin, the sleep hormone.

Start off with small doses between 200-400mg of magnesium per day. Once your body gets used to this dose, you can increase the dosage to up to 1,000mg per day.

Avoid certain foods

You need to avoid certain foods that trigger and exacerbate the symptoms of restless legs syndrome.

Stimulants, such as alcohol, caffeine, and tobacco, must be avoided close to bedtime. Further, consuming processed foods high in simple carbohydrates and items containing sugar in large amounts may trigger your symptoms.

Use compresses

Hot and cold compresses are often used for relief from muscle injury. Anecdotal evidence exists that people with RLS may find it helpful to use hot and cold compresses, which may reduce the uncomfortable sensations triggered by RLS.

Conclusion

Restless legs syndrome causes irritability, anxiety, and depression. It can lead to sleep disorders, such as insomnia, which further exacerbate the problem. If you think you have this condition, then get a diagnosis from your doctor.