Restless Legs Syndrome
Restless legs syndrome, also called Willis-Ekbom Disease, is a neurological sleep disorder in which a person experiences an urge to move their legs or arms, and this urge is accompanied by or in response to uncomfortable sensations in the limbs. These uncomfortable sensations are often described as creeping, crawling, tingling, burning, throbbing, pulling, or itching. The sensations can range from discomfort to painful. Restless legs syndrome can affect just one side of the body, but it more often occurs on both sides at once; sometimes the pain can even migrate around the body. Moving the legs gives the person some relief.
The prevalence of restless legs syndrome varies widely but ranges from 4 to 14 percent of the general population. The prevalence of restless legs syndrome increases with age, and women are more likely than men to have this condition. Restless legs syndrome is generally diagnosed after symptoms have persisted for at least three months
People with restless legs syndrome (RLS) experience uncomfortable feelings in their legs and have a strong desire to move their legs. This urge to move is worse when the person is resting or inactive, and frequent leg movement occurs to relieve that urge. Symptoms are worse in the evening or at night, with some people only experiencing the symptoms at night. The symptoms of RLS can make falling asleep difficult and may awaken a person from their sleep. As a result, restless legs syndrome is associated with daytime sleepiness, significant distress, and impairment in daily functioning. It can be a lifelong difficulty with no cure, but symptoms can also abate or disappear for periods of time.
The symptoms of RLS are unpredictable and tend to vary in severity and frequency, depending on the individual patient. They grow worse as the disorder progresses. Symptoms may appear once or twice weekly in a moderate case of RLS but appear more frequently in more severe cases. Restless legs syndrome can also contribute to anxiety, depression, difficulty concentrating, and poor performance at work or school. It can affect someone’s personal relationships and can make traveling extremely challenging.
The cause of restless legs syndrome is not clear. Signaling pathways may change in the brain, which may contribute to the syndrome. There are several factors that can influence the development of the condition. Risk factors include being female, increasing age, genetic variants, and a family history of restless legs syndrome.
Low levels of iron and abnormal regulation of dopamine may also play a role, a simple blood test can show whether there is an iron deficiency. Pregnant women are at greater risk for restless leg syndrome, particularly in the last trimester, but RLS symptoms generally clear up within four weeks of giving birth. Sleep deprivation and other sleep-related conditions, like sleep apnea, have been known to trigger episodes of restless legs syndrome. Additionally, symptoms can worsen if a person takes certain medications, such as antidepressants and medications that block dopamine in the brain.
Restless legs syndrome can be found in families as there is a genetic component, with symptom onset often appearing before the age of 40. The gene variants of PTPRD, BTBD9, and MEIS1 have been associated with RLS.
Treatment for restless legs syndrome depends on the severity of the condition. If symptoms are mild and do not cause a great deal of distress, behavioral changes such as increasing exercise, massaging the legs, or soaking the legs in water may be beneficial. Medication may be a necessary form of treatment if symptoms are more severe.
Medications approved by the U.S. Food and Drug Administration for restless legs syndrome include pramipexole, ropinirole, rotigotine patch, and gabapentin enacarbil. However, there can be side effects of these medications, including dizziness and fatigue among other complications. The symptoms of restless legs syndrome may also be associated with another medical condition such as iron deficiency, in which case symptoms may improve once the underlying condition has been treated.
Massage can alleviate the symptoms; likewise, heating pads and ice packs can be helpful. There are also devices such as vibrating pads for the legs as well as wraps that apply pressure to the feet.
Falling asleep and staying asleep can help improve all types of sleep difficulties. General sleep hygiene is advised.
• Go to sleep and wake up at the same time daily
• If you are awake in bed for more than five to 10 minutes, get up
• Avoid napping
• Avoid caffeine in the afternoon
• Avoid large meals, especially before bed
• Limit alcohol intake
• Ban screens in the bedroom
• Avoid screen time before bedtime
• Open a window for fresh air
• Keep a comfortable bedroom temperature
Caffeine in coffee, tea, and soda can exacerbate restless legs. In addition, alcohol and nicotine can also affect a person. These should be avoided especially before bedtime. In general, a proper diet with plenty of nutrients and less sugar and processed foods is recommended. A diet including iron—found in spinach, seafood, and legumes—as well as magnesium—found in leafy greens, nuts, seeds, and legumes—may help.
A regular exercise routine improves sleep overall. Simple regimens such as walking, yoga, swimming, jogging, bicycling, or other simple practices are all helpful. And with any physical activity, proper stretching will loosen tight muscles.
Some medications such as over-the-counter drugs for nausea, cold, and allergies can worsen restless legs by interfering with dopamine receptors. In addition, prescription antipsychotics and antidepressants can increase serotonin, which may also aggravate symptoms.