I have this constant urge to move my legs when I get into bed. A nagging crawling or creeping sensation develops in my limbs when I sit at my desk. This strange feeling of pulling, throbbing, or itching comes over me when I lay down. I feel like I can’t relax at night and get comfortable!
Physicians commonly hear stories like these when patients describe restless legs syndrome (RLS), also known as Willis-Ekbom disease. The disorder causes an uncomfortable and irresistible urge to move the lower limbs. As many as 10 percent of Americans may suffer from RLS.
People typically experience RLS during periods of inactivity, such as going to sleep or sitting for a while. Since moving provides a temporary feeling of relief, people with RLS often toss and turn in their sleep, jerk around, and generally feel restless.
“Restless legs syndrome is a common sleep-related movement disorder that can be frustrating for patients. They typically describe RLS as a tingling, antsy, and itchy sensation, as well as a constant feeling of needing to move their legs,” says Meagan Thompson, an advanced nurse practitioner in internal medicine and geriatrics at Summit Health.
RLS is a neurological disorder. However, it is underdiagnosed, mismanaged, and sometimes even stigmatized. Talk to your doctor if you suspect you have symptoms of this sleep disorder. Many treatments — including lifestyle changes and medications — can help you feel more comfortable and improve your quality of life.
Here are 10 things you may not know about RLS.
RLS occurs mainly at night and can severely disrupt sleep.
Symptoms of RLS are generally worse in the evening. Poor sleep can lead to daytime drowsiness, fatigue, irritability, difficulty concentrating, and a greater risk of developing chronic conditions. Sleep concerns often lead patients with RLS to seek treatment.
“It’s important that patients speak up about their symptoms and seek medical attention,” says Anita Mehta, DO, a neurologist at Summit Health. “Poor quality of sleep can lead to myriad health problems and decreased quality of life. Individuals with RLS find it difficult to fall or stay asleep.”
People may be hesitant to talk about RLS.
Lack of awareness can lead some individuals — and even physicians — to dismiss RLS symptoms. Talk candidly with your doctor.
“Our primary responsibility as providers is to help maintain and improve a patient’s overall state of health. I always encourage patients to advocate for themselves and to notify me of any new issues or concerns, without fear of judgment,” says Ms. Thompson.
Anyone can develop RLS.
While RLS affects certain groups more than others, individuals of any age or gender can develop the condition. Women are generally twice as likely to suffer from RLS than men. Even though it becomes more common with age, children can also develop RLS.
An RLS diagnosis is based on a set of symptoms.
No one blood test or imaging scan can confirm you have RLS. Instead, physicians have developed a set of criteria to identify the disorder based on your history and symptoms. To be diagnosed with RLS, you must meet five standards. According to the National Institutes of Health, these include:
- A strong and often overwhelming need or urge to move the legs that is often associated with abnormal, unpleasant, or uncomfortable sensations.
- The urge to move the legs starts or worsens during rest or inactivity.
- The urge to move the legs is at least temporarily and partially or fully relieved by movements.
- The urge to move the legs starts or is aggravated in the evening or night.
- The above four features are not due to any other medical or behavioral condition.
The cause of RLS is not fully understood.
Nerve cells in the brain use a chemical called dopamine to send messages and control body movements. Researchers think that these nerve cells do not function properly and that there is an imbalance of dopamine in people with RLS.
RLS also tends to run in families. However, there have been no specific gene mutations identified yet.
RLS is linked with iron deficiency.
Researchers have found that individuals who do not have enough iron in their blood commonly have RLS. Therefore, you should be tested for iron deficiency, which can also lead to anemia. In anemic patients, oral or intravenous iron supplementation can greatly improve RLS symptoms. In addition, a work-up can be pursued to identify the cause of the iron deficiency.
Certain disorders or medications are associated with RLS.
“It’s important for providers to rule out potential underlying causes or conditions that could be contributing to the patient’s symptoms,” explains Ms. Thompson.
Individuals with conditions like peripheral neuropathy, anemia, spinal cord injury, kidney disease, migraines, multiple sclerosis, Parkinson's disease, and pregnancy are more likely to have RLS, explains Dr. Mehta. Additionally, some medications are known to exacerbate existing RLS, including first-generation antihistamines such as diphenhydramine and hydroxyzine and certain antidepressants including mirtazapine.
Lifestyle changes can provide relief.
Good habits can be helpful for people with RLS. Anything that makes you sleep better will also reduce symptoms. For example, keeping a regular sleep schedule, limiting caffeine and alcohol, and stopping tobacco use can make a big difference in the quality of your slumber. Yoga, acupuncture, and massage can also help stretch and relax the limbs.
“I always recommend behavioral strategies first, such as regular exercise, reduced caffeine intake, good hydration, and leg massage as the first line of defense. I also identify any potential aggravating factors such as sleep disorders or medications that could be contributing to RLS symptoms,” adds Ms. Thompson.
Medications have been approved to treat RLS.
If you do not notice any improvement with lifestyle changes, it may be time to consider medication. The Food and Drug Administration has approved several drugs to treat RLS, which generally work by increasing the amount of dopamine in the brain that controls movements.
RLS often occurs with periodic limb movement disorder.
Periodic limb movement disorder (PLMD) is a condition that causes the legs and sometimes arms to twitch or jerk uncontrollably every 30 seconds. PLMD also becomes worse at night. Like RLS, it is thought to be caused by a deficit of the neurotransmitter dopamine. If present, your provider can help you manage both conditions and feel better.