“Restless Legs Syndrome”
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Restless legs syndrome (RLS) is not often discussed, but is actually fairly common, occurring in 10-15% of the population.
People with RLS complain of a discomfort in the legs (rarely the arms or chest) that is relieved only by walking.
The feeling is often described as ants crawling on the skin.
This uncomfortable sensation only occurs when a person is not moving (either sitting still or lying down) and is always worse at night. Generally, people afflicted with RLS also notice that they unconsciously move their legs as well.
Sometimes they describe their legs as jumping on their own, or they notice that while sitting, they are constantly jiggling them. Since RLS occurs mostly at night while the body is at rest and is relieved by movement, falling asleep and staying asleep can become very difficult.
Even when RLS sufferers manage to fall asleep, they have frequent jerking of the limbs called periodic limb movements of sleep (PLMS). Many elderly people develop PLMS – 34% of those over age 60 – even people who do not suffer from RLS and who have no other sleep complaints.
The number of people who have the symptoms of RLS increases with age, and some people who had mild symptoms when they were younger may find that the symptoms get much worse as they age.
There are many different medications available to treat both RLS and PLMS. These include medications that are usually used for Parkinson's disease, pain control and seizure disorders. It is important never to treat yourself for this condition, but instead to see a doctor with special knowledge about the diagnosis and treatment of RLS.
If you have restless legs syndrome (RLS), you may recognize these symptoms:
An urge to move the legs, often accompanied by uncomfortable sensations in the legs, usually described as a creeping or crawling feeling, but sometimes as a tingling, cramping, burning or just plain pain. Some patients have no definite sensation, except for the need to move. (The arms may also be affected, but that's much less common.)
The need to move the legs to relieve the discomfort, by stretching or bending, rubbing the legs, tossing or turning in bed, or getting up and pacing the floor. Moving usually offers some temporary relief of symptoms.
A definite worsening of the discomfort when lying down, especially when you're trying to fall asleep at night, or during other forms of inactivity, including just sitting.
A tendency to experience the most discomfort late in the day and at night. Sleep disturbances are common with RLS and are a major effect. The sleep disturbances can range from mild to severe, but sleep problems are often the reason that people suffering from RLS seek a doctor's help.
If leg twitching or jerking is also present, a related disorder called periodic limb movements during sleep (PLMS) may be the cause. With PLMS, the leg movements may be severe enough to awaken you. In RLS, PLMS-like symptoms can sometimes occur during wakefulness, as well as in sleep.
According to the National Center on Sleep Disorders Research, "restless legs syndrome is a common, under diagnosed, and treatable condition." Recent research suggests it affects about 10% of adults in North America and Europe with rates increasing with age. Lower prevalence has been found in India, Japan and Singapore, indicating that racial or ethnic factors are associated with RLS.
Secondary Restless Legs in Pregnancy
Up to 15 percent of pregnant women develop Restless Legs Syndrome (RLS) during the third trimester. A contributing cause may be iron and/or folate acid deficiency.
In general, RLS is more prevalent in women than men. RLS symptoms make it difficult to fall and stay asleep due to an uncontrollable urge to move the legs in response to unpleasant, restless, creepy feelings in the legs.
These feelings appear when at rest and often disrupt sleep as well. Moving the legs can stop these symptoms temporarily, but the irritation returns when the limb is still.
Fortunately, RLS symptoms usually end after delivery of the baby. Medications used to treat RLS may cause harm to the fetus and should be discussed with a doctor.
The cause of RLS is still unknown, but the symptoms tend to worsen over the years and become more severe in middle-to-old age. The fact that it occurs three to five times more frequently in first-degree relatives of people with RLS than in people without RLS suggests that heredity may be involved. Pregnancy or hormonal changes may temporarily worsen RLS symptoms.
Some cases of RLS are associated with iron deficiency anemia or nerve damage in the legs due to diabetes, kidney problems, alcoholism and Parkinson's disease. Stress, diet or other environmental factors may play a role for some people.
All of these cases are said to be secondary RLS. If there is no family history of RLS and no associated condition causing the disorder, RLS is said to be idiopathic, meaning without a known cause.
Because RLS patients were found to respond positively to treatment with levodopa, scientists have been investigating whether RLS is caused by dopamine deficiency. Dopamine is a chemical found naturally in the central nervous system where it largely functions as a neurotransmitter.
RLS can begin at any age and many individuals with RLS can trace their symptoms back to childhood, when their symptoms may have been called "growing pains" or attributed to hyperactivity because they had difficulty sitting quietly
The symptoms of RLS can range anywhere from bothersome to incapacitating. Fluctuations in severity are common, and occasionally the symptoms may disappear for periods of time.
Anxiety as bedtime approaches, frustration with nighttime awakenings, moodiness and depression, difficulty concentrating and excessive daytime sleepiness have all been reported in association with RLS.
It also can affect marital, family and social relations as well as having an adverse effect on school, work or other activities. Another effect can be increased drowsiness while driving or great difficulty performing overnight shift work.
The International Restless Legs Syndrome Study Group has established the following clinical criteria for diagnosis of RLS:
• A compelling urge to move the limbs.
• Motor restlessness; for example, floor pacing, tossing and turning, and rubbing the legs.
• The symptoms may be worse or exclusively present at rest, with variable and temporary relief by activity.
• Symptoms are worse in the evening and at night.
• Other associated features commonly found in RLS include:
• Sleep disturbances and daytime fatigue.
• Normal neurological exam in primary RLS.
• Involuntary, repetitive, periodic, jerking limb movements, either in sleep or while awake and at rest.
Most cases of RLS respond well to medical treatment. According to NCSDR, there are a number of pharmacological treatments for RLS.
Iron (ferrous sulfate), which is used in patients with serum ferritin levels of <50 mcg. Clonidine may be useful in hypertensive patients.
Try sleeping with your feet at a cooler temperature than the rest of your body, especially if you currently sleep with bed socks. Simply stick your feet out from under the covers and let yourself adjust to the coolness of your feet. If very hot weather, soak your feet in cool water before going to bed.
NCSDR notes that dopaminergic agents are the first-line drugs for most RLS patients. They are usually used to treat Parkinson's disease, but they also help to relieve RLS symptoms.
Periodic limb movements in sleep are repetitive movements, most typically in the lower limbs, that occur about every 20-40 seconds. If you have PLMS, or sleep with someone who has PLMS (also referred to as PLMD, periodic limb movement disorder), you may recognize these movements as brief muscle twitches, jerking movements or an upward flexing of the feet.
They cluster into episodes lasting anywhere from a few minutes to several hours.
Individuals with PLMS may also experience restless legs syndrome (RLS), an irritation or uncomfortable sensation in the calves or thighs, as they attempt to fall asleep or when they awaken during the night.
Walking or stretching may relieve the sensations, at least temporarily (see the RLS fact sheet).
However, research also shows that many individuals have PLMS without experiencing any symptoms at all.
It's not unusual for the bed partner to be the one who's most aware of the movements, since they may disturb his/her sleep.
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