Restless Legs Syndrome - The Sleep Doctor

Restless legs syndrome, also called Willis-Ekbom Disease, is a sleep disorder that causes people to feel an unpleasant urge to move their legs. Urges to move the limbs, which often feel irresistible to the person experiencing them, can worsen at night and while a person is resting.

For people with restless legs syndrome, moving the legs often brings temporary relief. However, discomfort often reoccurs shortly after the movement ends. This can make it difficult for people with restless legs syndrome to fall asleep and stay asleep. Lost sleep can then lead to impaired memory, reduced concentration, and symptoms of depression and anxiety.

Around 5% to 15% of people in the United States have restless legs syndrome. Experts believe that even more people may have this sleep disorder, as restless legs syndrome often goes undiagnosed in both children and adults. Learn more about restless legs syndrome, why it happens, and how to recognize and get treatment for the condition.

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Restless Legs Syndrome Symptoms

The main symptom of restless legs syndrome is an uncomfortable sensation in the legs and an urge to move them. Though symptoms most often affect the legs, they can also be felt in other body parts such as the arms, chest, or head.

The severity of symptoms varies from person to person. Sensations may feel like throbbing, itching, twitching, or an uncomfortable urge to stretch or move. Discomfort may be felt on both sides of the body, alternate between sides, or only be felt in one limb.

Restless legs syndrome generally occurs or worsens at night and in the evening. The symptoms usually begin when a person is not active and is sitting or lying down.

Moving the affected body part, stretching, or walking generally provides relief. However, the discomfort can quickly return after the movement stops. To reduce discomfort, people with restless legs syndrome may constantly move their legs and toss and turn while in bed.

Sleep problems are a common part of restless legs syndrome. Many people with the condition find it difficult to fall and stay asleep, and as a result, experience daytime sleepiness and fatigue. Most people with restless legs syndrome also experience involuntary movements in their arms or legs during sleep, a condition called periodic limb movement of sleep.

What Causes Restless Legs Syndrome?

Science has not yet uncovered the exact causes of restless legs syndrome. Genetics and a person’s environment likely play a role in the condition’s development.

Genetics: Studies suggest that various genes may be associated with restless legs syndrome, particularly in cases where people begin to experience symptoms before the age of 40. However, there is currently no genetic test for the condition.
Brain dysfunction: Research suggests that restless legs syndrome may be caused by an impairment in a part of the brain that controls movement. Cells in this area of the brain may have problems using dopamine, a chemical that plays a role in muscle activity.
Iron deficiency: Restless legs syndrome may also be caused by a deficiency of iron in the brain. Iron is a mineral that is important for the production of dopamine.

Other potential causes of restless legs syndrome include problems in circadian rhythms and issues with other chemicals in the nervous system. Restless legs syndrome may also be caused by abnormalities in nerves or blood vessels in the lower limbs.

Risk Factors

Research has found a variety of risk factors that increase the likelihood of developing restless legs syndrome. Restless legs syndrome can happen to people at any age, but it is more common as people get older.

Other risk factors that increase the chances of developing restless legs syndrome include:

A family history of restless legs syndrome
Low iron levels
Kidney failure or being on dialysis
Diseases of the spinal cord
Pregnancy
Multiple sclerosis
Parkinson’s disease
Nerve damage
Obesity
A sedentary lifestyle
Smoking

What Makes Restless Legs Syndrome Flare Up?

The symptoms of restless legs syndrome may flare up at night and when people are resting, sitting, or lying down. Lack of sleep can also aggravate the symptoms of restless legs syndrome. Symptoms may worsen after a night of insufficient or poor-quality sleep, or because of a coexisting sleep disorder that interferes with sleep, like obstructive sleep apnea.

Symptoms of restless legs syndrome can temporarily develop in people who take certain medications. Medications associated with restless legs syndrome include antinausea and antipsychotic medicines, some antidepressants, and certain medicines that are used for colds and allergies.

If you think a prescribed medication may be causing symptoms of restless legs syndrome, make sure to talk with your doctor before making any changes to your dosage.

Diagnosis of Restless Legs Syndrome

To diagnose restless legs syndrome, a health care provider will ask about a person’s symptoms, medical history, and perform a physical exam. The health care provider may be particularly interested in any family history of restless legs syndrome, current medications, and patterns in a person’s symptoms. Questions about symptoms may include:

What are your symptoms?
When do symptoms usually appear?
What seems to trigger your symptoms?
Do any activities relieve your symptoms?

While there is no specific medical test for restless legs syndrome, a health care provider may order testing to determine a person’s iron levels and to look for signs of kidney dysfunction or other underlying disease.

Restless Legs Syndrome Treatment

Although restless legs syndrome is a lifelong condition, treatment can help manage symptoms, improve daytime functioning, and enhance a person’s quality of life.

When determining the right treatment option, a doctor may consider multiple factors, including the severity of a person’s symptoms, their age, and their health history. Treatment options include lifestyle changes, iron replacement, and medications.

Lifestyle Changes

Most cases of restless legs syndrome can be treated without using medications. For people with mild symptoms of restless legs syndrome, a health care professional may recommend starting with behavioral changes. Lifestyle changes that may be helpful include:

Engaging in mentally stimulating activities when at rest or bored
Exercising regularly
Reducing or eliminating alcohol and caffeine
Avoiding anything that triggers symptoms

When symptoms flare up, a health care professional may suggest walking, biking, or soaking the limbs. Using a compression device or massaging the limbs may also help to reduce symptoms without the need for medication.

Getting enough sleep is critical for managing symptoms of restless legs syndrome, as sleep loss can cause symptoms to flare up. For this reason, a health care professional may review healthy sleep habits such as:

Iron Therapy

Iron supplements are used to manage symptoms in people with restless legs syndrome who have an iron deficiency. Doctors may recommend taking iron supplements orally before bed or supplemental iron given through an IV. Common side effects of iron supplements include an upset stomach and constipation.

Iron supplements are available over-the-counter. However, only people with an iron deficiency should use iron supplements to treat their symptoms, as too much iron can result in iron overload. Iron overload is a condition that occurs when there is excessive iron in the body and can damage organs if left untreated.

Restless Legs Syndrome Medication

A doctor may prescribe medications to help relieve the symptoms of restless legs syndrome. Some people may find that they have to try several different medications before finding one that helps reduce their symptoms. Doctors may also recommend switching medications over time if one medication loses its effectiveness.

Anti-seizure drugs: These drugs are often the first medication prescribed for restless legs syndrome and can help decrease both discomfort in the legs and nerve pain.
Dopaminergic drugs: Dopaminergic agents are a class of medications that are mainly used to treat Parkinson’s disease, a disorder that causes abnormal movements and problems with coordination and balance. When taken at night, these medications may reduce the symptoms of restless legs syndrome.
Opioids: A doctor may prescribe opioids to treat people who have severe symptoms and have not found success with other treatments. Opioids are a class of drugs that are used to reduce pain. Even small doses of opioids may help relieve a person’s symptoms, but they carry a risk of addiction.
Benzodiazepines: Benzodiazepines are a class of medications used to treat anxiety, muscle spasms, and other conditions. These medications also have a calming effect and can help people sleep better. However, benzodiazepines may be used as a last resort due to their side effects.

When to See a Doctor

It’s important to see a doctor if you have symptoms associated with restless legs syndrome, like discomfort in the limbs that interferes with your sleep. Your doctor can determine if you have restless legs syndrome and create a treatment plan for you.

If you’ve already been diagnosed with restless legs syndrome, and your treatment doesn’t seem to be helping, contact your doctor. Signs to look out for include:

Symptoms continuing to increase despite treatment
Worsening symptoms after a change in treatment
Finding that symptoms start earlier in the day or more quickly during periods of rest
Symptoms that begin to affect other body parts