Restless Legs Syndrome
Restless legs syndrome (RLS) is a disorder that causes a strong urge to move your legs. This urge to move often occurs with strange and unpleasant feelings in your legs. Moving your legs relieves the urge and the unpleasant feelings.
People who have RLS describe the unpleasant feelings as creeping, crawling, pulling, itching, tingling, burning, aching, or electric shocks. Sometimes, these feelings also occur in the arms.
The urge to move and unpleasant feelings happen when you're resting and inactive. Thus, they tend to be worse in the evening and at night.
RLS can make it hard to fall asleep and stay asleep. It may make you feel tired and sleepy during the day. This can make it hard to learn, work, and do other daily activities. Not getting enough sleep also can cause depression, mood swings, or other health problems.
RLS can range from mild to severe based on:
- The strength of your symptoms and how often they occur
- How easily moving around relieves your symptoms
- How much your symptoms disturb your sleep
One type of RLS usually starts early in life (before 45 years of age) and tends to run in families. It may even start in childhood. Once this type of RLS starts, it usually lasts for the rest of your life. Over time, symptoms slowly get worse and occur more often. If you have a mild case, you may have long periods with no symptoms.
Another type of RLS usually starts later in life (after 45 years of age). It generally doesn't run in families. This type of RLS tends to have a more abrupt onset. The symptoms usually don't get worse over time.
Some diseases, conditions, and medicines may trigger RLS. For example, the disorder has been linked to kidney failure, Parkinson's disease, diabetes, rheumatoid arthritis, pregnancy, and iron deficiency. When a disease, condition, or medicine causes RLS, the symptoms usually start suddenly.
Medical conditions or medicines often cause or worsen the type of RLS that starts later in life.
RLS symptoms often get worse over time. However, some people's symptoms go away for weeks to months.
If a medical condition or medicine triggers RLS, the disorder may go away if the trigger is relieved or stopped. For example, RLS that occurs due to pregnancy tends to go away after giving birth. Kidney transplants (but not dialysis) relieve RLS linked to kidney failure.
Treatments for RLS include lifestyle changes and medicines. Some simple lifestyle changes often help relieve mild cases of RLS. Medicines often can relieve or prevent the symptoms of more severe RLS.
Research is ongoing to better understand the causes of RLS and to find better treatments.
Faulty Use of Iron or Lack of Iron
Research suggests that the main cause of restless legs syndrome (RLS) is a faulty use of iron or a lack of iron in the brain. The brain uses iron to make the chemical dopamine (DO-pah-meen) and to control other brain activities. Dopamine works in the parts of the brain that control movement.
Many conditions can affect how much iron is in the brain or how it's used. These conditions include kidney failure, Parkinson's disease, diabetes, rheumatoid arthritis, pregnancy, and iron deficiency. All of these conditions increase your risk of RLS.
People whose family members have RLS also are more likely to develop the disorder. This suggests that genetics may contribute to the faulty use of iron or lack of iron in the brain that triggers RLS.
Nerve damage in the legs or feet and sometimes in the arms or hands may cause or worsen RLS. Several conditions can cause this type of nerve damage, including diabetes.
Medicines and Substances
Certain medicines may trigger RLS. These include some:
- Antinausea medicines (used to treat upset stomach)
- Antidepressants (used to treat depression)
- Antipsychotics (used to treat certain mental health disorders)
- Cold and allergy medicines that contain antihistamines
- Calcium channel blockers (used to treat heart problems and high blood pressure)
RLS symptoms usually get better or may even go away if the medicine is stopped.
Certain substances, such as alcohol and tobacco, also can trigger or worsen RLS symptoms. Symptoms may get better or go away if the substances are stopped.
Restless legs syndrome (RLS) affects about 5–15 percent of Americans. Many people who have RLS have family members with the disorder.
RLS can affect people of any racial or ethnic group, but the disorder is more common in people of Northern European descent. RLS affects both genders, but women are more likely to have it than men.
The number of cases of RLS rises with age. Many people who have RLS are diagnosed in middle age. People who develop RLS early in life tend to have a family history of the disorder.
People who have certain diseases or conditions or who take certain medicines are more likely to develop RLS. (For more information, go to "What Causes Restless Legs Syndrome?")
For example, pregnancy is a risk factor for RLS. It usually occurs during the last 3 months of pregnancy. The disorder usually improves or goes away after giving birth. Some women may continue to have symptoms after giving birth. Other women may develop RLS again later in life.
Signs, Symptoms, and Complications
The four key signs of restless legs syndrome (RLS) are:
- A strong urge to move your legs. This urge often, but not always, occurs with unpleasant feelings in your legs. When the disorder is severe, you also may have the urge to move your arms.
- Symptoms that start or get worse when you're inactive. The urge to move increases when you're sitting still or lying down and resting.
- Relief from moving. Movement, especially walking, helps relieve the unpleasant feelings.
- Symptoms that start or get worse in the evening or at night.
You must have all four of these signs to be diagnosed with RLS.
The Urge To Move
RLS gets its name from the urge to move the legs when sitting or lying down. This movement relieves the unpleasant feelings that RLS sometimes causes. Typical movements are:
- Pacing and walking
- Jiggling the legs
- Stretching and flexing
- Tossing and turning
- Rubbing the legs
People who have RLS describe the unpleasant feelings in their limbs as creeping, crawling, pulling, itching, tingling, burning, aching, or electric shocks. Severe RLS may cause painful feelings. However, the pain usually is more of an ache than a sharp, stabbing pain.
Children may describe RLS symptoms differently than adults. In children, the condition may occur with hyperactivity. However, it's not fully known how the disorders are related.
The unpleasant feelings from RLS often occur in the lower legs (calves). But the feelings can occur at any place in the legs or feet. They also can occur in the arms.
The feelings seem to come from deep within the limbs, rather than from the surface. You usually will have the feelings in both legs. However, the feelings can occur in one leg, move from one leg to the other, or affect one leg more than the other.
People who have mild symptoms may notice them only when they're still or awake for a long time, such as on a long airplane trip or while watching TV. If they fall asleep quickly, they may not have symptoms when lying down at night.
The unpleasant feelings from RLS aren't the same as the leg cramps many people get at night. Leg cramps often are limited to certain muscle groups in the leg, which you can feel tightening. Leg cramps cause more severe pain and require stretching the affected muscle for relief.
Sometimes arthritis or peripheral artery disease (P.A.D.) can cause pain or discomfort in the legs. Moving the limbs usually worsens the discomfort instead of relieving it.
Periodic Limb Movement in Sleep
Many people who have RLS also have a condition called periodic limb movement in sleep (PLMS). PLMS causes your legs or arms to twitch or jerk about every 10 to 60 seconds during sleep. These movements cause you to wake up often and get less sleep.
PLMS usually affects the legs, but it also can affect the arms. Not everyone who has PLMS also has RLS.
Related Sleep Problems
RLS can make it hard to fall or stay asleep. If RLS disturbs your sleep, you may feel very tired during the day.
Lack of sleep may make it hard for you to concentrate at school or work. Not enough sleep also can cause depression, mood swings, and other health problems such as diabetes or high blood pressure.
Your doctor will diagnose restless legs syndrome (RLS) based on your signs and symptoms, your medical and family histories, a physical exam, and test results.
Your doctor will use this information to rule out other conditions that have symptoms similar to those of RLS.
Your primary care doctor usually can diagnose and treat RLS. However, he or she also may suggest that you see a sleep specialist or neurologist.
Signs and Symptoms
You must have the four key signs of RLS to be diagnosed with the disorder.
Your doctor will want to know how your symptoms are affecting your sleep and how alert you are during the day.
To help your doctor, you may want to keep a sleep diary. Use the diary to keep a daily record of how easy it is to fall and stay asleep, how much sleep you get at night, and how alert you feel during the day.
For a sample sleep diary, go to the National Heart, Lung, and Blood Institute's "Your Guide to Healthy Sleep."
Medical and Family Histories
Your doctor may ask whether you have any of the diseases or conditions that can trigger RLS. These include kidney failure, Parkinson's disease, diabetes, rheumatoid arthritis, pregnancy, and iron deficiency.
Your doctor also may want to know what medicines you take. Some medicines can trigger or worsen RLS.
The most common type of RLS tends to run in families. Thus, your doctor may ask whether any of your relatives have RLS.
Your doctor will do a physical exam to check for underlying conditions that may trigger RLS. He or she also will check for other conditions that have symptoms similar to those of RLS.
Currently, no test can diagnose RLS. Still, your doctor may recommend blood tests to measure your iron levels. He or she also may suggest muscle or nerve tests. These tests can show whether you have a condition that can worsen RLS or that has symptoms similar to those of RLS.
Rarely, sleep studies are used to help diagnose RLS. A sleep study measures how much and how well you sleep. Although RLS can cause a lack of sleep, this sign isn't specific enough to diagnose the condition.
Researchers continue to study new ways to diagnose RLS.
Drug Therapy Trial
If your doctor thinks you have RLS, he or she may prescribe certain medicines to relieve your symptoms. These medicines, which are used to treat people who have Parkinson's disease, also can relieve RLS symptoms. If the medicines relieve your symptoms, your doctor can confirm that you have RLS.
Restless legs syndrome (RLS) has no cure. If a condition or medicine triggers RLS, it may go away or get better if the trigger is relieved or stopped.
RLS can be treated. The goals of treatment are to:
- Prevent or relieve symptoms
- Increase the amount of sleep you're getting and improve the quality of your sleep
- Treat or correct any underlying condition that may trigger or worsen RLS
Mild cases of RLS often are treated with lifestyle changes and sometimes with periodic use of medicines. More severe RLS usually is treated with daily medicines.
Lifestyle changes can prevent or relieve the symptoms of RLS. For mild RLS, lifestyle changes may be the only treatment needed.
Many common substances, such as alcohol and tobacco, can trigger RLS symptoms. Avoiding these substances can limit or prevent symptoms.
Some prescription and over-the-counter medicines can cause or worsen RLS symptoms. Tell your doctor about all of the medicines you're taking. He or she can tell you whether you should stop or change certain medicines.
Adopting good sleep habits can help you fall asleep and stay asleep—a problem for many people who have RLS. Good sleep habits include:
- Keeping the area where you sleep cool, quiet, comfortable, and as dark as possible.
- Making your bedroom sleep-friendly. Remove things that can interfere with sleep, such as a TV, computer, or phone.
- Going to bed and waking up at the same time every day. Some people who have RLS find it helpful to go to bed later in the evening and get up later in the morning.
- Avoiding staying in bed awake for long periods in the evening or during the night.
Doing a challenging activity before bedtime, such as solving a crossword puzzle, may ease your RLS symptoms. This distraction may make it easier for you to fall asleep. Focusing on your breathing and using other relaxation techniques also may help you fall asleep.
Regular, moderate physical activity also can help limit or prevent RLS symptoms. Often, people who have RLS find that if they increase their activity during the day, they have fewer symptoms.
Certain activities can relieve RLS symptoms. These include:
- Walking or stretching
- Taking a hot or cold bath
- Massaging the affected limb(s)
- Using heat or ice packs on the affected limb(s)
- Doing mentally challenging tasks
Choose an aisle seat at the movies or on airplanes and trains so you can move around, if necessary.
You may need medicines to treat RLS if lifestyle changes can't control symptoms. Many medicines can relieve or prevent RLS symptoms.
No single medicine works for all people who have RLS. It may take several changes in medicines and dosages to find the best approach. Sometimes, a medicine will work for a while and then stop working.
Some of the medicines used to treat RLS also are used to treat Parkinson's disease. These medicines make dopamine or mimic it in the parts of the brain that control movement. (Dopamine is a chemical that helps you move properly.)
If medicines for Parkinson's disease don't prevent or relieve your symptoms, your doctor may prescribe other medicines. You may have to take more than one medicine to treat your RLS.
Always talk with your doctor before taking any medicines. He or she can tell you the side effects of each RLS medicine. Side effects may include nausea (feeling sick to your stomach), headache, and daytime sleepiness.
In some cases, RLS medicines may worsen problems with excessive gambling, shopping, or sexual activity. Sometimes, continued use of RLS medicines may make your RLS symptoms worse.
Contact your doctor if you have any of these problems. He or she can adjust your medicines to prevent these side effects.
Restless legs syndrome (RLS) often is a lifelong condition. Symptoms may come and go often or go away for long periods. Symptoms often get worse over time.
If a condition or medicine triggers RLS, the disorder may go away if the trigger is relieved or stopped. For example, RLS that occurs due to pregnancy tends to go away after giving birth.
Although RLS has no cure, treatments can relieve or prevent RLS symptoms. Mild cases of RLS often are treated with lifestyle changes and sometimes with periodic use of medicines. More severe RLS usually is treated with daily medicines. (For more information, go to "How Is Restless Legs Syndrome Treated?")
Ongoing Medical Care
If you have RLS, see your doctor regularly so he or she can watch for changes in your symptoms. This will show whether your treatment is working and whether it will continue to work over time.
Call your doctor if you notice your treatment is no longer working or if you have new symptoms.
Try to plan long car trips and other long periods of inactivity at the times of day when your symptoms are least severe. Give yourself time to stretch or take walking breaks.
Choose an aisle seat at the movies or on airplanes and trains so you can move around if needed.
Consider finding a work setting where you can stand or walk around.
Emotional Issues and Support
Living with RLS may cause anxiety and stress. It's important to talk about how you feel with your health care team.
Joining a patient support group may help you adjust to living with RLS. You can see how other people who have the same symptoms have coped with them. Talk with your doctor about local support groups or check with an area medical center.
Support from family and friends also can help relieve stress and anxiety. Let your loved ones know how you feel and what they can do to help you.
The National Heart, Lung, and Blood Institute (NHLBI) leads or sponsors many studies aimed at preventing, diagnosing, and treating heart, lung, blood, and sleep disorders.