Is RLS Keeping You Awake?
For the estimated 10% of Americans with Restless Legs Syndrome (RLS), falling asleep can feel like
an uphill battle. Find out how you can recover your lost zzz’s here.
By Angela Whitaker
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What is Restless Legs Syndrome (RLS)?
If you’re losing sleep and wondering if you could have RLS, be careful not to confuse it with general fidgetiness or leg cramps. In contrast to these common ailments, RLS is a neurological condition causing a particular type of uncomfortable sensation in the lower legs. “Patients describe RLS sensations as creepy or crawly but not usually painful, and they are typically accompanied by an overwhelming and unpleasant urge to move the affected limbs,” says Dr. Kimberly Smith, a neurologist and sleep medicine physician with Hamilton Neurology Associates.
RLS symptoms tend to worsen at night or during extended periods of rest, and sufferers usually find getting up and walking around or moving the affected area will offer temporary relief. “There are three tell-tale signs of RLS,” says Dr. Smith. “Worsening of the sensations at rest, an urge to move the affected limbs, and relief of the sensation with movement.”
The Problem with RLS
Because RLS symptoms are triggered by long periods of sitting still, activities like flying in a plane, going to a movie theater, or sitting through a business meeting can pose serious challenges for RLS sufferers.
Perhaps the biggest problem with RLS, though, is that it keeps you from getting a good night’s rest. RLS can make going to sleep feel next to impossible. “RLS is classified as a movement disorder, but it’s sometimes considered a sleep disorder too because symptoms are worse in the evening and vigorous movement makes it difficult to fall asleep,” says Dr. Smith. “RLS is also related to another sleep disorder, called periodic limb movements of sleep (PLMS), which causes people to involuntarily jerk their legs and arms during the night.”
It’s fairly common for those with RLS to suffer from chronic insomnia, feel tired during the day, and struggle to concentrate, perform satisfactorily at work, or continue with once enjoyable activities. Eventually, this chronic sleep loss can result in mood issues like depression. It can also contribute to weight gain, a compromised immune system, or serious medical conditions like heart disease and diabetes.
The Four Primary Features of RLS
In order for a diagnosis of RLS to be made in an adult patient, each of these four features must be present.
- uncomfortable sensations in the legs with a clear need or urge to move the legs
- symptoms that are worse at night
- symptoms that come on with rest
- symptoms that are relieved with movement
What Causes RLS?
Primary RLS
- Primary RLS is the more common type of RLS. The exact cause is unknown.
- It often develops before age 45 and can even occur during childhood.
- It usually is a lifelong condition. Over time, symptoms tend to get worse and occur more often.
- May be linked to:
- Genetics. RLS tends to run in families.
- Gender. Women are two times more likely than men to develop RLS.
- Low Brain Iron. Studies conducted at Johns Hopkins University and Penn State University suggest that brain iron deficiency may contribute to RLS.
- Dopamine Dysregulation. RLS may be related to a dysfunction in the brain’s ability to use dopamine to control muscle activity.
Secondary RLS
- Secondary RLS is linked to an underlying condition or the use of certain drugs.
- It usually begins after age 45 with a more abrupt onset.
- It usually improves or disappears when the underlying issue is treated.
- May be linked to:
- Chronic diseases or conditions. Such as kidney failure, diabetes, iron deficiency (with or without anemia), Parkinson’s disease, rheumatoid arthritis, or varicose veins.
- Taking certain medications. Such as antidepressants, antihistamines, anti-nausea, and anti-psychotics.
- Pregnancy. Especially in the third trimester. However, symptoms generally disappear within four weeks of delivery.
Getting Help for RLS
“If you suspect that you have RLS, you should first talk to your primary care doctor,” says Dr. Naseer Humayun, a sleep medicine physician with Pulmonary and Sleep Medicine PC. “With a good history and physical exam, your primary doctor can rule out other causes of leg discomfort like rheumatoid arthritis and neuropathy (nerve damage). He or she can also refer you to a specialist if warranted.”
At your appointment, be prepared to answer questions regarding your symptoms, sleep habits, and the way you feel physically during the day. To make answering these questions easier and to ensure your answers are accurate, try to make time before your appointment to record the frequency and severity of your symptoms in a sleep diary for at least seven to 14 consecutive days. The Restless Legs Syndrome Foundation offers a complete sleep diary for download at rls.org/publications.
A sleep diary can be key in helping you identify specific problem areas. By keeping track of this information for at least one to two weeks, you may discover similarities or patterns to discuss with your health care provider.
Treating Mild to Moderate Symptoms
For people experiencing mild to moderate symptoms of RLS, certain lifestyle changes can offer relief.
“Sticking to a regular exercise routine and limiting your intake of caffeinated beverages and alcohol can help relieve RLS symptoms,” says Dr. Humayun. “It can also help to take a hot bath in the evening, massage or rub the legs, or apply hot or cold packs.”
“If RLS is due to iron deficiency, iron supplementation may be able to effectively relieve symptoms,” Dr. Humayun continues. Since certain nutritional deficiencies are associated with RLS, some patients may also consider taking certain vitamin supplements like folate, magnesium, or vitamin B12. However, before you begin a treatment plan or add a supplement to your diet, talk to your doctor – it’s possible to get too much of a good thing. Your health care provider can also work with you to determine the best overall treatment plan for you, as everyone experiences RLS differently.
Treating Severe Symptoms
In the case of severe RLS, which affects an estimated 2% of the population, a doctor may prescribe medications that reduce symptoms and allow for a more restful sleep.
“Dopamine agonist medications like levodopa, pramipexole, ropinirole, and rotigotine treat RLS by increasing the amount of dopamine,” says Dr. Humayun. “However, extended use can lead to side effects like excessive sleepiness, increased compulsive behavior, and most commonly, a paradoxical worsening of symptoms referred to as ‘augmentation.’”
“Other medications used for RLS include gabapentin enacarbil, which is converted into an anticonvulsant in the body before it has its effects. Its side effects may include sleepiness,” Dr. Humayan continues. “Opiates have also been used to treat refractory cases of RLS. However, this class of medications carries the potential for drug dependence.”
Learn More
While RLS can make certain everyday aspects of life a challenge, proper treatment can minimize symptoms, allowing for longer periods of sleep and a higher quality of life. For more information on RLS, including the answers to frequently asked questions and opportunities to network with others who have the disorder, visit the Restless Legs Syndrome Foundation at www.rls.org.
