Restless legs syndrome (RLS) is a sleep disorder in which a person experiences
unpleasant sensations in the legs described as creeping, crawling, tingling, pulling, or
painful. These sensations usually occur in the calf area but may be felt anywhere from the
thigh to the ankle. One or both legs may be affected; for some people, the sensations are
also felt in the arms. These sensations occur when the person with RLS lies down or sits
for prolonged periods of time, such as at a desk, riding in a car, or watching a movie.
People with RLS describe an irresistible urge to move the legs when the sensations occur.
Usually, moving the legs, walking, rubbing or massaging the legs, or doing knee bends can
bring relief, at least briefly.
RLS occurs in both sexes. Symptoms can begin any time, but are usually more common and
more severe among older people. Young people who experience symptoms of RLS are sometimes
thought to have "growing pains" or may be considered "hyperactive" because they cannot
easily sit still in school.
RLS symptoms worsen during periods of relaxation and decreased
activity. RLS symptoms also tend to follow a set daily cycle, with the
evening and night hours being more
troublesome for RLS sufferers than the morning hours. People with RLS
may find it difficult to relax and fall asleep because of their strong
urge to walk or do other activities to relieve the sensations in their
legs. Persons with RLS often sleep best toward the end of the night or
during the morning hours. Because of less sleep at night, people with
RLS may feel sleepy during the day on an occasional or regular basis.
The severity of symptoms varies from night to night and over the years
as well. For some individuals, there may be periods when RLS does not
cause problems, but the symptoms usually return. Other people may
experience severe symptoms daily.
Many people with RLS also have a related sleep disorder called periodic limb movements
in sleep (PLMS). PLMS is characterized by involuntary jerking or bending leg movements
during sleep that typically occur every 10 to 60 seconds. Some people may experience
hundreds of such movements per night, which can wake them, disturb their sleep, and awaken
bed partners. People who have RLS and PLMS have trouble both falling asleep and staying
asleep and may experience extreme sleepiness during the day. As a result of problems both in
sleeping and while awake, people with RLS may have difficulties with their job, social
life, and recreational activities.
Some common symptoms of RLS include:
- Unpleasant sensations in the legs (sometimes the arms
as well), often described as creeping, crawling,
tingling, pulling, or painful; - Leg sensations are relieved by walking, stretching,
knee bends, massage, or hot or cold baths; - Leg discomfort occurs when lying down or sitting for
prolonged periods of time; - The symptoms are worse in the evening and during the
night.
Other possible characteristics include:
- Involuntary leg (and occasionally arm) movements while
asleep; - Difficulty falling asleep or staying asleep;
- Sleepiness or fatigue during the daytime;
- Cause of the leg discomfort not detected by medical
tests; - Family members with similar symptoms.
Although the cause is unknown in most cases, certain factors
may be associated with RLS:
- Family history. RLS is known to run in some
families--parents may pass the condition on to their
children. - Pregnancy. Some women experience RLS during
pregnancy, especially in the last months. The
symptoms usually disappear after delivery. - Low iron levels or anemia. Persons with these
conditions may be prone to developing RLS. The
symptoms may improve once the iron level or anemia is
corrected. - Chronic diseases. Kidney failure quite often leads to
RLS. Other chronic diseases such as diabetes,
rheumatoid arthritis, and peripheral neuropathy may
also be associated with RLS. - Caffeine intake. Decreasing caffeine consumption may
improve symptoms.
In mild cases of RLS, some people find that activities such as taking a hot bath,
massaging the legs, using a heating pad or ice pack, exercising, and eliminating caffeine
help alleviate symptoms. In more severe cases, medications are prescribed to control symptoms.
Unfortunately, no one drug is effective for everyone with RLS. Individuals respond
differently to medications based on the severity of symptoms, other medical conditions,
and other medications being taken. A medication that is initially found to be effective
may lose its effectiveness with nightly use; thus, it may be necessary to alternate
between different categories of medication in order to keep symptoms under
control.
Certainly, any underlying medical conditions should be adequately evaluated and treated
before attempting to treat your symptoms of RLS. If an underlying iron or vitamin
deficiency is found to be the cause of your restless legs, supplementing with iron,
vitamin B12, or folate (as indicated) may be sufficient to relieve your symptoms. Because
the use of even moderate amounts of some minerals (such as iron, magnesium, potassium, and
calcium) can impair your body?s ability to use other minerals or can cause toxicity, you
should use mineral supplements only on the advice of your healthcare provider. Current
recommendations include checking a serum ferritin level (to evaluate iron-storage status)
and supplementing with iron if your ferritin level is less than 40 mcg/L.
Although many different drugs may help RLS, those most commonly used are found in the
following three categories:
- Benzodiazepines are central nervous system depressants
that do not fully suppress RLS sensations or leg
movements, but allow patients to obtain more sleep
despite these problems. Some drugs in this group may
result in daytime drowsiness. Benzodiazepines should
not be used by people with sleep apnea. - Dopaminergic agents are drugs used to treat
Parkinson's disease and are also effective for many
people with RLS and PLMS. These medications have been
shown to reduce RLS symptoms and nighttime leg
movements. - Opioids are pain-killing and relaxing drugs that can
suppress RLS and PLMS in some people. These
medications can sometimes help people with severe,
unrelenting symptoms.
A nondrug approach called transcutaneous electric nerve stimulation
may improve symptoms in some RLS sufferers who also have PLMS. The
electrical stimulation is applied to an area of the legs or feet,
usually before bedtime, for 15 to 30 minutes. This approach has been
shown to be helpful in reducing nighttime leg jerking.
Lifestyle changes involve determining, on an individual basis, which habits and
activities worsen or improve your symptoms of RLS. A healthy balanced diet, with vitamin
supplementation as necessary, is important in reducing the severity of your RLS. Though
caffeine consumption may initially appear to relieve your symptoms, your use of caffeine
most likely only delays, and often intensifies, your symptoms to a time later in the day.
The best solution is to avoid all caffeine-containing products, including chocolate and
caffeinated beverages such as coffee, tea, and soft drinks. The consumption of alcohol
increases the span or intensity of symptoms for most individuals; again, refraining from
the use of alcohol is your best solution.
Because fatigue and drowsiness tend to worsen the symptoms of RLS, implementing a
program of sleep hygiene should be a first step toward resolving your symptoms. Ideally,
sleep hygiene involves having a cool, quiet, and comfortable sleeping environment; going
to bed at the same time every night; arising at the same time every morning; and obtaining
a sufficient number of hours of sleep to feel well rested. Because of the circadian
component of RLS, you may find that you achieve your best sleep later in the 24-hour cycle
than is the societal norm-for example, you may find that sleeping from 2 a.m. until 10
a.m. works best for you, and you should not feel "lazy" if you need to sleep later in the
day.
Good sleep hygiene also involves a program of regular, moderate exercise. Typically,
sleep experts recommend that exercise should take place at least six hours before bedtime
to avoid an adverse impact on your sleep; however, many people with RLS find that
exercises, such as using a stationary bike or a treadmill, immediately before bedtime are
useful. Other people find that performing isometric exercises for a few minutes (i.e.,
standing with your back against a wall and your knees bent as if sitting in a chair) helps
to fatigue the muscles and is helpful. Excessive exercise, on the other hand, often
intensifies the restlessness. Experiment with a variety of exercise programs and develop
your own routine. You?ll soon find what works best for you.
Self-directed activities that counteract your sensations of RLS appear to be very
effective, although temporary, solutions to managing the disorder. You may find that
walking, stretching, taking a hot or cold bath, massaging your affected limb, applying hot
or cold packs, using vibration, performing acupressure, and practicing relaxation
techniques (such as biofeedback, meditation, or yoga) may help reduce or relieve your
symptoms. You may also find that keeping your mind actively engaged through activities
such as reading a gripping novel, performing intricate needlework, or playing video games
helps during times that you must stay seated, such as when you are traveling.
Due to recent advances, doctors today have a variety of means for treating RLS.
However, no perfect treatment exists and there is much more to be learned about the
treatments that currently seem to be successful.
The nutrients
mentioned above reflect the major nutritional supplements that may help
the condition. Please do remember however that nutritional
supplementation is an adjunct to medical treatment and in no way
replaces medical treatment.
