Restless Legs Syndrome – Causes, Symptoms, Treatment

Restless legs syndrome is quite a bothersome ailment, manifested by the need to constantly move the legs, often during sleep. Treatment of the disorder depends strictly on the immediate cause. RLS occurs statistically in 1 in 10 cases.

What is RLS?

Restless legs syndrome (RLS), also known as Wittmaack-Ekbom syndrome, Willis-Ekbom disease or Ekbom disease, is a common condition that affects about 15 percent of people. The risk of RLS increases with age, it is worth mentioning that women complain about this ailment more often than men. RLS usually affects adults between the ages of 20 and 30. It causes unpleasant sensations in the legs and an irresistible urge to move them.

Symptoms usually occur in the late afternoon or evening and are often worst at night when the person is resting, such as sitting or lying in bed. They can also occur when someone is inactive and sitting for a long time (such as when traveling in an airplane or watching a movie). Symptoms usually become more frequent and last longer with age. RLS can affect mood, concentration, performance at work and school, and personal relationships. If left untreated, it can lead to an approximately 20 percent decrease in work performance and, moreover, can lead to depression and anxiety.

It is estimated that over 80 percent of people with RLS have periodic limb movements in sleep (PLMS) during sleep. Characteristic of PLMS are involuntary movements of the legs (and sometimes the arms) during sleep, which usually occur every 15 to 40 seconds, sometimes all night long. It is worth adding that despite the development of PLMS and the majority of people with RLS, most people with PLMS do not have this syndrome.

Most cases of Restless Legs Syndrome can be treated with non-drug therapy and, if necessary, medications.

Also read: A sedentary lifestyle can cause many serious diseases

Restless legs syndrome – symptoms

Restless legs syndrome causes the person to have an irresistible urge to move their legs (and even arms or body).

The sensation is often difficult to define, but can be described as pain, throbbing, pulling, or itching. However, it rarely affects parts of the body other than the legs. While sensations may only be on one side of the body, they most often affect both sides. The sensations vary in severity, from unpleasant to irritating to painful. RLS people try to keep their legs moving because it is movement that alleviates the discomfort. To do this, patients walk, move their legs while sitting, or roll and roll in bed.

Characteristic of RLS is the worsening of symptoms at night, which causes problems with falling asleep and sleeping in general. Symptoms seem to disappear in the early morning. The symptoms themselves may vary in severity and frequency depending on the day.

In moderate cases, Restless Legs Syndrome symptoms appear once or sometimes twice a week, but in severe cases, Restless Legs Syndrome symptoms occur more than twice a week and cause troublesome breaks in sleep and impaired daytime functions.

Moreover, it is important to know that with Restless Legs Syndrome there are periods of improvement that may last for weeks or months in which the person does not feel any symptoms of the disease. This happens most often in the early stages of the disease. Unfortunately, the symptoms get worse over time. In addition, it is assumed that people who suffer from other conditions in addition to RLS develop more severe symptoms more quickly. People who only have Restless Legs Syndrome seem to be in a better position because they develop the disease more slowly, especially if they are sick at a young age.

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Restless legs syndrome – causes

Restless Legs Syndrome usually occurs unrelated to other diseases and is then described as idiopathic (about 80% of cases). When this ailment results from other diseases, it is called a secondary syndrome (about 20% of cases).

Restless legs syndrome can be genetic (specific gene variants have been associated with this disease). Evidence suggests that low levels of iron in the brain may also be responsible for RLS. In addition, researchers believe RLS may be related to dysfunction of the basal ganglia, the parts of the brain that control movement. They use dopamine, which is needed to produce fluid, purposeful muscle activity and movement. Disruption of these paths often results in involuntary movements.

It is believed that people with Parkinson’s disease, another disorder of the dopamine pathways in the basal ganglia, have an increased chance of developing RLS.

Additionally, restless leg syndrome may be associated with or be accompanied by:

1. end-stage renal disease and hemodialysis;
2. iron deficiency;
3. some drugs that may worsen the symptoms of Restless Legs Syndrome, such as anti-nausea drugs (e.g. prochlorperazine, metoclopramide), antipsychotics (e.g. haloperidol, phenothiazine derivatives), antidepressants that increase serotonin levels (e.g. fluoxetine, sertraline) and certain drugs for colds and allergies that contain older antihistamines (e.g. diphenhydramine);
4. taking alcohol, nicotine and caffeine;
5. pregnancy, especially in the last trimester; symptoms usually resolve within 4 weeks after the baby is born in most cases;
6. neuropathy.

Moreover, sleep disturbances and conditions such as sleep apnea can also worsen or trigger symptoms in some people. Reducing or eliminating these factors entirely can improve RLS symptoms.

Also check: Sleep deprivation and its importance for health. What can sleep disturbances lead to?

Restless Legs Syndrome – Diagnosis

There is no specific method that can tell you if you have RLS. The diagnosis is based on the assessment of the doctor who, when interviewing, takes into account whether:

1. the patient has a strong and overwhelming need to move his legs, which is often associated with abnormal or unpleasant sensations.
2. the patient’s urge to move the legs begins or worsens with rest or inactivity.
3. the patient’s urge to move the legs is at least temporarily and partially or completely discharged by the movement.
4. the patient’s urge to move the legs begins or increases in the evening or at night.
5. the above characteristics are not due to any other medical or behavioral condition.

In addition, the diagnosis may be helpful physical, neurological and medical history of the patient, and information about diseases in his family. It is also important what medications the patient is currently taking.

In the interview, the doctor will gather information on:

1. frequency, duration and intensity of symptoms;
2. whether exercise helps relieve symptoms;
3. how long does it take for the patient to fall asleep;
4. Whether the patient experiences any symptom-related pain;
5. whether the patient has any problems sleeping or functioning during the day.

In the diagnosis of Restless Legs Syndrome, laboratory tests are performed which can rule out other conditions, such as kidney failure, iron deficiency anemia (which is a separate condition associated with iron deficiency) or pregnancy, which may cause the symptoms of Restless Legs Syndrome. Blood tests, in turn, can identify iron deficiencies as well as other disorders.

Sometimes sleep tests such as polysomnography (a test that records the brain waves, heartbeat, breathing and movements of the legs throughout the night) can help, which can identify the presence of other causes of sleep disturbance (e.g. sleep apnea) that may be causing Restless Legs Syndrome .

It should be added that restless legs syndrome in children can be very difficult to diagnose. This is because it is more difficult for children to describe what symptoms they have, when they appear and for how long. Occasionally, restless legs syndrome in children is diagnosed as growing pains or ADHD.

Restless Legs Syndrome – Treatment

The frequency of Restless Legs Syndrome varies from symptoms every day to a few times a month. The essence of preventing restless legs syndrome is a healthy lifestyle and a proper diet. Moving an affected limb can provide temporary relief.

As a rule, doctors do not prescribe prescription drugs at the first symptoms of the disease, advising patients to get rid of addictions and modify their lifestyle. In acute restless legs syndrome, treatment with preparations used, for example, in the treatment of Parkinson’s disease is used. Sometimes the symptoms of RLS can be managed by treating related medical conditions such as peripheral neuropathy and diabetes. At the same time, when making an appropriate diagnosis, diseases related to iron deficiency (e.g. anemia) should be excluded.

Although medications for Restless Legs Syndrome are helpful, the medication in question will not work exactly in every case. Therefore, it is sometimes necessary to try several medications. However, you should be aware that your regular medications may lose their effect over time and may even worsen your condition, requiring you to change your medications.

Also read: How to take medications effectively?

Home remedies to combat restless leg syndrome

The key points in the treatment of restless legs syndrome are the abandonment of addictions such as smoking, drinking alcohol and coffee. Patients are advised to ensure adequate sleep (8 hours a day) and regular physical activity. Homemade treatment of RLS is also done by modifying the diet. The food you eat should contain high doses of iron and B vitamins (poultry, lean meat, seafood).

When it comes to physical activity, walking, yoga and other stretching and relaxation exercises, as well as activities such as taking a warm bath or using a heating pad or ice pack can help to heal restless legs syndrome. Lower limb massage is also worth considering among home remedies. If you want to put yourself in the hands of professionals, take advantage of therapeutic massage in Arkmedic medical facilities. Massage will relieve pain, stimulate circulation and strengthen muscles.

Restless legs syndrome – medications

The key to the initial diagnosis of Restless Legs Syndrome is the administration of high doses of iron, magnesium and vitamins B and C to the patient. Anyone with this condition is sent for a standard blood test to determine the level of ferritin. Consumption of complex preparations containing the above-mentioned vitamins and minerals in increased doses is considered the optimal solution in the treatment of restless legs syndrome.

However, it is important to know that iron is not well absorbed by the intestines and can cause constipation, which can be treated with stool softeners such as polyethylene glycol. Occasionally iron supplements will not produce the desired effects and it may be necessary to administer iron through a drip.

In addition, the treatment of restless legs syndrome includes:

1. antiepileptic drugs – are the drug of first choice for restless legs syndrome. They can slow down or block pain signals from the nerves in your legs. However, their use is associated with some side effects, such as dizziness, fatigue and drowsiness. Examples of anti-epileptic drugs used in restless legs syndrome are gabapentin and pregabalin. These drugs are especially effective in patients with the painful restless legs syndrome due to neuropathy.
2. dopaminergic agents – they increase the effect of dopamine, are widely used in the treatment of Parkinson’s disease. Interestingly, it has been shown that they alleviate the symptoms of uncontrollable leg syndrome when taken at night. They include, among others: ropinirole, pramipexole and rotigotine. These drugs are generally well tolerated, but may cause nausea, dizziness, or other short-term side effects. It is also worth knowing that the long-term use of these drugs may lead to worsening of the symptoms of RLS (symptoms may appear earlier in the evening or start to last around the clock), as well as to the development of impulsive or obsessive behavior. However, this process is reversible if the patient stops taking dopaminergic drugs.
3. opioids – These drugs are sometimes prescribed for people who have not responded well to other drugs. These include methadone, codeine, hydrocodone or oxycodone. Side effects include constipation, dizziness, nausea, worsening sleep apnea, and the risk of addiction; however, very low doses are often effective in controlling the symptoms of Restless Legs Syndrome.
4. benzodiazepines – they are used to help patients sleep well. However, benzodiazepines can make you feel sleepy during the day, reduce energy and affect concentration. Clonazepam and lorazepam are generally prescribed to treat anxiety, muscle cramps, and insomnia. As these medications can also cause or worsen sleep apnea in some cases, they should not be used in people with this condition. 

Restless legs syndrome – other treatments

The University of Maryland Medical Center recognizes that low levels of magnesium can contribute to RLS. The researchers referred to a study published in the scientific journal Sleep in 1998. The study involved 10 people with Restless Legs Syndrome, who found magnesium to reduce symptoms of insomnia and may be useful in the treatment of people with PLMD (periodic limb movement disorder; periodic movements of the limbs during sleep).

Magnesium is available in whole grains, nuts, and green leafy vegetables. Some people find that spraying magnesium oil on the affected part of the body can help, but this should not be used without consulting your doctor first. People with kidney problems should be careful when taking magnesium.

Studies on the effects of vitamin D on RLS have also been conducted, but the results have been mixed. Some link high levels of vitamin D with fewer symptoms, while others suggest that extra vitamin D is associated with a higher incidence of the disease during the summer months.

It has also been suggested that staying hydrated may positively affect RLS. This can be achieved by drinking plenty of water and avoiding caffeine and alcohol.

If you care about time and do not want to wait for the appointment at the clinic, arrange a consultation with your family doctor today via the halodoctor.pl portal.

Restless legs syndrome in pregnancy

Restless legs syndrome is increasingly noted among pregnant women. Apart from having to move their limbs, they complain of swelling and tingling in their legs. This ailment most often occurs in the last weeks of pregnancy. In the case of pregnant women, restless legs syndrome treatment should be based on lifestyle changes (increased physical activity in the form of walking and light exercise), and drug treatment should be the last resort.

It is assumed that RLS during pregnancy may be related to iron or folate deficiency. Therefore, supplementation with iron and folic acid is a safe treatment option, and these supplements are commonly used by pregnant women.

If supplementation does not bring the expected results and the symptoms of Restless Legs Syndrome are severe, gabapentin or benzodiazepines can be used if the doctor considers it appropriate, taking into account the associated risks for the fetus (cleft palate and neonatal syndromes, e.g. hypotension, hypothermia and respiratory depression).

See also: This is why Polish children get sick. A long list of ailments

Restless legs syndrome – prognosis

There is no cure for Restless Legs Syndrome, and the symptoms must be dealt with throughout their lives. It should be added, however, that nowadays this disease can be controlled by minimizing symptoms and prolonging restful sleep periods.

However, it should be remembered that the symptoms of Restless Legs Syndrome increase with age, especially in people who suffer from another condition or disease. In addition, some people may experience remission, periods when symptoms diminish or disappear for days, weeks, months, or years. Unfortunately, the symptoms of RLS will eventually come back.

As long as Restless Legs Syndrome does not cause significant problems during the day and night, the disease does not need to be treated.

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Restless legs syndrome – diet

While there are no dietary guidelines for people with Restless Legs Syndrome, it is good for sufferers to pay attention to the amount of vitamins and nutrients they provide to their body. It has been noted that some people with RLS are deficient in vitamins and minerals. In this case, changes to the diet should be made. Patients should also consider supplementation.

If you are deficient in iron, you should add more iron-rich foods to your diet:

1. dark green leafy vegetables;
2. peas;
3. dried fruits;
4. beans;
5. red meat and pork;
6. poultry and seafood;
7. iron-fortified foods such as certain cereals, pasta, and bread.

It’s worth mentioning that vitamin C helps your body absorb iron, so you can also combine iron-rich foods with the following sources of vitamin C:

1. citrus juices;
2. grapefruits;
3. oranges;
4. tangerines;
5. strawberries;
6. Kiwi;
7. melons;
8. tomatoes;
9. pepper;
10. broccoli;
11. leafy vegetables.

Sometimes caffeine can trigger Restless Legs Syndrome symptoms, but it can actually help as well. The patient should pay attention to caffeine and whether it increases symptoms or not.

Restless Legs Syndrome can worsen if you drink alcohol (it also affects your sleep) and should therefore be avoided.

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Restless legs syndrome and restful sleep

The symptoms of RLS can not only be painful and bothersome, but can also be a source of sleep problems. Lack of sleep and fatigue are dangerous to your health and well-being.

The patient, in addition to following the doctor’s recommendations, can also follow a few tips to increase the chances of a restful and relaxing sleep.

1. Check the mattress and pillows. It may be time to replace them. It is also worth paying attention to sheets, blankets and pajamas and possibly buying new ones.
2. Make sure your window blinds or curtains block light from the outside.
3. Remove all digital devices, including clocks, away from your bed.
4. Keep the bedroom tidy.
5. Make sure that the temperature in the bedroom is low (so as not to overheat).
6. Try to go to bed at the same time every evening and get up at the same time every morning, even on weekends (this will have a positive effect on the natural rhythm of sleep).
7. No longer use electronic devices at least one hour before bedtime.
8. Massage your legs just before going to bed or take a hot bath or shower.
9. Try to sleep with a pillow between your legs (this can prevent pinching the nerves and causing RLS symptoms).

See also: Problems with sleeping. How to deal with insomnia?

How To Live With Restless Legs Syndrome?

Restless Legs Syndrome usually lasts a lifetime, so you should follow these few rules to make your life easier with this condition.

1. Inform loved ones about your condition. Informing family members, friends and colleagues about RLS can help them better understand why we are behaving the way we do.
2. Don’t fight the need to move. Suppressing the urge to move can make your symptoms worse.
3. Keep a sleep diary. It is worth making a note of what medications and methods help or hinder the fight against RLS.
4. Stretch and massage the muscles. It’s a good idea to start and end the day with stretching exercises or a gentle massage.
5. Seek help. Support groups bring together family members and people with RLS. By participating in a group, the patient’s insights can help not only him, but also others.