Restless Leg Syndrome Overview
Restless legs syndrome (RLS) is a disorder of the part of the nervous system that causes an urge to move the legs. Because it usually interferes with sleep, it also is considered a sleep disorder.
Symptoms of Restless Legs Syndrome
People with restless legs syndrome have uncomfortable sensations in their legs (and sometimes arms or other parts of the body) and an irresistible urge to move their legs to relieve the sensations. The condition causes an uncomfortable, “itchy,” “pins and needles,” or “creepy crawly” feeling in the legs. The sensations are usually worse at rest, especially when lying or sitting.
The severity of RLS symptoms ranges from mild to intolerable. Symptoms can come and go and severity can also vary. The symptoms are generally worse in the evening and at night. For some people, symptoms may cause severe nightly sleep disruption that can significantly impair their quality of life.
Who Gets Restless Legs Syndrome?
Restless legs syndrome may affect up to 10% of the U.S. population. It affects both sexes, but is more common in women and may begin at any age, even in young children. Most people who are affected severely are middle-aged or older.
RLS is often unrecognized or misdiagnosed. This is especially true if the symptoms are intermittent or mild. Once correctly diagnosed, RLS can often be treated successfully.
Causes of Restless Legs Syndrome
In most cases, doctors do not know the cause of restless legs syndrome; however, they suspect that genes play a role. Nearly half of people with RLS also have a family member with the condition.
Other factors associated with the development or worsening of restless legs syndrome include:
Chronic diseases: Certain chronic diseases and medical conditions, including iron deficiency, Parkinson’s disease, kidney failure, diabetes, and peripheral neuropathy often include symptoms of RLS. Treating these conditions often gives some relief from RLS symptoms.
Medications: Some types of medications, including antinausea drugs, antipsychotic drugs, some antidepressants, and cold and allergymedications containing sedating antihistamines, may worsen symptoms.
Pregnancy: Some women experience RLS during pregnancy, especially in the last trimester. Symptoms usually go away within a month after delivery.
Other factors, including alcohol use and sleep deprivation, may trigger symptoms or make them worse. Improving sleep or eliminating alcohol use in these cases may relieve symptoms.
Diagnosis of Restless Legs Syndrome
There is no medical test to diagnose RLS; however, doctors may use blood tests and other exams to rule out other conditions. The diagnosis of RLS is based on a patient’s symptoms and answers to questions concerning family history of similar symptoms, medication use, the presence of other symptoms or medical conditions, or problems with daytime sleepiness.
Treatment for Restless Legs Syndrome
Treatment for RLS is targeted at easing symptoms. In people with mild to moderate restless legs syndrome, lifestyle changes, such as beginning a regular exercise program, establishing regular sleep patterns, and eliminating or decreasing the use of caffeine, alcohol, and tobacco, may be helpful. Treatment of an RLS-associated condition also may provide relief of symptoms.
Other non-drug RLS treatments may include:
- Leg massages
- Hot baths or heating pads or ice packs applied to the legs
- Good sleep habits
- A vibrating pad called Relaxis
Medications may be helpful as RLS treatments, but the same drugs are not helpful for everyone. In fact, a drug that relieves symptoms in one person may worsen them in another. In other cases, a drug that works for a while may lose its effectiveness over time.
Drugs used to treat RLS include:
- Dopaminergic drugs, which act on the neurotransmitter dopamine in the brain. Mirapex, Neupro, and Requip are FDA-approved for treatment of moderate to severe RLS. Others, such as levodopa, may also be prescribed.
- Benzodiazepines, a class of sedative medications, may be used to help with sleep, but they can cause daytime drowsiness.
Narcotic pain relievers may be used for severe pain. - Anticonvulsants, or antiseizure drugs, such as Tegretol, Lyrica, Neurontin, and Horizant.
Although there is no cure for restless legs syndrome, current treatments can help control the condition, decrease symptoms, and improve sleep.
The International Restless Legs Syndrome Study Group described the following symptoms of restless legs syndrome (RLS):
Strange itching, tingling, or “crawling” sensations occurring deep within the legs; these sensations may also occur in the arms.
A compelling urge to move the limbs to relieve these sensations
Restlessness — floor pacing, tossing and turning in bed, rubbing the legs
Symptoms may occur only with lying down or sitting. Sometimes, persistent symptoms worsen while lying down or sitting and improve with activity. In very severe cases, the symptoms may not improve with activity.
Other symptoms of RLS include the following:
- Sleep disturbances and daytime sleepiness
- Involuntary, repetitive, periodic, jerking limb movements that occur either in sleep or while awake and at rest; these movements are called periodic leg movements of sleep or periodic limb movement disorder. Up to 90% of people with RLS also have this condition.
In some people with RLS, the symptoms do not occur every night but come and go. These people may go weeks or months without symptoms (remission) before the symptoms return again.
The specific causes of restless legs syndrome (RLS) are not known. Disease in the blood vessels of the legs or in the nerves in the legs that control leg movement and sensation was once thought to cause RLS, but both of these suggestions have been rejected.
RLS may be related to abnormalities in brain chemicals (neurotransmitters) that help regulate muscle movements, or to abnormalities in the part of the central nervous system that controls automatic movements. Research is still being done in these areas.
RLS can sometimes be caused by an underlying medical condition (secondary RLS); however, most of the time the cause is not clear.
What Medical Conditions Are Linked to RLS?
Many different medical conditions have been linked to RLS. The two most common conditions are iron-deficiency anemia (low blood count) and peripheral neuropathy (damage to the nerves of the arms and legs, often caused by underlying conditions such as diabetes).
Other medical conditions linked to RLS include:
- Parkinson’s disease
- Varicose veins
- Some tumors
- Fibromyalgia
- Hyper- or hypothyroidism (over- or underactive thyroid glands)
- Pregnancy
- Cigarette smoking
- Vitamin and mineral deficiency, such as magnesium deficiency and vitamin B-12 deficiency
- Severe kidney disease and uremia (kidney failure causing build up of toxins within the body)
- Amyloidosis (build-up of a starch-like substance in the body’s tissues and organs)
- Lyme disease
- Damage to spinal nerves
- Rheumatoid arthritis and Sjögren syndrome
Certain medications or substances, such as:
- Alcohol
- Caffeine
- Anticonvulsant drugs (such as Dilantin)
- Antidepressant drugs (including amitriptyline, Paxil)
- Beta-blockers (drugs often used to treat high blood pressure)
- Antipsychotics
- Withdrawal from certain drugs, such as vasodilator drugs (for example, Apresoline), sedatives, or antidepressants (for example, Tofranil)
What Are the Risk Factors for RLS?
In many cases, RLS seems to run in families. People with a genetic link to RLS tend to get the condition earlier in life.
Find out how doctors diagnose restless legs syndrome.
Learn about restless legs syndrome treatments.
View the full table of contents for Your Guide to Sleep Disorders.
Exams and Tests
In most people with restless legs syndrome (RLS), poor sleep and daytime sleepiness are the most bothersome symptoms. Many people do not link their sleepproblem with the strange sensations in their legs. If you are having these sensations, be sure to mention it to your health careprovider. This provides a very important clue to what is causing you to sleep poorly.
Sleep disturbances have many different causes. Your health care provider may ask you detailed questions, including current and prior medical problems, family medical problems, medications, work history, travel history, personal habits, and your lifestyle. Your health care provider will look for signs of an underlying cause for your sleep problem.
There is no lab test or imaging study that can prove that you have RLS.
However, certain tests can help identify underlying medical conditions such as anemia and metabolic disorders (diabetes or kidney disease, for example) that may be linked to RLS:
- You may have blood drawn to check your blood cell counts and hemoglobin, basic organ functions, chemistry, and thyroid hormone levels.
- Needle electromyography and nerve conduction studies may be done if your health care provider sees signs of nerve problems like neuropathy.
Polysomnography (sleep testing) may be necessary to diagnose the sleep disturbances and determine if you have periodic limb movements. This is especially important in people who continue to have significant sleep disturbances despite relief of RLS symptoms with treatment.
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