Restless legs syndrome (RLS) is a condition in which you have an uncontrollable urge to move your legs, usually due to leg discomfort. It typically happens in the evenings or nights while you're sitting or lying down. Moving eases the unpleasant feeling temporarily. It can begin at any age and generally worsens as you age. It can disrupt sleep — leading to daytime drowsiness — and make traveling difficult.
The compelling desire to move is what gives restless legs syndrome its name. Common characteristics of RLS signs and symptoms include:
- Sensation starts after being at rest. 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 by movement. The sensation lessens with movement, such as stretching, jiggling your legs, pacing or walking.
- Worsening of symptoms in the evening. Symptoms occur mainly at night.
- Nighttime leg twitching. It 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.
Sometimes the sensations seem to defy description. Affected people usually don't describe the condition as a muscle cramp or numbness. They do, however, consistently describe the desire to move their legs. It's common for symptoms to fluctuate in severity. In some cases, symptoms disappear for periods of time, then recur.
When to see a doctor
Some people with restless legs syndrome never seek medical attention because they worry they won't be taken seriously. Some doctors wrongly attribute symptoms to nervousness, stress, insomnia or muscle cramps. But RLS has received attention and focus from the media and medical community in recent years, making more people aware of the condition. If you think you may have RLS, see your primary care doctor.
Often, there's no known cause for restless legs syndrome. Researchers suspect the condition may be due to 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 50. Pregnancy or hormonal changes may temporarily worsen RLS signs and symptoms. Some women get RLS for the first time during pregnancy, especially during their last trimester. However, signs and symptoms usually disappear after delivery.
RLS can develop at any age, even during childhood. The disorder is more common with increasing age and more common in women than in men.
Restless legs syndrome usually isn't related to a serious underlying medical problem. However, RLS sometimes accompanies other conditions, such as:
- Peripheral neuropathy. This damage to the nerves in your hands and feet is sometimes due to chronic diseases such as diabetes and alcoholism.
- Iron deficiency. Even without anemia, iron deficiency can cause or worsen RLS. If you have a history of bleeding from your stomach or bowels, experience heavy menstrual periods or repeatedly donate blood, you may have iron deficiency.
- Kidney failure. If you have kidney failure, you may also have iron deficiency, often with anemia. When kidneys don't function properly, iron stores in your blood can decrease. This, with other changes in body chemistry, may cause or worsen RLS.
Severe RLS can cause marked impairment in life quality and can result in depression. Insomnia may lead to excessive daytime drowsiness, but RLS may prevent you from daytime napping. If you have signs and symptoms of restless legs syndrome, make an appointment with your primary care doctor. After an initial evaluation, he or she may refer you to a doctor who specializes in conditions affecting the nervous system (neurologist) or a sleep specialist.
Your doctor will take your medical history and ask for a description of your symptoms. 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, your doctor may refer you to 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.
Sometimes, treating an underlying condition, such as iron deficiency, greatly relieves symptoms of restless legs syndrome. Correcting an iron deficiency may involve taking iron supplements. However, take iron supplements only with medical supervision and after your doctor has checked your blood-iron level.
If you have RLS without an associated condition, treatment focuses on lifestyle changes, and if those aren't effective, medications. 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. Certain medications, such as gabapentin (Neurontin) and pregabalin (Lyrica), work for some people with RLS.
- Muscle relaxants and sleep medications. This class of medications, known as benzodiazepines, helps you sleep better at night, but they don't 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).
It may take several trials for you and your doctor to find the right medication or combination of medications that work best for you.
Making simple lifestyle changes can help alleviate symptoms of RLS.
- Try baths and massages. Soaking in a warm bath and massaging your legs can relax your muscles.
- Apply warm or cool packs. Use of heat or cold, or alternating use of the two, may lessen your limb sensations.
- Try relaxation techniques, such as meditation, stretch or yoga. Stress can aggravate RLS Learn to relax, especially before bedtime.
- Establish good sleep hygiene. Fatigue tends to worsen symptoms of RLS, so it's important that you practice good sleep hygiene. Ideally, have a cool, quiet, comfortable sleeping environment; go to bed and rise at the same time daily; and get adequate sleep.
- Exercise. Getting moderate, regular exercise may relieve symptoms of RLS, but overdoing it or working out too late in the day may intensify symptoms.
- Avoid caffeine. Sometimes cutting back on caffeine may help restless legs. Try to avoid caffeine-containing products, including chocolate and caffeinated beverages, such as coffee, tea and soft drinks, for a few weeks to see if this helps.