Restless Legs Syndrome (RLS)
Symptoms, Treatment, and Self-Help
If you’re bothered by an overwhelming urge to move your legs when you
lie down, or unpleasant tingling, aching, or itching sensations in your
legs keep you up at night, you may have a sleep disorder known as
restless legs syndrome (RLS). Fortunately, restless legs syndrome can
be treated. Medical treatment, healthy lifestyle changes, and self-help
remedies can help you quiet your restless legs so you and your partner
can enjoy a peaceful and refreshing night’s sleep.
What is restless legs syndrome (RLS)?
Restless legs syndrome (RLS) is a recognized
neurological disorder that can interfere with resting or falling
asleep. If you have restless legs syndrome (RLS), a typical night might
look like this: You lie down in bed, ready to go to sleep, and just as
your body begins to relax, the uncomfortable leg sensations begin. You
try to ignore the crawling, tingling, or itching in your legs, hoping
it will go away, but it only gets worse. You toss and turn for a while,
but eventually the urge to move is overwhelming. You get out of bed to
stretch and pace the floor and, for a moment, you find relief. But
when you lie down again, the restless sensations in your legs start all
over again.
Understanding restless legs syndrome (RLS)
Although restless legs syndrome (RLS) is common—many
studies estimate that 1 out of 10 people have it—it hasn’t always been
easy to find help and support. Unfortunately, many RLS sufferers never
get proper treatment because it’s hard to explain and often
misdiagnosed as being “nervous.” Other people—even doctors—may not take
restless legs seriously, recognize the symptoms, or realize it’s a
real medical condition. Those who haven’t experienced the distressing
symptoms may not understand how severely restless legs syndrome can
impact the quality of your life and that of your bed partner.
The good news is that recent research has increased
our understanding of restless legs syndrome (RLS), leading to more
effective treatments. At the same time, restless legs syndrome is
becoming more widely recognized. If you or your partner suffers from
restless legs syndrome, there are plenty of options to help you find
relief and get the sleep you need.
What causes restless legs syndrome (RLS)?
Experts believe that restless legs syndrome is
caused by an imbalance of dopamine, a chemical that transmits signals
between nerve cells in the brain. Restless legs syndrome is usually
genetic. About 60% of people with restless legs have a family member
with the condition. Although anyone can have restless legs syndrome, it
is more common in older adults and women. In fact, about 40% of
mothers experience temporary restless legs syndrome during pregnancy.
Health conditions such as diabetes, iron deficiency, rheumatoid
arthritis, and kidney failure can also trigger restless legs syndrome.
Signs and symptoms of restless legs syndrome (RLS)
Not only are the signs and symptoms of restless legs
syndrome (RLS) different from person to person, they can be tricky to
explain. Some describe the leg sensations as “creeping,” “prickling,”
“burning,” “tingling,” or “tugging.” Others say it feels as if bugs are
crawling up their legs, a fizzy soda is bubbling through their veins,
or they have a “deep bone itch.”
The symptoms of restless legs syndrome (RLS) can
range from mildly annoying to severely disabling. You may experience
the symptoms only once in a while, such as when you’re under a lot of
stress, or restless legs may plague you every night. In severe cases of
restless legs syndrome (RLS), you may experience symptoms in your arms
as well as your legs.
- Leg discomfort and strong urge to move – Uncomfortable
sensations deep within the legs, accompanied by a strong, often
irresistible urge to move them. Many describe the sensations as
tingling, jitteriness, a “creepy crawly” feeling, itching, or pulling.
- Rest triggers the symptoms – Leg
pain is usually trigged by activity and relieved by rest, but with
restless legs syndrome, the reverse is true. Restless leg symptoms
start or become worse when you’re sitting, relaxing, or trying to rest.
- Symptoms get worse night – Restless
legs syndrome (RLS) typically flares up at night, especially when
you’re lying down. In more severe cases, the symptoms may begin earlier
in the day, but they become much more intense at bedtime.
- Symptoms improve when you walk or move your legs – The
uncomfortable sensations temporarily get better when you move,
stretch, or massage your legs. The relief continues as long as you keep
moving.
- Nighttime leg twitching – Many
people with restless legs syndrome (RLS) also have periodic limb
movement disorder (PLMD), a sleep disorder that involves repetitive
cramping or jerking of the legs during sleep. These leg movements
further disrupt your sleep.
Do your symptoms indicate restless legs syndrome (RLS)?
How many of the questions below are true for you?
- When you sit or lie down, do you have a strong desire to move your legs?
- Does your desire to move your legs feel impossible to resist?
- Have you ever used the words unpleasant,
creepy-crawly, creeping, itching, pulling, or tugging to describe your
symptoms to others?
- Does your desire to move often occur when you are resting or sitting still?
- Does moving your legs make you feel better?
- Do you complain of these symptoms more at night?
- Do you keep your bed partner awake with the jerking movements of your legs?
- Do your ever have involuntary leg movements while you are awake?
- Are you tired or unable to concentrate during the day?
- Do any of your family members have similar complaints?
- Does a trip to the doctor only reveal that nothing is wrong and there is no physical cause for your discomfort?
If you answered "yes" to a majority of these questions, you may have RLS.
Source:
Restless Legs Syndrom Foundation
Lifestyle treatments for restless legs syndrome (RLS)
There is a lot you can do to take care of restless
legs syndrome yourself. Mild restless legs syndrome (RLS) can often be
treated with lifestyle changes alone. The following daytime habits can
help reduce the frequency and severity of your restless legs symptoms.
- Sleep better by sticking to a regular sleep schedule.
Fatigue can worsen the symptoms of restless legs syndrome (RLS), so
doing what it takes to get enough sleep is crucial. Try hitting the sack
at the same time every night, allowing plenty of time for winding down
(try warm baths or reading in bed).
- Exercise in moderation.
Daily activity, including moderate aerobic exercise and lower-body
resistance training, can significantly reduce the symptoms of restless
legs syndrome (RLS). Swim, go for a walk, take the stairs, or spend a
few minutes doing jumping jacks. Keep in mind that excessive
exercise—like training for a marathon—can actually make restless legs
syndrome worse.
- Cut back on caffeine. Caffeine
often makes the symptoms of restless legs syndrome (RLS) worse. Try
reducing or eliminating your consumption of coffee, tea, soft drinks,
and caffeine-containing foods such as chocolate.
- Avoid alcohol and cigarettes. Many people with restless legs syndrome find that their symptoms improve when they stop drinking and smoking.
- Consider dietary supplements. Check
with a doctor or nutritionist to find out if you’re low on iron,
vitamin B, folic acid, or magnesium. Deficiencies can bring on restless
legs syndrome (RLS).
- Lose weight. If you’re overweight, dropping the extra pounds can often relieve or lessen the symptoms of restless legs syndrome (RLS).
- Try practicing relaxation techniques such as yoga and meditation.
Stress can make RLS symptoms worse. Daily stretching and meditation
can promote relaxation and alleviate restless legs syndrome (RLS).
Keep a sleep diary of restless legs syndrome (RLS) symptoms
Click here
to download Helpguide’s sleep diary. Logging changes in your diet,
lifestyle, sleep habits, and routine might help you and your doctor make
helpful changes to combat restless legs syndrome (RLS).
Self-help treatment for restless legs syndrome (RLS)
Living well with restless legs syndrome (RLS) means knowing how to
manage situations where you must be still. The following tips and tricks
will help you control restless legs syndrome so it doesn’t control
you.
- Pressure can help relieve the discomfort of restless legs
syndrome (RLS). Try wearing compression socks or stockings or wrap your
legs in bandages (but not so tight you’ll cut off circulation).
- Try sleeping with a pillow between your legs. It may prevent nerves in your legs from compressing.
- Try to find or create a work setting where you can be active. If
you work at an office, look into a desk that lets you stand and type.
- Tell friends, family, and coworkers why you have to move more
than others. They’ll likely be accommodating and want to help you
create a healthy environment.
- Choose an aisle seat at movies and on planes so that you can get up and move.
- Give yourself stretch breaks at work and during long car rides.
Stretches for restless legs syndrome (RLS)
Simple stretching can help stop the symptoms of restless legs
syndrome (RLS) in their tracks. Here’s a handful to help you get
started.
- Calf stretch – Stretch out arms so that palms
are flat against a wall and elbows are nearly straight. Keep right knee
slightly bent and step back a foot or two with left leg, positioning
the heel and foot flat on the floor. Hold for 20 to 30 seconds. Now
bend left knee while still keeping the heel and foot flat on the floor.
For a deeper stretch, move foot back a bit farther. Switch legs and
repeat.
- Front thigh stretch – Stand parallel to a wall
for balance. Keep one leg straight and bend other knee and hold ankle to
pull your heel up toward your buttock. Hold for 20 to 30 seconds.
Switch legs and repeat.
- Hip stretch – Stand facing a chair, with the
back for the chair against a wall for support. Raise left foot up and
rest it flat on the chair, with knee bent. (Or try placing your foot on
a stair while holding the railing for balance.) Keeping spine as
neutral as possible, press pelvis forward gently until you feel a
stretch at the top of the right thigh. Your pelvis will move forward
only a little. Hold for 20 to 30 seconds. Switch legs and repeat.
Tips for relieving restless legs syndrome (RLS) symptoms in the moment
- Get up and walk around
- Take a cold shower
- Soak in a hot tub
- Massage your legs
- Take an over-the-counter pain reliever
- Distract yourself with a game or activity
- Apply hot or cold packs to your legs
- Do leg stretches and exercises
Treatment for restless legs syndrome (RLS)
If self-help doesn’t relieve your restless legs syndrome (RLS)
symptoms, you may benefit from visiting a doctor or a sleep specialist.
Diagnosing restless legs syndrome (RLS)
While there are no laboratory tests that can
determine if you have restless legs syndrome, your doctor can diagnose
it by reviewing your medical history and conducting a physical exam. To
diagnose restless legs syndrome (RLS), your doctor will request:
- A complete medical history
- A survey to see if anyone else in your family has similar symptoms
- A diagnostic interview, to rule out other medical conditions
- A blood test for low iron levels
Your doctor may also review the medications you’re
taking. Some prescription drugs and over-the-counter drugs can make the
symptoms of restless legs syndrome worse.
Medications that can make restless legs syndrome (RLS) worse
- Over-the-counter sleeping pills
- Antihistamines (found in many cold and allergy pills such as Benadryl, NyQuil, and Dimetapp)
- Anti-nausea medications (such as Antivert, Compazine, and Dramamine)
- Calcium channel blockers (used for high blood pressure and heart problems)
- Antidepressants (such as Prozac, Effexor, and Lexapro)
- Antipsychotics (used for bipolar disorder and schizophrenia)
If a medical condition, such as an iron deficiency,
diabetes, or nerve damage is triggering your restless legs syndrome,
treating the underlying problem may relieve your RLS symptoms. But if
there is no underlying condition and lifestyle changes don’t bring
enough relief, you may need medication to reduce the restlessness in
your legs.
Medication as treatment for restless legs syndrome (RLS)
No single medication works for everyone with restless legs syndrome
(RLS). In fact, a drug that relieves one person’s restless legs may
actually make your symptoms worse. In addition, many people with
restless legs syndrome find that even medications that work initially
become less effective over time.
It’s also important to be aware of potential side effects, such as
nausea, headache, and daytime sleepiness. If you struggle with
compulsive shopping, gambling, or binge eating there is also a risk that
medication for restless legs syndrome (RLS) could make these problems
worse.
Before using medication for the treatment of restless legs syndrome (RLS)
Have you…
- given self-help a fair shot at non-medication treatments?
- considered how medication side effects may impact your life?
- weighed the pros and cons of medication vs. lifestyle changes?
- talked to your doctor about existing health conditions and drugs you’re taking?
Parkinson’s medication for restless legs syndrome (RLS)
Two medications have been have been approved by the US Food and Drug
Administration (FDA) for the treatment of restless legs syndrome:
- pramipexole (Mirapex)
- ropinirole (Requip)
These medications, originally used to treat
Parkinson’s disease, reduce the amount of motion in your legs by
boosting your dopamine levels or mimicking its effect in the brain.
Other Parkinson’s drugs that are sometimes used to treat restless legs
syndrome (RLS) include Sinemet (carbidopa/levodopa),
cabergoline and pergolide.
Side effects of Parkinson's medications for restless legs syndrome
include nausea, lightheadedness, fatigue, and an increased risk of
heart disease.
Other common medications for restless legs syndrome (RLS)
- Prescription painkillers (such as
codeine, oxycodone, Vicodin, and Percocet) can provide relief in
severe, unrelenting cases of restless legs syndrome. However,
prescription painkillers can be addictive. Side effects include nausea,
dizziness, and constipation.
- Sleep medications and muscle relaxants
(such as Ambien, Sonata, and Klonopin) can help you sleep better if the
symptoms of restless legs syndrome keep you up at night. However,
these medications do not eliminate the leg sensations and can cause
daytime drowsiness.
- Anti-seizure medications (such as
Neurontin, Tegretol, and Epitol) can be effective for painful daytime
symptoms of restless legs syndrome. Side effects include dizziness and
drowsiness.
It's normal for people to be restless at the most awkward times e.g. at
night, in a car or in an exam room. You just have to know how to avoid
it in the first place. 
