Do you experience a constant urge to move your legs due to an unpleasant sensation—typically a creepy, crawly sensation—that gets worse with inactivity and gets better when you move around? Is it worse at the end of the day? If so, then you may have restless legs syndrome (RLS), according to Aparajitha Verma, MD, medical director of the Sleep Disorders Center at the Methodist Neurological Institute in Houston, Texas. About five to 10 percent of the general population is affected, and RLS gets worse with age. Women are at higher risk than men. (1)
Restless legs syndrome is a clinical diagnosis. It’s diagnosed in a doctor’s office with criteria based on what the patient tells the doctor. This means there are no machine tests or blood tests, X-rays or other technological methods to confirm it. Tests may be given, but only to rule out other diagnoses. (1)
RLS has been around forever, but now that we are living longer it’s becoming more prominent in elderly patients, says Dr. Michael Sellman, chief of neurology at Mercy Medical Center in Baltimore. “It can be hard to diagnose in the elderly because many elderly people are quite stoic about not getting enough sleep. Seniors will typically say ‘I’m not getting a good night’s sleep because I’m old, I’m not supposed to sleep.’”
There are other possible diagnoses when a patient complains of RLS symptoms, Dr. Sellman says. Neuropathic pain can cause movements of the legs. Nerve injury or trauma can sometimes do it. People who move their legs for other reasons, such as cramps at bedtime, bad backs or necks, or severe anxiety, might think they have RLS. You have to have periodic limb movements during sleep, a clinical feature of RLS, to confirm the diagnosis, but sometimes the patient herself won’t know if her limbs are moving—someone else has to be in the room. “If you sleep by yourself you may feel you toss and turn, but unless your husband comes in and says my wife does this weird thing with her legs all night long, you might not know you have RLS.” (2)
According to the National Institutes of Health, the following questions may aid in the diagnosis of restless legs syndrome. (3)
- Does the patient report “creeping, crawling, or uncomfortable, difficult-to-describe feelings” in the legs or arms that are relieved by moving or rubbing them?
- Is there a correlation between RLS symptoms and time of day? Do the symptoms worsen with rest or inactivity?
- Do sensations interfere with sleep onset or returning to sleep?
- What daytime consequence does the patient report (e.g., fatigue, sleepiness, confusion, lack of attention)?
- Does the bed partner report that the patient’s legs or arms jerk during sleep? (Relates to periodic limb movements of sleep.)
- Does the patient have secondary causes of RLS, such as low iron stores, diabetes mellitus, kidney disease, or pregnancy?
- Are neurologic symptoms or diagnoses present?
- Is there a relationship between symptoms and medications, such as tricyclic antidepressants or selective serotonin reuptake inhibitors?
- Was the onset of symptoms correlated with a change in medication?
- Do family members report similar symptoms? Have any family members been diagnosed with RLS?
The same report lists the terms most commonly used to describe the sensations of RLS.
- like water flowing
- like worms or bugs crawling under the skin
- like an electric current
Other common sleep disorders
In addition to RLS, the most common sleep disorders are insomnia, sleep apnea, and narcolepsy.(4) Insomnia is characterized by difficulty falling asleep or staying asleep, or having unrefreshing sleep. Another important symptom is having at least one daytime problem, such as fatigue, sleepiness, problems with mood or concentration, accidents at work or while driving, etc. We all have insomnia occasionally, but chronic insomnia becomes a problem when you can’t fall asleep or stay asleep at least three nights a week.(4)
Sleep apnea is the most serious of the common sleep disorders, as it can cause strokes, heart attacks, or even sudden death. People with untreated sleep apnea stop breathing repeatedly during their sleep, sometimes hundreds of times during the night. They may be totally unaware of it, all they know is that they keep falling asleep during the day. Snoring is one symptom, but a sleep study is usually ordered for a definitive diagnosis. (4)
Narcolepsy, a neurological disorder, is another common sleep disorder that often goes undiagnosed and untreated. People with narcolepsy experience excessive daytime sleepiness and intermittent, uncontrollable episodes of falling asleep during the day. These sudden sleep attacks may occur during any type of activity at any time of the day. Narcolepsy usually begins between the ages of 15 and 25, but it can become apparent at any age. (4)
If it’s unclear whether or not you have sleep apnea, RLS, or another sleep disorder, a sleep specialist will review your symptoms and may suggest that you undergo a sleep study. He or she may refer you to a sleep disorder clinic for a sleep study or polysomnogram (PSG). You will spend the night sleeping at a lab, with electrodes attached to various parts of your body that electronically transmit and record specific physical activities while you sleep. The data from a sleep study can very helpful in determining whether or not you have a sleep disorder, and how severe it is. In the case of sleep apnea, a sleep study can be a lifesaver. (4)