Do you have trouble sleeping at night? Have you been having unpleasant or strange sensations in your legs? Do you find that you have an uncontrollable urge to move your legs when you are sitting or lying down? If so, you might have a condition called restless legs syndrome. Read on to learn more.
What is restless legs syndrome?
Restless legs syndrome (RLS), also called Willis-Ekbom Disease, is classified as a sleep disorder, and for good reason, since symptoms are triggered by resting and attempting to sleep. But it’s also classified as a movement disorder, as well, since people with this condition move their legs to help relieve symptoms, according to the National Institute of Neurological Disorders and Stroke (NINDS) of the National Institutes of Health (NIH). However, NINDS states that this condition is “best characterized as a neurological sensory disorder with symptoms that are produced from within the brain itself.”
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RLS can greatly affect quality of life since it causes exhaustion and daytime sleepiness. In turn, this affects mood, concentration, job performance, and personal relationships. Untreated RLS can also cause anxiety and depression. The NINDS estimates that up to 7-10% of people in the U.S. have RLS, and the prevalence is higher in people who have diabetes.
What are the symptoms of restless legs syndrome?
The main symptom of RLS is an urge to move the legs. This is due to sensations in the legs that include:
- Throbbing
- Itching
- Crawling
- Pulling
- Creeping
- Burning
These symptoms tend to occur at bedtime, although they can occur during any extended time of inactivity, such as driving or sitting.
RLS primarily affects the legs, but some people may experience this in their arms and rarely, in the chest or the head. Symptoms can affect one side or both sides of the body.
Moving the legs or the arms helps to relieve symptoms, so people with RLS tend to frequently keep their legs in motion by tossing and turning in bed, moving their legs while they are sitting, or getting up to walk around. Symptoms may vary in severity and frequency; when RLS symptoms occur more than twice a week, sleep and daytime function can be severely impaired.
People with RLS may have a remission of symptoms, but symptoms tend to become more severe over time. Also, people who have RLS and another medical condition tend to have more severe symptoms that develop more quickly.
Who gets restless legs syndrome?
The Sleep Foundation states that RLS affects 5-10% of adults and 2-4% of children. It’s more common in women than men, and more severe symptoms tend to occur in older adults. RLS can begin at any age, and symptoms become more frequent and last longer with age.
What causes restless legs syndrome?
RLS can be genetic, meaning that it can run in families who develop symptoms before the age of 40. NINDS says that there is evidence that RLS is related to a dysfunction in a section of the brain called the basal ganglia that controls movement and that uses a chemical called dopamine. Dopamine is needed to produce smooth, purposeful muscle activity and movement. When dopamine pathways in the brain are disrupted, for example, in the case of Parkinson’s disease, it can result in involuntary movements. Of note, people with Parkinson’s disease have a higher risk of developing RLS.
In addition, RLS can occur because of other factors or conditions, including:
- End-stage kidney disease and hemodialysis
- Peripheral neuropathy
- Pregnancy
- Iron deficiency
- Hypothyroidism
- Diabetes
- Rheumatoid arthritis
- Spinal cord conditions
- Use of alcohol, nicotine, and caffeine
Some medications may trigger RLS symptoms, such as:
- Anti-nausea drugs
- Antipsychotic drugs
- Antidepressants that increase serotonin
- Cold and allergy medicines that contain diphenhydramine
- Calcium channel blockers, used to treat high blood pressure, angina, and arrhythmias
Why do people with diabetes have a higher risk of restless legs syndrome?
Having diabetes is a risk factor for RLS. Experts believe that long-term high blood sugars can cause nerve damage (neuropathy); nerve damage in the lower legs and feet may contribute to RLS.
A meta-analysis published in the journal The Lancet in 2022, which included approximately 836,000 people, showed that RLS occurred in 25% of people with diabetes (much higher than in the general population). Also, up to 96% of people with both RLS and type 2 diabetes have diabetic neuropathy.
How is restless legs syndrome diagnosed?
There’s no specific test for RLS, but certain criteria strongly suggest RLS. These include the urge to move the legs that:
- Is associated with unpleasant sensations
- Starts or worsens during rest or inactivity
- Is partially or totally relieved by movement
- Is aggravated in the evening or night
- Can’t be explained by another medical or behavioral condition
A health care provider should do a physical and neurological exam, as well as take your medical and family history and ask you about your symptoms. They may run blood tests to check for issues such as iron deficiency anemia, and other lab tests to check for conditions such as kidney disease. You may also be referred to a sleep specialist if sleep apnea is suspected.
How is restless legs syndrome managed?
Treatment of RLS can depend on any underlying causes as well as severity of symptoms, and may include:
- Lifestyle measures: These can include avoiding or limiting alcohol, caffeine, and tobacco; establishing more regular sleep habits; exercise; leg massage; and taking a warm bath or using a heating pad or ice pack.
- Medical devices: The FDA has approved two devices to treat RLS, including a compression foot wrap and a vibrating pad. These are available by prescription and are intended for people with moderate to severe RLS.
- Dietary supplements: For low ferritin and low transferrin saturation, which can indicate an iron deficiency, iron supplements may be recommended. In some cases, iron given through an IV may be needed. There is also some evidence that magnesium supplements can reduce RLS symptoms. Check with your health care provider before taking iron or magnesium supplements, however.
- Medications: Medication may be prescribed for moderate to severe RLS. These can include anti-seizure drugs, such as gabapentin and pregabalin, dopaminergic agents (used to treat Parkinson’s disease), benzodiazepines, such as clonazepam and lorazepam, and opioids, such as methadone, codeine, hydrocodone, and oxycodone. Since some of these medications can cause serious side effects, including addiction, they might only be prescribed if other treatments don’t work.
If you think you might have RLS, talk with your health care provider about your symptoms, as well as the best treatment for you.
Want to learn more about sleeping well with diabetes? Read “Getting the Sleep You Need,” “Eating for Better Sleep” and “Feeling Fatigued: Here’s How to Fight It.”
