RESTLESS LEGS KEEPING YOU UP AT NIGHT? CAN WE HELP?

It's become a pattern. Just when you crawl into bed and begin to fall asleep, your legs begin to twitch and jerk. You may feel burning or a crawling sensation deep inside your calves that seem to go away when you move your legs. These same sensations often return whenever you sit down and relax. If these symptoms sound familiar, you may have restless legs syndrome (RLS). 

RLS can cause significant disruption to your sleep cycle and can worsen if left untreated. It can also mimic other conditions and therefore should be diagnosed by a neurologist or sleep specialist to ensure appropriate diagnosis and treatment.

Risk factors

Approximately 5% to 15% of the population suffers from RLS, a neurological condition that can be associated with a variety of factors including:

• Genetics
• Low iron levels
• Kidney disease or diabetes
• Neuropathy
• Spinal cord disease
• Multiple sclerosis

The condition occurs more frequently in women than men and becomes more common with age. You have a 3 to 6 times higher risk for RLS if you have a first-degree relative with the condition such as parents, siblings or children.

Symptoms of restless legs syndrome

The condition is associated with these symptoms:

• Unpleasant leg crawling sensations or urges to move the legs, particularly during periods of rest or inactivity
• Relief from these symptoms by leg movement such as stretching or walking
• Worsening symptoms in the evening or night
• Twitching or kicking of the legs throughout the night while sleeping
• Aching, throbbing, pulling, itching, crawling, or creeping feeling in the legs with an unavoidable urge to move the limbs.
• These sensations may occur when sleeping, resting or sitting for long periods, such as in a car or airplane.

About 80% of people with restless legs will experience periodic leg movements during sleep. This includes jerk-like leg movements that occur throughout the night, often causing partial awakenings that disrupt sleep and may cause daytime sleepiness. Some people may not even be aware of these movements and it is often the bed partner that observes the leg movements and complains. Although most patients start having symptoms in the evenings, some might have symptoms during periods of inactivity during the day as well. 

RLS symptoms may vary from day to day, in severity and frequency, and from person to person. In severe cases of RLS, the symptoms occur more than twice a week.

Restless Legs Syndrome Interrupts Sleep

During sleep, many individuals with RLS have involuntary or jerking leg movements called periodic limb movements. These movements may disrupt sleep and over time contribute to sleep deprivation, negatively impacting one’s health.

Periodic limb movements may also occur during the day, but they’re harder to notice then, because most people naturally move around after their legs start to bother them.

RLS usually affects the legs. But it can also cause unpleasant feelings in the arms, torso, or even a phantom limb.

Like any condition that impacts quality of sleep, RLS can lead to daytime sleepiness, anxiety and depression, confusion, and difficulty thinking clearly.

RLS and periodic limb movements may also disturb the sleep of a bed partner. This could cause fatigue for both people and can strain the relationship.

Causes of RLS

There are several different causes of RLS:

1. Iron Deficiency
Although Restless Legs Syndrome is quite common, many people with the condition are unaware that iron deficiency is a major cause.

Even if someone’s blood iron level is in the normal range, iron stores in the brain and nervous system can still be low, causing iron deficiency.

2. Disruption of Dopamine in the Brain
RLS also may be related to a dysfunction in a part of the brain that controls movement. The basal ganglia uses the brain chemical dopamine to produce smooth, purposeful muscle activity and movement. Disruption of dopamine levels in the brain can result in involuntary movements.

Individuals living with Parkinson’s disease have an increased risk of developing RLS.

3. Other Health Conditions
RLS appears to be linked to the following health conditions and underlying factors:

• Sleep deprivation and conditions such as sleep apnea
• Use of alcohol, nicotine, and caffeine
• Neuropathy (nerve damage)
• End-stage renal disease and hemodialysis
• Pregnancy or hormonal changes, especially in the last trimester (in most cases, symptomsusually disappear within four weeks after delivery).

4. Family History of RLS
RLS often runs in families, and specific gene variants have been identified with the
condition.

Occurrence of RLS in the U.S. Population

According to the National Health Institute, it is estimated that up to seven to 10 percent of the U.S. population may have RLS. The condition occurs in both males and females, although females are more likely to have it.

RLS generally is a lifelong condition. Many people who are severely affected are middle-aged or older. Symptoms typically become more frequent and last longer as a person ages.

Diagnosis and Treatment of RLS

RLS can begin at any age, although its diagnosis and treatment in children is often
challenging. Children may not be able to provide a good description of the symptoms, and some childhood conditions can mimic RLS.

Treatment for RLS is based on the patient’s assortment and severity of symptoms.

Getting regular exercise and enough sleep may be enough to lessen mild symptoms.

RLS tends to be a lifelong condition that can be managed with lifestyle changes,
medications and treatment of symptoms if caused by underlying disorders. If the
underlying cause is iron or folic acid deficiency, supplements alone may be sufficient to relieve your symptoms.

Lifestyle changes include:

• Avoid or decrease the use of alcohol, nicotine, and caffeine
• Change or maintain a regular sleep pattern
• Try moderate, regular exercise
• Massage the legs or take a warm bath
• Apply a heating pad or ice pack
• Use foot wraps specially designed for people with RLS, or vibration pads to the back of the legs
• Do aerobic and leg-stretching exercises of moderate intensity.
• Avoid alcohol consumption
• Practice good sleep habits
• Take warm or cool baths
• Leg massages
• Avoidance of antidepressants, antihistamines and anti-nausea agents that can trigger or worsen restless legs

Medications are extremely helpful and many people have no symptoms at all with
occasional adjustments to meds.

If not treated appropriately, RLS can worsen and can affect other parts of the body such as the arms. Overuse of certain medications can also lead to RLS augmentation which is associated with a progressive escalation of symptoms by increased medication dosages. This can make the condition more difficult to treat, prompting the need for management by a specialist.

Restless legs syndrome can be very disruptive to your lifestyle. Do not dismiss your
symptoms. Make sure that you talk to your doctor or see a specialist who can help.