Restless Legs Syndrome

Restless legs syndrome (RLS), sometimes called shaking leg syndrome, represents a disorder that affects the nervous system causing an overwhelming and uncontrollable urge to move the lower limbs even during sleep, thus interfering with this normal and peaceful activity and leading to insomnia. This condition can affect anyone, regardless of the age, and it worsens throughout the years. Even though researchers have not discovered the main cause of restless legs syndrome, they associate many conditions with it. Doctors usually perform a detailed evaluation in order to provide necessary treatment, which generally consists in medications. Nevertheless, self-care and lifestyle changes can bring a significant personal contribution from the patient in treating restless legs syndrome.


Causes of Restless Legs Syndrome

At the beginning, specialists tried to link disease of the nerves or blood vessels in the lower extremities to restless legs syndrome, but this suggestion faced rejection so the specific cause of the unpleasant disorder remained unknown. Further research led specialists into believing in the existence of a connection between this condition and neurotransmitters that have the mission to control muscle movements or abnormalities in the central nervous system that control automatic bodily movements. Restless legs syndrome appears to be in relation with underlying conditions including iron deficiency and neuropathy, which refers to nerve damage in the arms and legs, renal disease in the last stage and pregnancy in the last trimester, certain medications like antidepressants, anti-nausea and antipsychotic drugs, alcohol and nicotine use. Other medical conditions involve Lyme disease and Parkinson’s disease, varicose veins and rheumatoid arthritis. Apparently, restless legs syndrome runs in families taking into account that researchers discovered specific gene variants that they immediately associated with the disease. In certain cases, sleep deprivation and sleep apnea can represent triggers for restless legs syndrome disturbing symptoms.


Signs and Symptoms of Restless Legs Syndrome

People with restless legs syndrome feel compelled to move their lower extremities due to abnormal and uncomfortable sensations in that area. They describe these sensations as itching, pulling, crawling, throbbing and creeping. In rare cases, the condition affects other parts of the body, such as the arms, chest and even the head. Some people experience mild symptoms considered irritating while other people define them as painful, thus the severity of the sensations vary from person to person. The only solution to obtain relief is constantly moving the legs even when lying in bed in order to reduce or prevent the sensations from occurring. Because symptoms of restless legs syndrome usually become worse during the night, people encounter difficulties falling and staying asleep. The much-needed opportunity for them to enjoy refreshing sleep is early in the morning, which strangely represents a symptom-free period. Symptoms vary not only in severity but also in frequency. Therefore, in moderate cases of restless legs syndrome, they occur approximately two times a week impeding the person to fall asleep as normally and disrupting daytime function while in severe cases, they occur more often resulting in troublesome sleep interruption and daytime function impairment. In early stages of restless legs syndrome, people can experience remissions meaning that symptoms show a surprising improvement that can last several weeks and even months. However, over time symptoms inevitably become more severe and unbearable. In people with restless legs syndrome and associated medical condition, symptoms generally develop faster.


Diagnosis of Restless Legs Syndrome

In the lack of specific tests for restless legs syndrome, doctors establish a diagnosis while taking into consideration basic criteria. The patient must show a powerful and irresistible urge to move the lower limbs following uncomfortable sensations that people normally do not experience. This unbearable urge of moving the legs worsens during inactive periods so it should aggravate in the evenings and during the nights. Leg movements partially or totally relieve the urge, even if just temporarily. Ultimately, if doctors do not find other medical condition responsible for the mentioned features, they start focusing on the only variant left, namely restless legs syndrome. Apart from providing information regarding his medical and family history, the patient must write down a list containing current medications and continue by describing the intensity, duration and frequency of the symptoms. A physician will pay close attention to the symptoms characteristics, triggers as well as relieving actions and factors. Performing a neurological and physical examination usually helps when attempting to establish a correct diagnosis for restless legs syndrome. Furthermore, laboratory tests allow doctors to eliminate the possibility of other conditions with similar symptoms including iron deficiency anemia, kidney failure and pregnancy. Sometimes, studying the patient’s sleep pattern enables the identification of other factors that lead to sleep disruption, like sleep apnea. Doctors generally encounter more difficulties when trying to establish a diagnosis for children because they do not know how to describe the experienced symptoms clearly and correctly, so consequently, doctors confound pediatric restless legs syndrome with attention deficit disorder.


Triggers of Restless Legs Syndrome

Due to the unknown cause and the undiscovered cure for the restless legs syndrome, knowing the specific factors that trigger the unpleasant symptoms is very important for minimizing or preventing them. Possible triggers refer to medication, lack of sleep, temperature, stress, clothing and refined sugar. Following a regular bedtime program and getting enough sleep may prevent symptoms of restless legs syndrome from becoming worse. Other effective solutions include performing relaxation techniques like meditation, yoga or deep breathing that have the power to reduce tension and anxiety, avoiding extreme temperatures and using cold showers and hot bats for temporary relief, wearing different clothes and removing processed foods from the diet as well as sweetened drinks.  Regular exercise consisting in walks before bedtime and gentle stretching can ease the symptoms of restless legs syndrome.


Treatment for Restless Legs Syndrome

Doctors cannot provide a specific cure for restless legs syndrome and for this reason, the main goal is to relieve the symptoms. In some cases, doctors can take control over the symptoms by identifying and treating an underlying condition, such as iron deficiency, diabetes or peripheral neuropathy. Because not all patients can take a wonder medicine that will manage restless legs syndrome, doctors need to test the efficiency of different drugs and determine which one works best for each patient. The most common medications prescribed by doctors to treat the condition involve dopamine agonists and dopaminergic agents, anticonvulsants and alpha2 agonists, opiates and benzodiazepines.

  • Dopamine agonists reduce motion in the patient’s legs by increasing dopamine level in his brain. However, their benefits come with unpleasant side effects including nausea, daytime sleepiness and lightheadedness while dopaminergic agents cause involuntary movements, hallucinations and vomiting if used daily.
  • Anticonvulsants decrease uncomfortable sensations in the lower extremities as well as nerve pain. Side effects refer to sleepiness, fatigue and dizziness.
  • Opiates like methadone, hydrocodone or codeine intervene when other medications do not provide satisfactory results in patients with severe symptoms of restless legs syndrome and provoke nausea, constipation and dizziness. Doctors usually prescribe very low doses to prevent patients from becoming addicted.
  • Benzodiazepines are sedatives meaning that they do not relieve symptoms but help the patient enjoy a restful sleep. Therefore, doctors generally prescribe them to treat insomnia, muscles spasms and anxiety. Sometimes, they lead to daytime sleepiness, concentration problems and reduced energy.

Other methods that help people cope with restless legs syndrome involve foot wraps, pneumatic compressions and vibrations pads.

  • A foot wrap relieves the symptoms of this condition by applying pressure on specific points on the patient’s foot in order to compel the brain to respond and relax the muscles. According to certain studies, this represents an efficient solution that improves sleep quality and provides significant improvements in terms of symptoms.
  • Pneumatic compression consists in covering the patient’s foot with a sleeve that inflated and deflates, thus squeezing gently the limb. Doctors use this method in hospitals with the goal to improve circulation and prevent the accumulation of blood resulting in clots. Researchers proved that pneumatic compression does help with uncomfortable symptoms of restless legs syndrome after a certain number of people used it for a month and noticed improved symptoms and daytime function as well as better sleep.
  • A vibration pad does not have the purpose to relieve the symptoms but to help the patients get the much-needed sleep. This method works by placing the pad on the limb, more exactly on the affected area and adjusting the vibration intensity, which usually lasts approximately 30 minutes and provides counter-stimulation. This concept refers to overruling the uncomfortable sensations provoked by restless legs syndrome and using vibrations to distract the patient from the unpleasant symptoms.
  • Near-infrared spectroscopy (NIRS) represents a non-invasive treatment that still has to gain popularity for relieving symptoms of restless legs syndrome. The painless treatment consists in penetrating the skin with light beams causing blood vessels dilatation and increasing circulation. Apparently, this helps because researchers believe that low oxygen levels in the lower limb causes the condition. According to several studies, people who benefited from NIRS four weeks experienced noticeable improvement in circulation and restless legs syndrome symptoms.


Prognosis for Restless Legs Syndrome

Because restless legs syndrome has no cure, patients must live with the condition their entire life. Symptoms worsen throughout the years even faster for people who suffer from an underlying disease. Even though some individuals experience remissions, when the symptoms lessen for days and even years, these inconveniences eventually reappear. If restless legs syndrome manifests with mild symptoms that allow the person to fall asleep and go through the day without significant discomfort, doctors do not necessarily prescribe medical treatment. In conclusion, although restless legs syndrome does not completely disappear, doctors can help patients cope with it by minimizing symptoms and improving the quality of sleep.


Common Myths about Restless Legs Syndrome

“Restless legs syndrome is not a serious disorder” represents a misconception that people actually believe. Indeed, mild cases of restless legs syndrome are not dangerous. However, people who experience severe symptoms simply cannot get enough sleep, as they normally should leading to a significantly decreased quality of life. Moreover, restless legs syndrome can accompany serious medical conditions like anemia and diabetes, neuropathy and kidney failure. Sometimes, the negative effects of this condition, which mainly refer to sleep problems, can provoke death.

“Restless legs syndrome only affects the lower limbs” is partially true. Nevertheless, some people experience symptoms in other parts of their bogy including torso, arms and even face. Moreover, according to certain studies, restless legs syndrome presents a relation with abnormalities in central nervous system.

“Restless legs syndrome is a product of the mind”: People with this condition face higher chances of suffering from depression, anxiety and panic disorder so doctors resort to antidepressants when treating restless legs syndrome. However, specialists confirm its connection with issues concerning brain chemical transmissions.

“When having restless legs syndrome, you have to resist the urge of moving your lower limbs” definitely does not represent an effective solution. Specialists recommend engaging in various activities that have the power to distract people from the unpleasant effects of the condition. Attempting to fight the urge of moving the legs will only keep them focused on the affected area and even intensify the sensations.

“Restless legs syndrome affects only adults”: Studies prove that children with sleeping issues also have restless legs syndrome, even though doctors mistake the condition for attention deficit disorder or simply consider the symptoms nothing more than “growing pains”. This happens because usually doctors establish a diagnosis after discussing with the patient regarding the characteristics of his symptoms. Practically, they rely on the patient saying and a child does not know exactly how to express in words the uncomfortable symptoms of restless legs syndrome.

Last updated on March 2nd, 2018

Chris Riley

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