Restless Legs Syndrome

Restless legs syndrome (RLS) is a disorder of the nervous system. RLS causes a powerful urge to move the legs – so much so that the legs become uncomfortable when people are lying down or sitting, typically in the evenings. People typically describe RLS symptoms as abnormal, unpleasant sensations in their legs or feet, usually on both sides of the body. Some people describe it as a creeping, crawling, tingling, or burning sensation. Less commonly, the sensations affect the arms.

Moving eases the unpleasant feeling temporarily. RLS can make it hard to fall asleep and stay asleep.

Lifestyle changes, such as regular sleep habits, relaxation techniques, and moderate exercise during the day can help improve the symptoms of RLS. Medicines may also reduce the symptoms of RLS.

RLS can begin at any age and generally worsens as you age. It can disrupt sleep and make traveling and day-to-day activities difficult.

RLS is characterized by a compelling desire to move the legs. Several other features of RLS are common.

• The sensation or urge to move starts after being at rest. The sensation typically begins after you have been lying down or sitting for an extended time, such as in a car, airplane or movie theater.
• The discomfort or sensations are relieved by movement. The sensation of RLS lessens with movement, such as stretching, jiggling your legs, pacing, or walking.
• The symptoms worsen in the evening. Symptoms can occur at any time, but typically, they occur at night.
• Nighttime leg twitching. RLS may be associated with another, more common condition called periodic limb movement of sleep, which causes your legs to twitch and kick, possibly throughout the night, while you sleep.

The sensations associated with RLS, which generally occur within the limb rather than on the skin, are described as:

• crawling
• creeping
• pulling
• throbbing
• aching
• itching

It is common for symptoms to fluctuate in severity. In some cases, symptoms disappear for periods of time, then recur.

In most cases, there is no known cause for RLS. In other cases, RLS is caused by a disease or condition, such as anemia or pregnancy. Some medicines can also cause temporary RLS. Caffeine, tobacco, and alcohol may make symptoms worse. An imbalance of dopamine – the chemical that transports messages about muscle movement – in the brain likely plays a role in RLS.

RLS may run in families, especially if the condition begins before age 50.

Several things can trigger or worsen RLS symptoms, including:

• sitting for long periods of time such as in a car, airplane, or theater
• some conditions such as iron deficiency, kidney failure, diabetes, nerve problems, or pregnancy
• taking certain medicines such as some antihistamines or antidepressants
• drinking alcohol or caffeine
• smoking or using other tobacco products
• not getting enough sleep

If RLS is suspected, your doctor may conduct a physical and a neurological exam. Blood tests, particularly for iron deficiency, may be ordered to exclude other possible causes for your symptoms. In addition, you may see a sleep specialist. This may involve an overnight stay at a sleep clinic, where doctors can study your sleep if another sleep disorder such as sleep apnea is suspected to cause your symptoms.

RLS is diagnosed on the basis of the following criteria:

• you have a strong, often irresistible urge to move your legs, usually accompanied by uncomfortable sensations typically described as crawling, creeping, cramping, tingling or pulling
• your symptoms start or get worse when you are resting, such as sitting or lying down
• your symptoms are partially or temporarily relieved by activity, such as walking or stretching
• your symptoms are worse at night
• your symptoms cannot be explained solely by another medical or behavioral condition

Several lifestyle changes may improve RLS symptoms, including:

• limiting or avoid caffeine, alcohol, and smoking
• switching or stopping any medicines that might be making your RLS worse. (Never stop taking any medicine without first talking with your doctor or pharmacist.)
• exercising a few times a week to strengthen your lower body
• going to bed around the same time each night and wake up around the same time each morning
• taking baths and getting massages to relax the muscles in your legs
• applying warm or cool packs to lessen your limb sensations
• usingrelaxation techniques, such as meditation or yoga, to reduce stress that may aggravate RLS

The goal of RLS treatment is to relieve symptoms and allow you to sleep better. If you have RLS without an associated condition, treatment focuses on lifestyle changes. Medications are available if lifestyle changes do not achieve symptoms relief.

Several prescription medications, most of which were developed to treat other diseases, are available to reduce the restlessness in your legs. These include:

• medications that increase dopamine in the brain. These medications reduce motion in your legs by affecting the level of the chemical messenger dopamine in your brain. Ropinirole (Requip), rotigotine (Neupro), and pramipexole (Mirapex) are approved by the Food and Drug Administration for the treatment of moderate to severe RLS.
• drugs affecting calcium channels in the muscle cells. Certain medications, such as gabapentin (Neurontin) and pregabalin (Lyrica), work for some people with RLS.
• opioids. Narcotic medications can relieve mild to severe symptoms, but they may be addicting if used in high doses. Some examples of these medications include codeine, oxycodone (Oxycontin, Roxicodone), combined oxycodone and acetaminophen (Percocet, Roxicet), and combined hydrocodone and acetaminophen (Norco).
• muscle relaxants and sleep medications. This class of medications, known as benzodiazepines, helps you sleep better at night, but they do not eliminate the leg sensations, and they may cause daytime drowsiness. Commonly used sedatives for RLS include clonazepam (Klonopin), eszopiclone (Lunesta), temazepam (Restoril), zaleplon (Sonata), and zolpidem (Ambien).