Restless Legs Syndrome (RLS)

Sleep Disorders

An Introduction To Restless Legs Syndrome (RLS)

Restless Legs Syndrome (RLS) is a neurological disorder in which patients experience irrepressible sensations in the legs or arms while sitting or lying still. Terms used to describe RLS may include creepy, crawly, pulling, tingling, itching, or gnawing. Often the person with RLS has difficulty being specific about the sensations in their legs. The sensations are rarely described as painful. RLS differs from the “pins and needles” feeling when the blood supply is cut off from a limb (“My foot fell asleep!”). These uncomfortable feelings usually begin in the evening and upon arrival to bed, unless severe, RLS is absent during the morning and early afternoon.

Symptoms are worse or only present when the affected individual is at rest. The sensations usually disappear or diminish when the limb is moved. The person with RLS may experience movements of the toes, feet or legs in the evening when he/she sits or lies down. For this reason, RLS individuals are often labeled “nervous” or “fidgety.” Because those with RLS have a constant need to stretch or move their limbs to get rid of the uncomfortable feelings, sleep is often disturbed. Those who suffer from RLS can have very severe insomnia.

Excessive Daytime Sleepiness during the day due to sleep deprivation can be one result of RLS. Severe RLS also limits certain activities because of the confinement of traveling in a car or airplane, sitting through a meeting, or watching a movie. These individuals find it nearly impossible to sit without moving for any length of time. Anxiety and depression are often associated with RLS. Approximately 80 percent of people with RLS also suffer from Periodic Limb Movement Disorder (PLMD).

How Common Is Restless Legs Syndrome?

Five to 15 percent of the population will experience RLS at some time in their life. RLS is more commonly seen in the elderly, and it may be more prevalent in women, although it can occur at any age and in any sex.

It is difficult to determine a general age of symptom onset. Most RLS sufferers are diagnosed between the ages of 30 and 60. Often, a healthcare provider was unable to identify or treat the disorder. However, many people with RLS report having had symptoms most of their lives. Children as young as 3 years old have been diagnosed with RLS. Many adults diagnosed with RLS were called “hyperactive,” or “fidgety” as children because of their constant movement and an inability to sit still.

One-third to one-half of RLS cases are considered to be due to heredity. A child, regardless of gender, whose parent suffers from RLS has a significantly increased risk of inheriting RLS. The genetic form of RLS is often more severe and more difficult to treat.

There are some secondary causes of RLS that may intensify the underlying symptoms of RLS. Pregnancy and nutrient deficiency (iron) can cause RLS. Occasionally the ingestion of more caffeine than usual may worsen the symptoms of RLS. Symptoms may decrease or disappear altogether when caffeine is eliminated from the diet. In a study by Goodman et al., nearly 20% of women complain of RLS during a singular pregnancy. In some cases, poor circulation seems to be the cause of RLS, especially when associated with pregnancy. Nutrient deficiencies, such as iron deficiency anemia, have also been linked to Restless Legs Syndrome.

Disorders that seem to have a connection with or provoke RLS include rheumatoid arthritis, anemia, muscle or nerve disorders, kidney diseases, and alcoholism.

If a person has not presented with a family history or secondary factors of RLS, the cause often remains a mystery.

Diagnosing Restless Legs Syndrome: When Should I See A Doctor?

If an individual suspects he or she has RLS, self-help measures may alleviate the tingling sensations. These include avoiding stimulants (coffee, tea, soda, chocolate, and certain medications), becoming overly tired, and exposure to very warm or very cold environments before going to bed.

A regular exercise program in the late afternoon, especially involving the legs, has shown to be effective in treating very mild cases of RLS. However, it is interesting to note that symptoms often get worse at the onset of regular exercise, but decrease after a week or two. Extension stretching of the calves, thighs, and hips at bedtime may help relieve symptoms. Home remedies such as a hot bath, leg massage, heating pad and aspirin may also help. Vitamin or mineral supplements can also be investigated, although to make an objective evaluation about whether or not they are effective, keeping a sleep log is recommended.

If self-help remedies prove ineffective, a visit to a healthcare provider is recommended. In addition to a thorough physical examination, appropriate laboratory tests, and a medical history, patients are often diagnosed on the basis of three classic symptoms. These symptoms include an increase in the sensations in one or more limbs when at rest, an irrepressible urge to move or relieve the sensations in the affected limb, and the reduction of the symptoms after movement. The physician will need to verify if the symptoms are genetic or nutrient-related.

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