Do you experience any strange sleeping behaviors or know someone who does? Restless leg syndrome can occur during sleep, but what is it all about? Out of curiosity, I searched for the answers and here it is.
What is Restless Leg Syndrome? Restless leg syndrome is a long term disorder that causes a strong urge to move one’s legs. There is often an unpleasant feeling in the legs but “improves” when moving the legs.
Restless leg syndrome is also called the “Willis-Ekbom Disease” and it is often described as aching, tingling or crawling in nature. For rare cases, the arms can also be affected by this disease.
The disease normally occurs before sleep or when simply at rest. Meaning, the legs are usually unable to relax and urges the patient to keep moving them.
Due to the fact that it definitely makes sleeping difficult, may patients experience the consequences of sleep-deprivation and often face daytime sleepiness or hypersomnia.
It is also common for patients to feel tired all the time and lose control of their emotional stability. Some even lose control of their weight gain.
The disease can also cause depression or potentially worsen it.
Some reports also show that patients may experience limb twitching during sleep or periodic limb movement disorder (PLMD), which is also another sleep disorder.
Females are more commonly affected by restless leg syndrome than males and it becomes more common with age. The syndrome affects an estimated 2.5 to 15% of the American population.
There are two main types of restless leg syndrome one can be diagnosed with.
- Two Main Types of Restless Leg Syndrome:
- Early Onset Restless Leg Syndrome
- Usually starts before age 45 and runs in families, implying that it can be inherited. As the affected person ages, the disease also worsens.
- Late Onset Restless Leg Syndrome
- Begins after age 45 and it can start all of a sudden, but does not worsen unlike the early onset RLS.
- Early Onset Restless Leg Syndrome
Symptoms
Other than the biggest and most obvious symptom that is the uncontrollable moving of the legs caused by an uncomfortable “pain” in the legs, there are other symptoms that can also help verify the illness.
- Strange sensation in the legs
- Examples are unexplained itching, tingling or “crawling” sensations occurring deep within the legs and may also occur in the arms
- The sensations can also be described as:
- Creeping
- Pulling
- Throbbing
- Aching
- Electric
- The sensations can also be described as:
- Examples are unexplained itching, tingling or “crawling” sensations occurring deep within the legs and may also occur in the arms
- The sensation begins at rest
- The uncomfortable sensations only occur at rest when there is no activity
- Moving relieves the sensation
- If the strange sensation goes away after moving the legs or affected area such as the arm, it’s a sign of restless leg syndrome
- Worsened condition at night
- At night or evening, the symptoms appear to be worsened since there are usually less activity at that time to keep the body “distracted”
- Restless sleep
- Difficulty going to sleep by moving continuously, switching positions every minute, rubbing the legs, stretching and folding the legs
- Night time leg twitching
- Periodic limb movement disorder (PLMD) is often associated with restless leg syndrome. The twitching sensation causes the person to unconsciously move their legs during sleep.
- Not caused by any medical or behavioral condition
- If all of the symptoms above occur without explanation or is not caused by a medical or behavioral problem, then it can be considered as clear signs of restless leg syndrome
Other symptoms may also be applied as the effect of the restless leg syndrome.
- Hypersomnolence
- Hypersomnia is “daytime sleepiness”. People with restless leg syndrome struggle to sleep properly at night and thus, may feel excessive daytime sleepiness after waking.
- Feeling tired all the time
- Restless sleep can lead to unwanted fatigue in the day and may carry on throughout the day
- Lack of emotional stability
- Disrupted sleep can also disrupt the hormone production inside the body, causing irritability and other emotional distress
- Uncontrolled weight gain
- When the hormone production activity is affected by poor sleep quality, it can cause a person to gain weight faster than normal
- Decreased ability to focus
- Sleep deprivation takes away the body’s energy and also disrupts the overall health of the body, leading to a decreased ability to focus or stay focused
Please keep in mind that experiencing one or more of the listed symptoms does not automatically mean you might have restless leg syndrome as it can be a sign of other illnesses as well.
For better diagnosis, consult your doctor.
Diagnosis
Diagnosing restless syndrome is generally based on the person’s symptoms after ruling out its other potential causes.
There are no specific tests for restless leg syndrome, but non-specific laboratory tests can be used to rule out other causes such as vitamin deficiencies. Five symptoms are often used to confirm the diagnosis.
- Five Symptoms of Restless Leg Syndrome
- Uncontrollable urge to move the limbs
- Occurs during rest or inactivity of the body
- The disease temporarily disappears with activity
- It worsens in the evening or at night time
- Not caused by any medical or behavioral condition
- Other symptoms for Restless Leg Syndrome
- Hereditary or genetic component
- Positive response to dopaminergic therapy
- Recurring leg movements during day or sleep
- The disease strongly affects middle-aged people
- Experiencing other sleep disturbances
- Iron deficiency or decreased iron stores
The main symptoms have to be associated with a sleep disturbance or impairment in order to complete a restless syndrome diagnosis.
Conducting a sleep study or a polysomnography is also one of the tests that can be done to determine what may be causing the restless leg syndrome.
(Related: “How to Do a Sleep Study?”)
Differential Diagnosis
There are diseases that may be confused with or should be differentiated from restless leg syndrome. Here are some common conditions that is often mistaken for restless leg syndrome.
- Common differential diagnosis
- Positional discomfort
- Local leg injury
- Arthritis
- Leg cramps
- Leg edema
- Venous stasis
- Peripheral neuropathy
- Habitual foot tapping or leg rocking
- Anxiety
- Radiculopathy
- Myalgia
- Drug-induced akathisia
- Less common differential diagnosis
- Peripheral artery disease
- Myelopathy
- Myopathy
- Vascular or neurogenic claudication
- Hypotensive akathisia
- Orthostatic tremor
- Moving toes
- Painful legs
Causes
There are different possible causes behind restless leg syndrome and plenty of risk factors that people should be aware of in order to have an idea what may be causing the illness or worsening it.
- Low iron levels (iron deficiency)
- Iron deficiency, with or without anemia, can cause or worsen restless leg syndrome.
Bleeding from your stomach or bowels, experiencing heavy menstrual periods are signs of iron deficiency. Repeatedly donating blood can also cause low iron levels.
- Iron deficiency, with or without anemia, can cause or worsen restless leg syndrome.
- Attention Deficit Hyperactivity Disorder (ADHD)
- Studies has shown that there are links between ADHD and restless leg syndrome as both have dysfunctions related to the neurotransmitter dopamine.
Both also have similar medications that work for each other.
A study in 2005 suggested that approximately 44% of people with ADHD that had existing restless leg syndromes and up to 26% of people with restless leg syndrome also had ADHD.
- Studies has shown that there are links between ADHD and restless leg syndrome as both have dysfunctions related to the neurotransmitter dopamine.
- Genetics or Hereditary
- Restless leg syndrome can run in families and can be passed down through genetics
- Kidney failure
- When kidneys don’t function properly, iron stores in your blood can decrease. This and other changes in body chemistry may cause or worsen restless leg syndrome.
- Parkinson’s disease
- Parkinson’s disease is a long-term degenerative disorder of the central nervous system that mainly affects the motor system, which is why it may cause or worsen restless leg syndrome.
- Pregnancy
- Pregnancy will cause hormonal changes that may temporarily worsen the symptoms of restless leg syndrome.
Some women encounter the disease for the first time during pregnancy especially during their last trimester. However, signs and symptoms usually disappear after giving birth.
- Pregnancy will cause hormonal changes that may temporarily worsen the symptoms of restless leg syndrome.
- Diabetes
- Rheumatoid arthritis
- Using antidepressants
- Antipsychotics
- Antihistamines
- Calcium channel blockers
If you suspect that you may have restless leg syndrome, please consult a doctor immediately.
Treatment
For most cases, restless leg syndrome can be resolved by treating the underlying cause behind it. Curing primary restless syndrome itself is still not possible, but treating its symptoms can be done.
Usually, treatment also includes lifestyle changes along with the help of medication. Here’s a list of treatments that may involve basic lifestyle changes, medications or more.
- Avoid or limit alcohol consumption
- Alcohol can affect your body’s overall health, but mostly, it causes the muscles to relax too much but may trigger the “strange sensations” for people with the syndrome.
- Avoid or limit smoking cigarettes
- Nicotine may also cause discomfort for your lungs and can worsen the effects of restless leg syndrome.
- Follow a proper sleep routine
- Some health experts state that a proper sleep routine can help control the severity of restless leg syndrome
- Stay away from caffeine
- Caffeine can heighten your senses and may actually worsen the effects of restless leg syndrome
- Get plenty of exercises
- Getting the right amount of physical activity can help control the effects of restless leg syndrome, but avoid exercising too hard when it’s close to bed time.
- Try relaxing therapies
- Get a massage, sniff that lavender or use aromatherapy, do yoga and other relaxing activities that will not only help your mental health but also relax your body positively.
- Treat underlying causes
- Such as anemia, Parkinson’s disease, diabetes, nutritional deficiencies, thyroid disease and kidney disease
- Iron supplements
- There is some evidence that adequate iron supplementation moderately improves restlessness for people with restless leg syndrome.
- Pramipexole
- Medication used to treat restless legs syndrome (RLS) as well as Parkinson’s disease (PD). Other similar drugs reduce symptoms, improve sleep quality and quality of life.
- Levodopa
- Levodopa is a type of amino acid used in medications to increase dopamine concentrations
- Ropinirole
- Has a faster onset effect with shorter duration
- Rotigotine
- Commonly used as a transdermal patch which continuously provides stable plasma drug concentrations. It results in therapeutic effect for patients throughout the day.
- Gabapentin or pregabalin
- a non-dopaminergic treatment for moderate to severe primary restless leg syndrome
- Benzodiazepines
- Benzodiazepines are sedatives that may or may not always help relieve the symptoms which is why it is only used as a secondary option
- Alpha2 agonists
- This activates nerve cells (neurons) that “turn down” the part of the nervous system that controls muscle involuntary movements and sensations.
- Opioids
- Only used for severe cases of restless leg syndrome that do not respond to other measures due to their high rate of side effects, which may include constipation, fatigue, and headache.
Reminder: Most of these medications can be dangerous if used improperly. Please follow your doctor’s prescription and keep your usage to the level that is recommended for you.
For better guidance, consult your doctor to avoid unwanted drug addiction
Prognosis
Restless leg syndrome is known to gradually worsen as the affected patient ages. There is no direct cure for the disease itself, only for its symptoms.
However, the worsening may be slower for those with the idiopathic form of restless leg syndrome compared to those with medical conditions associated with the disease.
Currently, therapies that can control the disorder, minimizing its symptoms and increasing periods of restful sleep are the most commonly used methods of relieving the distress caused by the disease.
For some cases, some people also have remissions or periods when the symptoms may decrease or temporarily disappear for days and it may last for weeks up to months and then come back again randomly.
The symptoms will usually reappear first before the disease itself “reoccurs”.
As of now, being diagnosed with restless leg syndrome does not mean or indicate another neurological diseases like the Parkinson’s disease.
Restless leg syndrome symptoms can actually worsen over time when dopamine-related drugs are used for treatment.
A side effect called “augmentation” may represent symptoms occurring throughout the and affect movements of all limbs.
Epidemiology
According to studies, restless leg syndrome affects an estimated 2.5 to 15% of the American population.
And a minority of 2.7% experience daily symptoms of the disease that can either be mild or severe.
Restless leg syndrome is twice as common in woman than in men while Caucasians are more prone to restless leg syndrome than people of African descent.
The disease occurs in 3% of individuals from the Mediterranean or Middle Eastern region and in 1 to 5% of those from the Far East.
This indicates that different genetic or environmental factors such as diet may affect the prevalence of the restless leg syndrome.
When older aged people are diagnosed with restless leg syndrome, they may experience a stronger syndrome or have severe symptoms.
Apparently, the prevalence of restless leg syndrome tends to increase with age as well as its severity and longer duration of its symptoms.
The disease is also more common in people with iron deficiency, people that are pregnant or have an end-stage kidney disease. Poor general health is widely linked to restless leg syndrome.
The prevalence of restless leg syndrome among pregnant women is about 19% and 7% of these women with severe symptoms managed to have a complete recovery from the syndrome four weeks after giving birth.
Patients with uremia on the other hand, are treated by renal dialysis and have a prevalence from 20% to 57% while patients with kidney transplant have a substantial enhancement compared to those treated with dialysis.
History
The restless leg syndrome is also known as the “Willis-Ekbom Disease” and it was the first known medical description of restless leg syndrome made by Sir Thomas Willis back in 1672.
Sir Thomas Willis emphasized the sleep disruption and limb movements experienced by people with restless leg syndrome.
“Wherefore to some, when being abed they betake themselves to sleep, presently in the arms and legs,leapings and contractions on the tendons, and so great a restlessness and tossings of other members ensue, that the diseased are no more able to sleep, than if they were in a place of the greatest torture.”
— Sir Thomas Willis, wrote in his published work “De Anima Brutorum, 1672″ translated to The London Practice of Physick, 1685
Related Questions
What foods can help restless leg syndrome?
Foods that are rich in iron can treat iron deficiency which is believed to be potentially cause or worsen restless leg syndrome.
- Examples of food rich in Iron:
- Liver
- Spinach
- Dark leafy greens
- Dried fruit
- Red meat
- Poultry
- Pork
- Seafood
- Iron-fortified cereals
- Iron supplements
Is Restless Leg Syndrome serious?
No, for most cases, restless leg syndrome is not a serious disease but treating it is still important. Majority of people with restless leg syndrome have the idiopathic form which means there’s no known cause.
The idiopathic form also develops slower than the other type of restless leg syndrome. Restless legs syndrome can only get worse in people with other medical conditions if they don’t get those conditions treated.
According to experts, those with the idiopathic form of restless leg syndrome have lesser risks of developing other serious illnesses such as Parkinson’s disease.
Can anxiety cause restless leg syndrome?
Yes, anxiety is believed to cause but most often, believed to worsen restless leg syndrome. It is also possible that the syndrome itself is the one causing anxiety in a person.
As of today, the causes behind restless syndrome is still being studied and how mental related disorders such as anxiety or depression can possibly contribute to the illness.
