Topic Overview
What is restless legs syndrome?
Restless legs
syndrome (RLS) is a disorder related to sensation and movement. People with
restless legs syndrome have an unpleasant feeling or sensation in their legs
when they lie down to sleep. Most people also have a very strong urge to move
their legs, and moving the legs sometimes makes them feel better. But all this
movement makes it hard or impossible to get enough sleep.
When you
don't get enough sleep, you may start to have problems getting things done
during the day because you're so tired. You may also be sleepy or have trouble
concentrating. So it’s important to see your doctor and get help to manage your
symptoms.
What causes restless legs syndrome?
Usually there
isn't a clear reason for restless legs. The problem often runs in families.
Sometimes there is a clear cause, like not getting enough iron. If that’s the
case, treating the cause may solve the problem.
Women sometimes
get restless legs while they are pregnant. The problem usually goes away after
the baby is born.
Other problems that are sometimes linked to
restless legs syndrome include kidney failure,
rheumatoid arthritis,
diabetes, nerve damage, anemia, and
Parkinson's disease. But most people who seek
treatment do not have any of these other problems.
What are the symptoms?
Restless legs syndrome
makes you feel like you must move your legs. These feelings are often described
as tingling, "pins and needles," prickling, pulling, or crawling.
Moving your legs will usually make your legs feel better, at least for a
short time. This problem usually happens at night when you are trying to relax
or go to sleep.
After you fall asleep, your legs may begin to jerk
or move. These movements are called periodic limb movements. They can wake you
from sleep, which adds to your being overtired. Although periodic limb movement
is considered a separate condition, it often happens to people who have
restless legs syndrome.
How is restless legs syndrome diagnosed?
One of
the hardest parts of having restless legs syndrome is getting to the diagnosis.
Often doctors don't ask about sleep or don't ask about the symptoms of restless
legs. If you're not sleeping well, or if you think you may have restless legs
syndrome, tell your doctor.
Your doctor will talk with you about
your symptoms to make sure that the feelings in your legs you describe are
typical of restless legs syndrome and not caused by some other problem.
You may have blood tests to rule out other problems that could be causing
your symptoms. In some cases, the doctor may order tests of your nerves to be
sure there is no nerve damage. Your doctor may also order a sleep study called
a
polysomnography. This test records how often your legs
jerk or move while you sleep.
How is it treated?
If your symptoms are mild, a
few lifestyle changes may be enough to control your symptoms. Some changes that
may help:
- Avoid tobacco, alcohol, and
caffeine.
- Keep your bedroom cool, quiet, and comfortable, and use
it only for sleeping, not for watching TV.
- Get regular
exercise.
- Massage the leg or the arm, or use heat or ice
packs.
When symptoms are more severe, medicines may help control
your leg movements and help you sleep. There are different types of medicine,
and you may have to try a few to find the one that works best.
Frequently Asked Questions
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Symptoms
The main symptom of
restless legs syndrome (RLS) is an irresistible urge
to move your legs because of uncomfortable and sometimes painful sensations
deep within your legs. Some people describe the sensations as aching, creeping,
crawling, or prickling. Symptoms usually begin about 15 minutes after you lie
down to sleep or to relax, or when you have not moved for long periods, such as
when traveling in a car or airplane. Symptoms that occur frequently can result
in significant sleep loss, fatigue, and problems with daytime
functioning.
After they are asleep, most people with RLS also
have involuntary or jerking leg movements called
periodic limb movements. These movements can interrupt
your sleep, which adds to problems with fatigue. Periodic limb movements may
also occur during the day, although most people move around after their legs
begin to bother them. As a result, the periodic limb movements that people have
when they are awake may not be noticed except under unusual
circumstances.
Restless legs syndrome and periodic limb movements
also often disturb the sleep of a bed partner. This can cause fatigue for both
people and can strain the relationship.
Symptoms may start during
infancy or any time during your life. At first, your symptoms may be mild and
occur only once in awhile. Typically, symptoms get worse with age. After age
50, many people with this condition have daily symptoms and suffer from
significant sleep loss. Severe
insomnia,
fatigue,
anxiety,
depression, and lack of social activity can become a
problem and cause a decline in quality of life.
Restless legs
syndrome may start or become worse during pregnancy, especially after week 20.
Symptoms usually go away soon after the baby is born, unless the mother had
this condition before she became pregnant.
Other conditions—such
as leg cramps, certain nerve disorders, or arthritis—can produce symptoms that
are similar to those of restless legs syndrome. But most of those other
conditions do not occur primarily at night and when a person is at rest. Leg
cramps that are not caused by restless legs syndrome often do occur at night,
but they usually involve intense pain in certain muscles, unlike the leg cramps
caused by restless legs syndrome.
The kind of "nervous leg" seen
in some people during the day is not restless legs syndrome, in most cases.
People who have "nervous legs" are not moving their legs because they feel the
need to. In fact, they are often unaware that they are moving their
legs.
Exams and Tests
A doctor diagnoses
restless legs syndrome by asking questions about your
symptoms. A physical exam may be done to look for other possible problems that
could be causing your symptoms.
Restless legs syndrome is
diagnosed by your doctor based on the following four criteria:
- You have an urge to move your legs, usually
because of uncomfortable sensations such as tingling, "pins and needles,"
prickling, crawling, or pain. In some cases, you may not feel any unpleasant
sensations but still feel the urge to move your legs or your
arms.
- The sensations and the urge to move your legs begin or get
worse during periods of rest or inactivity, such as when you are sitting or
lying down.
- The sensations and the urge to move your legs are
partially or totally relieved by movement. But relief may be temporary and only
last while you are walking, stretching, or moving your legs.
- The
urge to move your legs and the sensations are worse in the evening or at night.
But some people may have severe sensations and urges to move their legs
throughout the day and night.
Other factors that may support a diagnosis include:
- Having a family history (in a parent or
sibling) of restless legs syndrome.
- Having
periodic limb movements—involuntary jerking or
movement of your legs—while you are awake or asleep.
- Showing
improvement when the medicine
dopamine is used.
A sleep study called a
polysomnography may be done to help your doctor
diagnose restless legs syndrome or rule out other sleep disorders. This test
records the electrical activity of your brain, eye movements, muscle activity,
heart rate, breathing, air flow through your nose and mouth, and blood oxygen
levels.
Although this test is not essential, it provides details
of limb movement symptoms. These details may help evaluate the severity of your
symptoms. The severity ranges from people who have restless legs syndrome
occasionally, with only mild difficulty falling asleep, to those who have it
frequently, with repeated interruptions of sleep. Serious sleep problems can
greatly affect your ability to function during the day.
Common problems with diagnosing restless legs syndrome
Many cases go undiagnosed because:
- Many people do not seek a doctor's help when
they have symptoms.
- Most people visit a doctor during the day, when
symptoms are not present or are only mild.
- Some doctors do not
recognize the condition and may believe that the symptoms are caused by other
conditions, such as insomnia, stress, muscle cramps, or arthritis.
Restless legs syndrome does occur in children but it is
difficult to diagnose for the same reasons. Children often are not able to
describe their symptoms. A parent's observations of the child's behavior and
sleep may be helpful. Knowing that a parent or other close relative has
restless legs syndrome can also help the doctor make a diagnosis of restless
legs syndrome in the child.
Other conditions to consider
Polysomnography and
related sleep study tests may also be done to help identify problems that can
interfere with sleep. You may be evaluated for
other conditions with symptoms similar to restless legs syndrome. These
conditions include
varicose veins,
arthritis, or
intermittent claudication (a tight, aching, or
squeezing pain in the calf, foot, thigh, or buttock that occurs during
exercise).
You also may be asked about behaviors, habits, and
physical traits that may be related, such as:
- Smoking.
- Lack of regular,
moderate exercise.
- Being overweight and having a high
body mass index.
You may also have tests to check for
other diseases or health conditions—such as
diabetes,
peripheral neuropathy, pregnancy, kidney problems, or
iron deficiency anemia—that can cause your symptoms.
Tests will vary depending on what your doctor identifies as likely problems.
Treatment Overview
Treatment for
restless legs syndrome is based on the type of
symptoms you have and how bad your symptoms are. Getting regular exercise and
enough sleep may relieve mild symptoms. Medicines may be tried when symptoms
are severe and interfere with sleep and daily functioning. If your symptoms are
being caused by another medical condition (such as
iron deficiency anemia), that condition can be treated
first.
Initial treatment
Changing your daily routine is
sometimes enough to control your symptoms. Stretching, walking, exercising
regularly, taking a hot or cold bath, using massage, and avoiding smoking and
caffeine may reduce or control your symptoms.
If your symptoms are
caused by
another medical condition such as
diabetes or
iron deficiency anemia, you will be treated for that
condition first. For example, if iron deficiency is causing restless legs
syndrome, you will be prescribed iron supplements.
Restless legs syndrome
that starts during pregnancy
usually goes away soon after the baby is born, most often within days. Your
doctor may recommend conservative treatment, such as regular exercise and
stretching, to relieve symptoms. Your condition may be reevaluated if it
doesn't go away after you have given birth.
Children with restless
legs syndrome are not usually treated with drugs right away. Instead, regular,
moderate exercise and regular sleep routines are tried first. If this treatment
is not effective, the doctor may prescribe drugs—such as levodopa or dopamine
agonists—that help increase a chemical in the brain called
dopamine. These medicines can reduce symptoms as well
as involuntary leg movements at night. Clonidine, a drug that is usually used
to treat high blood pressure, has also been used to treat restless legs
syndrome in children.
Ongoing treatment
If your symptoms are mild, you
will probably be able to control the uncomfortable sensations and urges to move
your legs through regular exercise, stretching, walking, losing weight if you
are overweight, and by avoiding smoking and caffeine. Sometimes a hot or cold
bath or massage can help. If your doctor finds out that your
restless legs syndrome is caused by another condition
(such as
diabetes or
iron deficiency anemia), treating that condition will
usually resolve your symptoms.
If your symptoms do not improve,
drugs may be used to control involuntary leg movements and help you sleep, such
as:1
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Dopamine agonists, such as ropinirole
(Requip), pramipexole (Mirapex), and the dopamine precursor, levodopa
(Sinemet).
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Anticonvulsants, such as gabapentin
(Neurontin).
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Opioids, such as oxycodone (Percocet)
and hydrocodone (Lortab).
Also, your doctor may prescribe sedative-hypnotics
(including
benzodiazepines and the newer non-benzodiazepine drugs
like zolpidem [Ambien], zaleplon [Sonata], and eszopiclone [Lunesta]), alone or
together with dopamine agonists, opioids, or anticonvulsants.
Medicines are started at the lowest effective dose. Sometimes doses are
split, although both are usually taken in the evening. Sometimes drugs are
combined to better control symptoms and manage side effects.
If
your doctor recommends medicine, make sure that you discuss expectations and
understand the potential benefits and risks of the drug. Let your doctor know
about all of the other drugs you are taking. Drugs taken for other conditions
sometimes contribute to restless legs syndrome. For example, antidepressants
improve restless legs syndrome in some people but make it worse in
others.
Treatment if the condition gets worse
If you
continue to have symptoms even though you are receiving treatment with drugs
and are exercising regularly, eating right, and not smoking or using caffeine,
your symptoms may need to be reevaluated. Many other conditions can cause the
sensations found in
restless legs syndrome, including several vitamin and
mineral deficiencies.
Your doctor may recommend different drugs or
a combination of drugs. Follow up with your doctor if your symptoms do not
improve.
Home Treatment
There are ways to improve your symptoms
of
restless legs syndrome at home.
Try:
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Exercise. Regular,
moderate exercise may reduce symptoms. Avoiding long periods between activity
and avoiding sudden bursts of intense activity may also be helpful. Talk to
your doctor before starting an exercise program.
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Heat or cold. Your symptoms may be relieved by bathing in very hot or
very cold water. Applying a heating pad or ice bag to your legs may also help
symptoms.
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Changing your sleep schedule.
Fatigue can make your symptoms worse. Because symptoms
typically improve around 4 a.m. to 6 a.m., try going to bed later than usual or
allowing extra time for sleeping in to help you get the rest you need.
RLS: Getting more sleep
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Stretching and massage.
You may be able to control your symptoms by gently stretching and massaging
your legs before bed or as discomfort begins.
Avoid:
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Caffeine and alcohol.
These may make your symptoms worse.
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Certain medicines. Some prescription and
over-the-counter (OTC) medicines (such as cold and
sinus medicines) can make symptoms of RLS worse. If you think your symptoms get
worse after you take a certain medicine, talk to your doctor.
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Being confined for long periods. Try to plan for
situations where you will need to remain seated for long stretches. For
example, if you are traveling by car, plan to make some stops so you can get
out and walk around.
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Excessive exercise.
Although moderate exercise may help relieve symptoms, unusually intense
workouts may make them worse. Try to identify at what level exercise helps and
at what point it triggers restless legs syndrome.
See your doctor if your symptoms do not improve, if they
become worse, or if they significantly interfere with your sleep and daily
functioning.
Other Places To Get Help
Organizations
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National Institute of Neurological Disorders and
Stroke
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| P.O. Box 5801 |
| Bethesda, MD 20824 |
| Phone: |
1-800-352-9424
(301) 496-5751 |
| TDD: |
(301) 468-5981 |
| Web Address: |
www.ninds.nih.gov |
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The National Institute of Neurological Disorders and
Stroke (NINDS), a part of the National Institutes of Health, is the leading
U.S. federal government agency supporting research on brain and nervous system
disorders. It provides the public with educational materials and information
about these disorders.
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National Heart, Lung, and Blood Institute
(NHLBI)
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| P.O. Box 30105 |
| Bethesda, MD 20824-0105 |
| Phone: |
(301) 592-8573 |
| Fax: |
(240) 629-3246 |
| TDD: |
(240) 629-3255 |
| E-mail: |
nhlbiinfo@nhlbi.nih.gov |
| Web Address: |
www.nhlbi.nih.gov |
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The U.S. National Heart, Lung, and Blood Institute
(NHLBI) information center offers information and publications about preventing
and treating:
- Diseases affecting the heart and circulation, such as heart
attacks, high cholesterol, high blood pressure, peripheral artery disease, and
heart problems present at birth (congenital heart diseases).
- Diseases that affect the lungs, such as asthma, chronic
obstructive pulmonary disease (COPD), emphysema, sleep apnea, and
pneumonia.
- Diseases that affect the blood, such as anemia,
hemochromatosis, hemophilia, thalassemia, and Von Willebrand disease.
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National Sleep Foundation
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| 1522 K Street NW |
| Suite 500 |
| Washington, DC 20005 |
| Phone: |
(202) 347-3471 |
| Fax: |
(202) 347-3472 |
| E-mail: |
nsf@sleepfoundation.org |
| Web Address: |
www.sleepfoundation.org |
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The National Sleep Foundation, an independent nonprofit
organization, can provide you with brochures on sleep disorders and a list of
accredited sleep disorder clinics.
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Restless Legs Syndrome Foundation
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| 1610 14th Street NW |
| Suite 300 |
| Rochester, MN 55901 |
| Phone: |
(507) 287-6465 |
| Fax: |
(507) 287-6312 |
| E-mail: |
rlsfoundation@rls.org |
| Web Address: |
www.rls.org |
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The Restless Legs Syndrome Foundation is a nonprofit organization
dedicated to improving the lives of people with restless legs syndrome (RLS).
General medical information and research updates are available online and
through newsletters and special publications. The Web site has numerous links
to support groups and resources for more information about the
condition.
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WE MOVE
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| 204 West 84th Street |
| New York, NY 10024 |
| E-mail: |
wemove@wemove.org |
| Web Address: |
www.wemove.org |
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WE MOVE is an Internet resource for movement disorder
information. The organization is dedicated to educating people about the latest
treatment options for neurologic movement disorders. WE MOVE also has
information on support groups and hosts discussions and chat rooms on the Web
site.
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References
Citations
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Earley CJ (2003). Restless legs syndrome.
New England Journal of Medicine, 348(21):
2103–2109.
Other Works Consulted
- Buysse DJ, et al. (2008). Sleep-related movement
disorders: Restless legs syndrome and periodic limb movement disorder section
of Sleep disorders. In RE Hales et al., eds., American Psychiatric Textbook of Psychiatry, 5th ed., pp. 957–960. Washington,
DC: American Psychiatric Publishing.
- Esteves AM, et al. (2009). Effect of acute and chronic
physical exercise on patients with periodic leg movements. Medicine and Science in Sports and Exercise, 41(1):
237–242.
Credits
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Author
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Monica Rhodes |
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Editor
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Kathleen M. Ariss, MS |
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Associate Editor
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Pat Truman, MATC |
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Primary Medical Reviewer
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Martin Gabica, MD - Family Medicine |
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Primary Medical Reviewer
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Anne C. Poinier, MD - Internal Medicine |
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Specialist Medical Reviewer
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Karin M. Lindholm, DO - Neurology |
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Last Updated
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March 13, 2009 |
