A condition known as restless legs syndrome (RLS) causes an uncontrollable urge to move the legs, usually due to an uncomfortable feeling in the legs. Typically it occurs at night when you are sitting or lying down. When you move, the unpleasant feeling is temporarily relieved.
Often, there is no known cause for RLS. Researchers suspect the condition may be caused by an imbalance of the brain chemical dopamine, which sends messages to control muscle movement.
Sometimes RLS runs in families, especially if the condition starts before age 40. Researchers have identified sites on the chromosomes where genes for RLS may be present.
RLS may also be associated with certain conditions, such as iron deficiency, kidney failure, pregnancy, diabetes, Parkinson’s disease, and peripheral neuropathy.
The chief symptom of RLS is an urge to move the legs. Common accompanying characteristics of RLS include:
Sensations that begin while resting. The sensation typically begins after you’ve been lying down or sitting for an extended time, such as in a car, airplane or movie theater.
Relief with movement. The sensation of RLS lessens with movement, such as stretching, jiggling the legs, pacing or walking.
Worsening of symptoms in the evening. Symptoms occur mainly at night.
Nighttime leg twitching. RLS may be associated with another, more common condition called periodic limb movement of sleep, which causes the legs to twitch and kick, possibly throughout the night, while you sleep.
People typically describe RLS symptoms as compelling, unpleasant sensations in the legs or feet. They usually happen on both sides of the body. Less commonly, the sensations affect the arms.
The sensations, which generally occur within the limb rather than on the skin, are described as:
Crawling
Creeping
Pulling
Throbbing
Aching
Itching
Electric
Sometimes the sensations are difficult to explain. People with RLS usually don’t describe the condition as a muscle cramp or numbness. They do, however, consistently describe the desire to move the legs.
It’s common for symptoms to fluctuate in severity. Sometimes, symptoms disappear for periods of time, then come back.
Your provider will take your medical history and ask for a description of your symptoms. A diagnosis of RLS is based on the following criteria, established by the International Restless Legs Syndrome Study Group:
You have a strong, often irresistible urge to move the legs, usually accompanied by uncomfortable sensations.
Your symptoms start or get worse when you’re 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.
Symptoms can’t be explained solely by another medical or behavioral condition.
Your provider may conduct a physical and a neurological exam. Blood tests, particularly for iron deficiency, may be ordered to rule out other possible causes for your symptoms.
In addition, your provider may refer you to a sleep specialist. This may involve an overnight stay and a study at a sleep clinic if another sleep disorder such as sleep apnea is suspected. However, a diagnosis of RLS usually doesn’t require a sleep study.
Sometimes, treating an underlying condition, such as iron deficiency, greatly relieves symptoms of RLS. Correcting an iron deficiency may involve receiving iron supplements orally or intravenously. The use of iron supplements must, however, be supervised by your provider and after your blood-iron level has been tested.
If you have RLS without an associated condition, treatment focuses on lifestyle changes. If those aren’t effective, your provider might prescribe medications.
Several prescription medications, most of which were developed to treat other diseases, are available to reduce the restlessness in the legs. These include:
Rotigotine and pramipexole are approved by the Food and Drug Administration for treatment of moderate to severe RLS because they increase levels of the chemical messenger dopamine in the brain. There are usually mild side effects associated with these medications, such as nausea, lightheadedness, and fatigue. However, they can also cause impulse control disorders, such as compulsive gambling and daytime sleepiness.
Drugs affecting calcium channels. Certain medications, such as gabapentin, gabapentin enacarbil and pregabalin, work for some people with RLS.
You can use muscle relaxants and sleep medications to sleep better at night, but they won't eliminate leg sensations, and they may cause drowsiness during the day. These medications are generally used if no other treatment works.
Opioids. Narcotic medications are used mainly to relieve severe symptoms, but they may be addicting if used in high doses.
There is no sure way to prevent RLS, but you may be able to reduce the frequency and severity of your symptoms by making some lifestyle changes. These include:
Avoiding or limiting the use of alcohol, caffeine, and nicotine, which may worsen RLS symptoms.
Practicing good sleep hygiene, such as going to bed and waking up at the same time every day, avoiding naps, and creating a comfortable and quiet sleeping environment.
Exercising regularly, but not too close to bedtime, as this may help reduce stress and improve blood circulation.
Massaging the legs, applying heat or cold, or using a vibrating device to relax the muscles and ease the discomfort.
Stretching the legs, especially the calf muscles, before going to bed.
Taking a warm bath or shower before bedtime to relax the body and mind.
Trying relaxation techniques, such as meditation, yoga, or deep breathing, to cope with stress and anxiety that may trigger RLS symptoms.
Seeking support from others who have RLS, such as joining a support group or online forum, to share experiences and tips.
