What is restless leg syndrome?
Restless leg syndrome, or RLS, is a neurological disorder. RLS is also known as Willis-Ekbom disease, or RLS/WED.
RLS causes unpleasant sensations in the legs, along with a powerful urge to move them. For most people, that urge is more intense when you’re relaxed or trying to sleep.
The most serious concern for people with RLS is that it interferes with sleep, causing daytime sleepiness and fatigue. RLS and sleep deprivation can put you at risk for other health problems, including depression if not treated.
RLS affects about 10 percent of Americans, according to the National Institute of Neurological Disorders and Stroke. It can occur at any age, though it’s usually more severe in middle age or later. Women are twice as likely as men to have RLS.
At least 80 percent of people with RLS have a related condition called periodic limb movement of sleep (PLMS). PLMS causes the legs to twitch or jerk during sleep. It can happen as often as every 15 to 40 seconds and can continue all night long. PLMS can also lead to sleep deprivation.
RLS is a lifelong condition with no cure, but medication can help manage symptoms.
The most prominent symptom of RLS is the overwhelming urge to move your legs, especially when you’re sitting still or lying in bed. You might also feel unusual sensations like a tingling, crawling, or pulling sensation in your legs. Movement may relieve these sensations.
If you have mild RLS, symptoms may not occur every night. And you might attribute these movements to restlessness, nervousness, or stress.
A more severe case of RLS is challenging to ignore. It can complicate the simplest activities, like going to the movies. A long plane ride can also be difficult.
People with RLS are likely to have trouble falling asleep or staying asleep because symptoms are worse at night. Daytime sleepiness, fatigue, and sleep deprivation can harm your physical and emotional health.
Symptoms usually affect both sides of the body, but some people have them on only one side. In mild cases, symptoms may come and go. RLS can also affect other parts of the body, including your arms and head. For most people with RLS, symptoms worsen with age.
People with RLS often use movement as a way to relieve symptoms. That might mean pacing the floor or tossing and turning in bed. If you sleep with a partner, it may well be disturbing their sleep as well.
More often than not, the cause of RLS is a mystery. There may be a genetic predisposition and an environmental trigger.
More than 40 percent of people with RLS have some family history of the condition. In fact, there are five gene variants associated with RLS. When it runs in the family, symptoms usually start before age 40.
There may be a connection between RLS and low levels of iron in the brain, even when blood tests show that your iron level is normal.
RLS may be linked to a disruption in the dopamine pathways in the brain. Parkinson’s disease is also related to dopamine. That may explain why many people with Parkinson’s also have RLS. Some of the same medications are used to treat both conditions. Research on these and other theories is ongoing.
It’s possible that certain substances like caffeine or alcohol can trigger or intensify symptoms. Other potential causes include medications to treat:
Primary RLS isn’t related to an underlying condition. But RLS can actually be an offshoot of another health problem, like neuropathy, diabetes, or kidney failure. When that’s the case, treating the main condition may resolve RLS issues.
There are certain things that may put you in a higher risk category for RLS. But it’s uncertain if any of these factors actually cause RLS.
Some of them are:
- Gender: Women are twice as likely as men to get RLS.
- Age: Although you can get RLS at any age, it’s more common and tends to be more severe after middle age.
- Family history: You’re more likely to have RLS if others in your family have it.
- Pregnancy: Some women develop RLS during pregnancy, particularly in the last trimester. This usually resolves within weeks of delivery.
- Chronic diseases: Conditions such as peripheral neuropathy, diabetes, and kidney failure, may lead to RLS. Often treating the condition relieves symptoms of RLS.
- Medications: Antinausea, antipsychotic, antidepressant, and antihistamine medications may trigger or aggravate symptoms of RLS.
- Ethnicity: Anyone can get RLS, but it’s more common in people of Northern European descent.
Having RLS can affect your overall health and quality of life. If you have RLS and chronic sleep deprivation, you may be a higher risk of:
- heart disease
- kidney disease
- early death
There isn’t one single test that can confirm or rule out RLS. A large part of the diagnosis will be based on your description of symptoms.
To reach a diagnosis of RLS, all the following must be present:
- overwhelming urge to move, usually accompanied by strange sensations
- symptoms get worse at night and are mild or absent in the early part of the day
- sensory symptoms are triggered when you try to relax or sleep
- sensory symptoms ease up when you move
Even if all the criteria are met, you’ll probably still need a physical examination. Your doctor will want to check for other neurological reasons for your symptoms.
Be sure to provide information about any over-the-counter and prescription medications and supplements you take. And tell your doctor if you have any known chronic health conditions.
Blood tests will check for iron and other deficiencies or abnormalities. If there’s any sign that something besides RLS is involved, you may be referred to a sleep specialist, neurologist, or other specialist.
It may be harder to diagnose RLS in children who aren’t able to describe their symptoms.
Home remedies, while unlikely to completely eliminate symptoms, may help reduce them. It may take some trial and error to find the remedies that are most helpful.
Here are a few you can try:
- Reduce or eliminate your intake of caffeine, alcohol, and tobacco.
- Strive for a regular sleep schedule, with the same bedtime and wake-up time every day of the week.
- Get some exercise every day, such as walking or swimming.
- Massage or stretch your leg muscles in the evening.
- Soak in a hot bath before bed.
- Use a heating pad or ice pack when you experience symptoms.
- Practice yoga or meditation.
When scheduling things that require prolonged sitting, such as a car or plane trip, try to arrange them for earlier in the day rather than later.
If you have an iron or other nutritional deficiency, ask your doctor or nutritionist how to improve your diet. Talk to your doctor before adding dietary supplements. It can be harmful to take certain supplements if you aren’t deficient.
These options may be useful even if you take medication to manage RLS.
Medication won’t cure RLS, but it can help manage symptoms. Some options are:
Drugs that increase dopamine (dopaminergic agents)
These medications help decrease motion in your legs.
Drugs in this group include:
- pramipexole (Mirapex)
- ropinirole (Requip)
- rotigotine (Neupro)
Side effects may include mild lightheadedness and nausea. These medications can become less effective over time. In some people, they can cause daytime sleepiness impulse control disorders, and worsening of RLS symptoms.
Sleep aids and muscle relaxants (benzodiazepines)
These medications don’t completely eliminate symptoms, but they can help you relax and sleep better.
Drugs in this group include:
- clonazepam (Klonopin)
- eszopiclone (Lunesta)
- temazepam (Restoril)
- zaleplon (Sonata)
- zolpidem (Ambien)
Side effects include daytime sleepiness.
These medications can decrease pain and strange sensations and help you relax.
Drugs in this group include:
- oxycodone (Oxycontin)
- combined hydrocodone and acetaminophen (Norco)
- combined oxycodone and acetaminophen (Percocet, Roxicet)
Side effects may include dizziness and nausea. You should not use these products if you have sleep apnea. These medicines are powerful and addicting.
These medications help lessen sensory disturbances:
- gabapentin (Neurontin)
- gabapentin enacarbil (Horizant)
- pregabalin (Lyrica)
Side effects may include dizziness and fatigue.
It may take several attempts before you find the right medication. Your doctor will adjust the medication and dosage as your symptoms change.
Children can experience the same tingling and pulling sensations in their legs as adults with RLS. But they may have a hard time describing it. They might call it a “creepy crawly” feeling.
Children with RLS also have an overwhelming urge to move their legs. They’re more likely than adults to have symptoms during the day.
RLS can interfere with sleep, which can affect every aspect of life. A child with RLS may seem inattentive, irritable, or fidgety. They may be labeled disruptive or hyperactive. Diagnosing and treating RLS can help address these problems and improve school performance.
To diagnose RLS in children up to age 12, the adult criteria must be met:
- overwhelming urge to move, usually accompanied by strange sensations
- symptoms worsen at night
- symptoms are triggered when you try to relax or sleep
- symptoms ease up when you move
Additionally, the child must be able to describe the leg sensations in their own words.
Otherwise, two of these must be true:
- There’s a clinical sleep disturbance for age.
- A biological parent or sibling had RLS.
- A sleep study confirms a periodic limb movement index of five or more per hour of sleep.
Any dietary deficiencies must be addressed. Children with RLS should avoid caffeine and develop good bedtime habits.
If necessary, medications that affect dopamine, benzodiazepines, and anticonvulsants may be prescribed.
There aren’t any specific dietary guidelines for people with RLS. But it’s a good idea to review your diet to make sure you’re getting enough essential vitamins and nutrients. Try to cut high-calorie processed foods with little or no nutritional value.
Some people with symptoms of RLS are deficient in particular vitamins and minerals. If that’s the case, you can make some changes to your diet or take dietary supplements. It all depends on what your test results show.
If you’re deficient in iron, try adding more of these iron-rich foods to your diet:
- dark green leafy vegetables
- dried fruit
- red meat and pork
- poultry and seafood
- iron-fortified foods such as certain cereals, pasta, and bread
Vitamin C helps your body absorb iron, so you might also want to pair iron-rich foods with these sources of vitamin C:
- citrus juices
- grapefruit, oranges, tangerines, strawberries, kiwi, melons
- tomatoes, peppers
- broccoli, leafy greens
Caffeine is tricky. It can trigger symptoms of RLS in some people, but actually helps others. It’s worth a little experimentation to see if caffeine affects your symptoms.
Alcohol can make RLS worse, plus it’s known to disrupt sleep. Try to avoid it, especially in the evening.
Those strange sensations in your legs can be uncomfortable or painful. And those symptoms can make it almost impossible to fall asleep and stay asleep.
Sleep deprivation and fatigue are dangerous to your health and well-being.
In addition to working with your doctor to find relief, there are a few things you can do to improve your chances of restful sleep:
- Inspect your mattress and pillows. If they’re old and lumpy, it may be time to replace them. It’s also worth investing in comfortable sheets, blankets, and pajamas.
- Make sure window shades or curtains block outside light.
- Remove all digital devices, including clocks, away from your bed.
- Remove bedroom clutter.
- Keep your bedroom temperature on the cool side so you don’t get overheated.
- Put yourself on a sleep schedule. Try to go to bed at the same time each night and get up at the same time each morning, even on weekends. It’ll help support a natural sleep rhythm.
- Stop using electronic devices at least one hour before bedtime.
- Just before bedtime, massage your legs or take a hot bath or shower.
- Try sleeping with a pillow between your legs. It might help prevent your nerves from compressing and triggering symptoms.
Symptoms of RLS can spring up for the first time during pregnancy, usually in the last trimester. Data suggests that pregnant women may have two or three times higher risk of RLS.
The reasons for this aren’t well-understood. Some possibilities are vitamin or mineral deficiencies, hormonal changes, or nerve compression.
Pregnancy can also cause leg cramps and difficulty sleeping. These symptoms can be hard to distinguish from RLS. If you’re pregnant and have symptoms of RLS, talk to your doctor. You may need to be tested for iron or other deficiencies.
You can also try some of these home care techniques:
- Avoid sitting still for prolonged periods, especially in the evening.
- Try to get a little exercise every day, even if it’s just an afternoon walk.
- Massage your legs or perform leg stretching exercises before bed.
- Try using heat or cold on your legs when they’re bothering you.
- Stick to a regular sleep schedule.
- Avoid antihistamines, caffeine, smoking, and alcohol.
- Make sure you’re getting all the nutrients you need from your diet or from prenatal vitamins.
Some of the medications used to treat RLS are not safe to use during pregnancy.
RLS in pregnancy usually goes away on its own within weeks after giving birth. If it doesn’t, see your doctor about other remedies. Be sure to mention if you are breast-feeding.
It’s called restless “leg” syndrome, but it can also affect your arms, trunk, or head. Both sides of the body are usually involved, but some people have it on only one side. Despite these differences, it’s the same disorder.
About 80 percent of people with RLS also have periodic limb movement of sleep (PLMS). This causes involuntary leg twitching or jerking during sleep that can last all night long.
Peripheral neuropathy, diabetes, and kidney failure cause symptoms like RLS. Treating the underlying condition often helps.
Many people with Parkinson’s disease also have RLS. But most people who have RLS don’t go on to develop Parkinson’s. The same medications can improve symptoms of both conditions.
It’s not uncommon for people with multiple sclerosis (MS) to have sleep disturbances, including restless legs, limbs, and body. They’re also prone to muscles spasms and cramps. Medication used to combat fatigue associated with chronic diseases can also cause this. Medication adjustments and home remedies may help.
Pregnant women are at higher risk of RLS. It usually resolves on its own after the baby is born.
Anyone can have occasional leg cramps or strange sensations that come and go. When symptoms interfere with sleep, see your doctor for a proper diagnosis and treatment. Be sure to mention any underlying health conditions.
According to the National Institute of Neurological Disorders and Stroke, RLS affects about 10 percent of Americans. This includes one million school-age children.
Among people with RLS, 35 percent had symptoms before age 20. One in ten report symptoms by age 10. Symptoms tend to worsen with age.
Incidence is twice as high in women as in men. Pregnant women may have two or three times higher risk than the general population.
It’s more common in people of Northern European descent than in other ethnicities.
Certain antihistamines, antinausea, antidepressant, or antipsychotic medications can trigger or worsen symptoms of RLS.
About 80 percent of people with RLS also have a disorder called periodic limb movement of sleep (PLMS). PLMS involves involuntary leg twitching or jerking every 15 to 40 seconds during sleep. Most people with PLMS don’t have RLS.
Most of the time, the cause of RLS isn’t obvious. But more than 40 percent of people with RLS have some family history of the condition. When it runs in the family, symptoms usually start before age 40.
There are five gene variants associated with RLS. The change in the BTBD9 gene associated with higher risk of RLS is present in about 75 percent of people with RLS. It’s also found in about 65 percent of people without RLS.
There’s no cure for RLS. But medication and lifestyle modifications can help manage symptoms.