If you’ve never struggled with Restless Leg Syndrome, then the term might bring to mind visions of sentient legs wandering aimlessly along city streets or through meadows of wildflowers.
If you have struggled with Restless Leg Syndrome, then you don’t need us to tell you it’s nothing like a cakewalk.
Instead, Restless Leg Syndrome is a condition that can impact a person’s ability to fall or stay asleep and may make it difficult to sit still for extended periods of time. These effects can have negative consequences for a person’s overall quality of life.
If that sounds like a dismal prognosis, here’s the good news: A large variety of management options can make living with Restless Leg Syndrome significantly more bearable. While researchers still have a lot of questions about the condition, here’s what we know so far about the symptoms, causes, risk factors, consequences, and treatment options for Restless Leg Syndrome.
Note: The content on Sleepopolis is meant to be informative in nature, but it shouldn’t be taken as medical advice, and it shouldn’t take the place of medical advice and supervision from a trained professional. If you feel you may be suffering from any sleep disorder or medical condition, please see your healthcare provider immediately.
What Is Restless Leg Syndrome?
Restless Leg Syndrome is generally thought to be a neurological disorder that triggers uncomfortable sensations in the legs as well as an overwhelming urge to move the legs in an attempt to gain relief from those sensations. The condition is also referred to as RLS, Willis-Ekbom Disease (WED), Nocturnal myoclonus, Akathisia, spare legs, or “the kicks”.
In addition to being a nervous system disorder, Restless Leg Syndrome is also classified as a sleep disorder because it commonly disrupts an affected person’s ability to fall and/or stay asleep. We’ll touch more on this below.
Cases of Restless Leg Syndrome are often classified in one of two ways: as primary (or idiopathic) RLS or secondary RLS. Primary/idiopathic RLS refers to a case of Restless Leg Syndrome in which the cause is unknown. Secondary RLS refers to a case of Restless Leg Syndrome in which the condition is provoked by the development of another disease or health condition.
Restless Leg Syndrome is often confused with Periodic Limb Movement During Sleep (PLMS), a separate condition that causes a person’s legs to twitch or jerk around while they’re sleeping. While the two conditions often overlap (the majority of people who have RLS also present with PLMS), they are not the same thing. For starters, RLS is a neurological disorder, while the clinical significance of PLMS is not yet know. Additionally, many folks who have PLMS never develop RLS.
Once you begin to understand the symptoms, causes, and risk factors for Restless Leg Syndrome, it becomes much easier to tell the two conditions apart. So let’s dive in.
What Are the Symptoms of Restless Leg Syndrome?
The symptoms of Restless Leg Syndrome can manifest in one or all of the following ways:
- An uncomfortable feeling in the legs that might be described as itchy, resembling pins and needles, twitchy, throbbing, achy, crawling, pulling, or just plain ’ol uncomfortable. These sensations can be difficult to articulate, especially to someone who has never experienced RLS. The sensations may exist on one or both sides of the body or alternate between the two sides of the body
- A similarly uncomfortable feeling in the feet or (more rarely) the arms, chest, or head
- A powerful urge to move the legs in an effort to reduce the uncomfortable feelings. Moving or stretching the legs may temporarily relieve the symptoms, but the uncomfortable sensation will likely come back
- A worsening of symptoms in the evening, at night, and when somebody is lying or sitting down for extended periods of time (such as during a long car or plane ride, while watching a movie, or while unwinding on the couch or in bed)
As if these symptoms weren’t uncomfortable enough, what can make RLS even more frustrating is that its symptoms can be highly unpredictable.
Symptoms may range from mild to severe, change from day to day, and/or come and go over the course of days, weeks, or months. Some people may experience symptoms only one time per week (or even less frequently), while others may experience them multiple times per week. Some people may experience spontaneous remissions lasting multiple weeks or months, only to have the symptoms crop back up again down the road. Some people find that their symptoms get worse over the time, but others may identify effective management options that help them cope with RLS and mitigate its impact on their lives.
What Causes Restless Leg Syndrome?
The fact that Restless Leg Syndrome can manifest in so many different ways—and so differently from person to person—helps explain why it’s been difficult for doctors and researchers to identify a specific cause of RLS. That said, several theories have been gaining traction in the medical community. Here are some of the factors that may contribute to Restless Leg Syndrome:
- Dopamine dysfunction. There’s strong evidence to suggest that Restless Leg Syndrome may result from an imbalance of dopamine, which is a brain chemical that is responsible for controlling muscle movement (among other duties). Disruption of dopamine pathways may result in the involuntary movements that are characteristic of RLS.
- Genetics. Almost 50 percent of people who suffer from Restless Leg Syndrome have a family member who also deals with the condition. This suggests genes may have a role to play in the development of the condition.
- Certain medications. While they may not be a direct cause of RLS, a variety of medications may exacerbate its symptoms. These include certain antidepressants, antinausea drugs, antipsychotic drugs, calcium channel blockers, and cold and allergy medications that contain antihistamines.
- Chronic illnesses. Some chronic medical issues and diseases may have a link to Restless Leg Syndrome. These include diabetes, end-stage renal disease, fibromyalgia, kidney failure, Lyme disease, multiple sclerosis (MS), Parkinson’s disease, peripheral neuropathy (aka nerve damage), rheumatoid arthritis, certain tumors, and spinal cord conditions. Effective management of these conditions typically helps relieve some or all of the symptoms of RLS.
- Vitamin or mineral deficiencies. There’s some evidence that low levels of iron in the brain may provoke RLS. Magnesium and vitamin B-12 deficiency may also have a link to the condition.
- Pregnancy. Some pregnant women may experience symptoms of Restless Leg Syndrome during their pregnancy. If RLS is going to crop up during someone’s pregnancy, it’s most likely to happen during the last trimester. In the case of pregnancy-induced RLS, most people experience relief from their symptoms within a month or so of delivery.
- Sleep deprivation. It’s a cruel irony that RLS may cause sleep deprivation—and that sleep deprivation, in turn, may provoke the symptoms of RLS. This helps explain why there’s a strong link between sleep apnea (a condition which often provokes sleep deprivation) and RLS.
- Alcohol, caffeine, and/or nicotine use. In some cases, the use of these substances may trigger or exacerbate the symptoms of Restless Leg Syndrome.
While Restless Leg Syndrome may be provoked by serious medical conditions, the good news is RLS in itself isn’t typically a sign that a person has a severe medical issue. The condition itself is not dangerous, but it may still have a mild or severe impact on someone’s quality of life.
Who Is At Risk for Restless Leg Syndrome?
Once you know some of the causes of Restless Leg Syndrome, you can begin to understand who might be at risk for developing this condition. For example:
- Someone with a family member who suffers from Restless Leg Syndrome may be more likely to develop the condition.
- Someone who is dealing with any of the medical conditions or taking any of the medications that can exacerbate RLS may experience its symptoms.
- Someone who has abnormal dopamine and/or iron levels in the brain may be more likely to develop RLS.
- Pregnant people (especially those in their last trimester) may be at risk for temporarily developing RLS.
Additionally, there are a few other factors that may play a role in RLS risk. To wit:
- While Restless Leg Syndrome can affect people of any sex, it’s more common in women.
- RLS can affect people of any age (even children), but it’s most common in people who are middle-aged or older. Additionally, people who develop RLS at a younger age may find that their symptoms get worse as they age.
- RLS can also affect people of any ethnic or racial background, but studies suggest it’s most common among people of northern European descent.
All told, Restless Leg Syndrome affects an estimated five to 15 percent of the U.S. population. (Approximately three percent of the population is severely affected by the condition.) That’s a rough estimate, because the condition is frequently misdiagnosed. This is one of the reasons why some people with RLS may suffer for years without any answers. Once an RLS diagnosis is determined, it’s much easier to develop an effective management plan for the condition. Which brings us to the next section…
How Is Restless Leg Syndrome Diagnosed?
As noted above, a correct diagnosis of Restless Leg Syndrome is essential for proper management of the condition. Nevertheless, many people with RLS wait a long time for a diagnosis (or are never diagnosed at all).
This is largely because Restless Leg Syndrome can be very difficult to diagnose. There is currently no medical test that can determine whether a person has RLS, which means it’s up to a doctor to evaluate a patient’s physiological status, medical history, and other factors in order to rule out other conditions and determine whether RLS might be at play.
In order to reach a diagnosis of Restless Leg Syndrome, most doctors will utilize a variety of exam procedures including blood tests, a neurological exam, an overnight evaluation at a sleep clinic, and an evaluation of a patient’s current symptoms and medical conditions, family medical history, medication use, daytime sleepiness, and other factors. A doctor may determine that you have Restless Leg Syndrome if your symptoms match the following criteria:
- You have an irresistible urge to move your legs, typically in response to uncomfortable sensations in the legs.
- Your symptoms either kick in or escalate when you’re at rest.
- Your symptoms get worse in the evening and/or nighttime.
- Your symptoms are somewhat or fully relieved by moving the legs.
- The preceding four symptoms can’t be attributed to any other conditions.
If you’re concerned that you might be dealing with Restless Leg Syndrome, it’s important to consult a medical professional. Symptoms of RLS, trouble sleeping, daytime drowsiness, depression, and a diminished quality of life are all signs that you may want to schedule an appointment with your doctor. In order to prepare for your visit, it’s helpful to keep a log of your symptoms—how they manifest, when they occur, and so on. This can aid your doctor in making a correct diagnosis.
How Does Restless Leg Syndrome Impact Sleep?
As you might imagine, the sensations provoked by RLS can make it difficult to fall and stay asleep during the night. If your legs are feeling uncomfortable or you’re experiencing an unbearable urge to move around, then odds are good you won’t be falling asleep any time soon. Because RLS symptoms generally get worse at night, this situation is all too common among those who have Restless Leg Syndrome.
People who are dealing with moderate to severe cases of RLS may find their symptoms occur multiple times a week, which can significantly disrupt their ability to obtain high-quality sleep on a regular basis. Even people with milder cases of RLS may find that the condition impairs their sleep quality.
The consequences of this frequent inability to fall and stay asleep can have major ramifications for a person’s quality of life. Some of the negative effects of not getting enough sleep include:
- Daytime sleepiness
- Diminished quality of mood
- Difficulty concentrating or thinking clearly
- Impaired performance at school or work
- Decreased productivity (In fact, moderate to severe RLS is linked to a 20 percent decrease in productivity)
- Increased irritability, which can impact personal relationships
- Impaired memory
- Difficulty completing daily tasks
- Reduced immune system function
- A greater risk of heart disease, stroke, diabetes, kidney disease, anxiety, and depression
As noted above, one of the ironies of Restless Leg Syndrome is that it can cause sleep deprivation—and that sleep deprivation, in turn, can exacerbate symptoms of RLS. This can result in a negative feedback loop in which both the symptoms of RLS and the consequences of sleep deprivation get progressively worse. Luckily, there are plenty of ways to manage this condition and reduce its impact on overall sleep quality.
How Does Restless Leg Syndrome Impact Sleep Partners?
Restless Leg Syndrome doesn’t only affect the sleep of people who have this condition. It can also disrupt the sleep of anyone who shares a bed with a person who has RLS.
That’s because people who are dealing with RLS are likely to move a lot in bed, whether that manifests as tossing and turning, shaking or stretching the legs, or getting in and out of bed in an effort to relieve the uncomfortable sensations that are characteristic of Restless Leg Syndrome. Unless someone’s partner is capable of sleeping like a log under these circumstances, odds are good they’re going to be kept awake right along with the person suffering from RLS.
A partner’s sleep deprivation can result in a number of negative consequences. For starters, it can mean they suffer from the same harmful effects described above, from diminished cognitive abilities to reduced immune system function, impaired work performance, and excess fatigue.
Not only that, but partners who are kept awake by someone dealing with RLS may start to resent their sleep deprivation. This can lead to increased irritability and conflicts, which may strain the relationship.
So what’s a sleep-deprived partner to do? Here are a few ideas:
- Assist your partner in relieving their symptoms by massaging their legs, supplying them with heating pads or cold packs, and so on. This can help you both get back to sleep more quickly.
- Encourage your partner to consult a doctor and adopt the lifestyle changes described below. This can help your partner manage their condition more effectively, which should decrease the number of nights they spend struggling with symptoms.
- Consider investing in a mattress that limits movement transfer when one partner is tossing and turning. (Read on to help find the best mattress type for you!) You might also consider using separate blankets so their movements don’t tug the blankets off of you and increase the chances that you’ll wake up.
- If all else fails, consider sleeping in a different room on the nights that your partner’s symptoms are especially disruptive.
What Are Some Treatments for Restless Leg Syndrome?
Let’s start with the bad news: There is no way to prevent RLS, and there is no cure for Restless Leg Syndrome.
That being said, here’s the good news: There are a lot of treatments available for Restless Leg Syndrome, including both drug and non-drug treatment options. While these treatments may not completely eliminate RLS symptoms, they can help ease their severity and facilitate better sleep so RLS doesn’t have such a large impact on a person’s quality of life. The best treatment options for a person suffering from RLS will probably depend on the potential cause(s) of their RLS and the severity of their symptoms.
For example, if a person experiences only mild symptoms of Restless Leg Syndrome and the condition isn’t interfering with their sleep or quality of life, they may not require any treatment at all. Or, if a person’s RLS is linked to another medical condition, then their best treatment option may be effective management of the other condition. Sometimes this is all that’s needed to ameliorate the symptoms of Restless Leg Syndrome.
Meanwhile, non-drug treatment options are usually ideal for people whose RLS symptoms are mild to moderate. These management techniques include a variety of lifestyle changes such as:
- Adopting a regular, moderate exercise program
- Creating a consistent sleep schedule that involves going to bed and waking up around the same time every day
- Practicing other good sleep habits such as removing electronics from the bedroom, using the bed for nothing other than sleep, and creating an environment that is conducive to sleep by making the bedroom cool, dark, and quiet
- Reducing or terminating the use of alcohol, caffeine, and/or tobacco
- Regularly obtaining leg massages
- Staying hydrated and eating a healthy, nutrient-packed diet
- Soaking in a hot bath (and massaging the legs while in the bath)
- Applying heating pads or ice packs to the legs (or alternating between the two)
- Employing relaxation techniques such as meditation, Tai Chi, acupuncture, or yoga
- Supplementing with iron, magnesium, and/or vitamin D (This should be done with the supervision of a physician)
- Scheduling long car and/or plane rides for earlier in the day, when symptoms are less likely to be severe
- Avoiding the use of medications that may exacerbate RLS (if possible)
- Enjoying regular orgasms (This might sound silly, but research suggests orgasms may ease RLS symptoms because they trigger the release of dopamine in the brain)
- Utilizing modern treatment devices such as a foot wrap, pneumatic compression, and/or a vibrating pad
While lifestyle changes are the preferred treatment option for RLS, in some cases a doctor may prescribe a variety of medications in an effort to treat the condition. If pursuing the medication route, a doctor might consider the following types of drugs:
- Anticonvulsants or antiseizure drugs. These may make the urge to move one’s legs more bearable and ease painful, “creepy crawly” sensations in the legs.
- Sleep medications and/or muscle relaxants. These may help people with RLS sleep better at night.
- Dopamine-enhancing drugs. These drugs influence dopamine levels in the brain. For some people, this may result in an improvement in RLS symptoms.
- Drugs that influence calcium levels. While it’s not totally clear why, these types of medications may improve RLS symptoms in some individuals.
- Narcotic pain relievers (aka opioids). These can help relieve symptoms in people whose RLS manifests as severe pain in the legs.
Employing prescription medication in an effort to manage Restless Leg Syndrome can involve a lot of trial and error, because the same drug may help alleviate one person’s symptoms and exacerbate another person’s. It’s also possible that a drug may help for a while and then gradually decrease in effectiveness. Additionally, many of these drugs come with their own set of unpleasant side effects, and most of them are not recommended during pregnancy.
Living with Restless Leg Syndrome
While there is no way to prevent or cure Restless Leg Syndrome, the good news is there are plenty of ways to cope with it. If RLS is interfering with your ability to get good sleep or otherwise diminishing your quality of life, it’s important to consult the advice of a medical professional. By working together with your doctor, you can enact lifestyle changes and develop a treatment plan that helps you effectively manage even the most restless of legs.