Restless Leg Syndrome

The main causes of restless leg syndrome include brain dopamine concentrations, genetic history, and brain iron concentrations.

Restless leg syndrome (RLS, restless legs syndrome) is an overwhelming urge to twitch and move the legs, usually when sitting or lying down. It is a common cause of painful legs.

The leg pain of restless leg syndrome typically eases with the motion of the legs and becomes more noticeable at rest. Restless leg syndrome also features worsening symptoms and leg pain during the early evening or later at night.

Restless leg syndrome is often abbreviated as RLS; it has also been termed shaking leg syndrome. Nighttime involuntary jerking of the legs during sleep is also known as periodic leg/limb movement disorder.

Restless leg syndrome (RLS) can be classified into two forms:

1. Early-onset RLS: People with early-onset RLS have symptoms beginning before the age of 45 years old.
   • These people are more likely to have a family history of the disorder.
   • They frequently suffer from RLS without any associated discomfort.
   • Women tend to develop RLS at a younger age than men.
2. Late-onset RLS: Late-onset RLS may be caused by neurological disorders and may be present with pain in the legs.
   • People with late-onset RLS may not have a family history of RLS.

The cause of restless leg syndrome is unknown to most people; however, restless leg syndrome has been associated with the following:

• Pregnancy
• Obesity
• Smoking
• Iron deficiency and anemia
• Nerve disease
• Polyneuropathy (which can be associated with hypothyroidism, heavy metal toxicity, toxins, and many other conditions)
• Other hormone diseases such as diabetes
• Kidney failure (which can be associated with vitamin and mineral deficiency)

Some drugs and medications have been associated with restless leg syndrome including:

• Caffeine
• Alcohol
• H2-histamine blockers (such as ranitidine [Zantac] and cimetidine [Tagamet]), and certain antidepressants (such as amitriptyline [Elavil, Endep])

Occasionally, restless leg syndrome runs in families. Recent studies have shown that restless leg syndrome appears to become more common as a person ages. Also, poor venous circulation of the legs (such as with varicose veins) can cause restless leg syndrome.

Restless leg syndrome is relatively common during pregnancy, especially in the second half of pregnancy. While most medications used to treat restless leg syndrome have not been adequately studied in pregnant women, the non-medication treatments and techniques described above can be very helpful. Furthermore, avoiding caffeine, warm compresses, massage, and regular exercising according to the doctors' suggestions can be helpful.

Risk factors for developing restless leg syndrome include:

• Female gender
• Lifestyle factors
  • Higher body mass index (BMI)
  • Sedentary lifestyle
  • Smoking
  • Poor diet
• Pregnancy
• Low iron levels
• Lower socioeconomic status
• Poor health
• Elderly age
• Certain medical conditions
  • Parkinson's disease
  • Chronic kidney disease
  • Psychiatric disorders
  • Neuropathy (nerve damage)
  • Spinal cord issues (injuries, tumors, and other conditions)
  • Multiple sclerosis (MS)
• Family history of RLS
• Problems with circadian rhythm
• Abnormalities in other neurotransmitters like serotonin, glutamate, adenosine, histamine, and gamma-aminobutyric acid (GABA)
• Problems with nerves or blood flow in the legs

Many different symptoms are described by people with restless leg syndrome, for example:

• Leg pain
• Cramps
• Tingling
• Itchy
• Burning
• Aching

The characteristic nighttime worsening of symptoms in persons with restless legs syndrome frequency leads to insomnia. Because of lack of sleep, children and some adults may be very drowsy, irritable, and aggressive during daytime hours.

Restless leg syndrome usually begins slowly. Over time, the legs become more affected. Less frequently, restless leg syndrome can affect the arms.

Your primary care doctor may diagnose and treat restless leg syndrome. Your doctor may also refer you to a neurologist or a sleep specialist.

The National Institutes of Health says that four criteria must be met for the diagnosis of RLS in a person (adult or child):

• A strong urge to move your legs. This urge often, but not always occurs with unpleasant feelings in your legs. When the disorder is severe, you also may have the urge to move your arms.
• Symptoms that start or get worse when you're inactive. The urge to move increases when you're sitting still or lying down and resting.
• Relief from moving. Movement, especially walking, helps relieve unpleasant feelings.
• Symptoms that start or get worse in the evening or at night.

Treatment of restless leg syndrome is first directed toward any underlying illness if known, which may include:

• Blood testing to reveal underlying iron deficiency anemia may reveal the underlying cause.
• If varicose veins are thought to be the cause, then surgery to repair the circulation may be considered.
• Reduction or elimination of caffeine, nicotine, and alcohol from a person's diet can be very helpful.
• Stopping smoking can significantly diminish or prevent symptoms.
• Getting better sleep and exercise can help some persons affected by restless legs.
• Pregnant women who do not sleep well at night and other people with sleep disorders may develop RLS.

Medications used to treat restless leg syndrome include:

• natural supplements (such as iron)
• carbidopa-levodopa (Sinemet)
• opioids (such as hydrocodone, or tramadol [Ultram] for intermittent symptoms)
• carbamazepine (Tegretol, Tegretol XR, Equetro, Carbatrol)
• clonazepam (Klonopin)
• diazepam (Valium)
• triazolam (Halcion)
• temazepam (Restoril)
• baclofen (Lioresal)
• bromocriptine
• clonidine (Catapres, Catapres-TTS, Jenloga)
• gabapentin (Neurontin)
• gabapentin enacarbil (Horizant ER)
• ropinirole (Requip)
• pramipexole (Mirapex)
• rotigotine patch (Neupro)

Other treatments that have been helpful for some people with restless leg syndrome include:

• Warm/cold baths
• Electric nerve stimulation
• Oral magnesium
• Acupuncture
• Natural treatments such as quinine water at bedtime (tonic water)

Anxiety may trigger or increase RLS symptoms according to some researchers. Some people have experienced a decrease in anxiety by using over-the-counter (OTC) products, natural home remedies, and naturopathic treatments for anxiety, for example, lavender soap fumes or acupuncture. These natural treatments may reduce symptoms of RLS.

Some of these natural remedies may cause side effects. Talk to your doctor before using home remedies or alternative treatments for restless leg syndrome.

You can fall asleep with restless legs by making certain lifestyle changes, such as:

1. Relax before bedtime: Relaxing yourself with a soothing night ritual may relieve restless legs. Try reading a book in bed, listening to soft music, or taking a hot bath before bed will help you relax.
2. Stretch before bed: Yoga, Pilates, and other stretching practices can frequently assist in relaxing both the mind and the body.
3. Avoid stimulants: Consumption of stimulants, such as coffee or any beverage that contains caffeine, alcohol, or nicotine, should be avoided because they can exacerbate restless legs syndrome (RLS).
4. Avoid electronics: The blue light from screens stimulates your brain and suppresses sleep hormones, so it is recommended to avoid using electronics one to two hours before bedtime.
5. Maintain optimum temperature: You tend to fall asleep faster in dark, quiet, and cool rooms. Keep your bedroom well-ventilated and slightly on the cooler side.
6. Stick to a sleep schedule: Going to bed and waking up at the same time every day can help your body's normal sleep patterns. You must follow a sleep schedule even during weekends.
7. Sleep with a pillow between legs: Sleeping with a cushion between your legs may be an option. It may provide comfort and support to your legs resulting in fewer overnight RLS symptoms.
8. Iron supplements: Iron deficiency may cause restless legs syndrome even when you do not have anemia. If your doctor confirms that you have lower iron levels, you may be prescribed iron supplements.
9. Dopamine agonists: The U.S. Food and Drug Administration approved dopamine agonists pramipexole and rotigotine to treat RLS. Dopamine agonists limit the urge to move, relieve sensory complaints in the legs, and reduce involuntary leg jerks during sleeping.
10. Other drugs: Medical conditions, such as diabetes, thyroid issues, and others, can cause restless legs syndrome. Treating these conditions with appropriate medications and keeping them under control may prevent flare-ups of RLS.

Muscle relaxants, opioids, and sleep medications may relieve pain and help you get good sleep.

There is no cure for restless leg syndrome; however, the condition usually responds well to home remedies and medications. The outlook is excellent for people with restless leg syndrome as long as it does not weaken or damage the function of the legs.

Because restless legs syndrome (RLS) flares up during rest, the sensations urge you to move your legs constantly all through the night. You may get fewer hours of sleep each night if you have RLS.

• Many people with severe instances of RLS sleep for fewer than five hours every night.
• Milder instances of RLS do not disrupt your sleep as much; however, it can still result in a poor quality of sleep.

The accumulated sleep loss from restless legs syndrome can leave you drowsy during the day, irritated, and make concentrating difficult. This may have a significant influence on both your work and personal life.

People who suffer from restless legs syndrome are more prone to suffer from depression or anxiety.

Many conditions can mimic restless leg syndrome including:

• Parkinson's disease
• Fibromyalgia
• Muscle diseases
• Joint conditions
• Nerve problems such as peripheral neuropathy caused by diabetes (diabetic neuropathy)
• Circulation difficulties

In children, restless leg syndrome is often misdiagnosed as "growing pains."

While you cannot prevent restless leg syndrome, you can help prevent the onset of symptoms through lifestyle changes, such as avoiding the triggers of the condition.

Symptoms of RLS are triggered and worsened by the following:

• Alcohol
• Nicotine
• Caffeine
• Stress
• Obesity
• Lack of physical activity
• Prolonged exposure to cold weather
• Fatigue
• Medications used to treat the following:
  • Nausea
  • Antihistamines for colds and allergies
  • Antidepressants
  • Antipsychotics
  • Diuretics
  • Calcium channel blockers
  • Spinal anesthesia