Restless legs syndrome (RLS) is a sleep disorder in which a
in the legs
. These sensations usually occur
in the calf area but may be felt anywhere from the thigh to the
ankle. One or both legs may be affected. For some people, the
sensations are also felt in the arms. These sensations occur when
the person with RLS lies down or sits for prolonged periods of
time, such as at a desk, riding in a car, or watching a movie.
People with RLS describe an
irresistible urge to move the
when the sensations occur. Usually, moving the legs,
walking, rubbing or massaging the legs, or doing knee bends can
bring relief, at least briefly. RLS symptoms worsen during periods
of relaxation and decreased activity. RLS symptoms also tend to
follow a set daily cycle, with the evening and night hours being
more troublesome for RLS sufferers than the morning hours.
People with RLS may find it difficult to relax and fall asleep
because of their strong urge to walk or do other activities to
relieve the sensations in their legs. They often sleep best toward
the end of the night or during the morning hours. Because of less
sleep at night, people with RLS may feel sleepy during the day on
an occasional or regular basis. The severity of symptoms varies
from night to night and over the years as well. For some
individuals, there may be periods when RLS does not cause problems,
but the symptoms usually return. Other people may experience severe
Many people with RLS also have a related sleep disorder called
periodic limb movements in sleep (PLMS)
. PLMS is
characterized by involuntary jerking or bending leg movements
during sleep that typically occur every 10 to 60 seconds. Some
people may experience hundreds of such movements per night, which
can wake them, disturb their sleep, and awaken bed partners. People
who have RLS and PLMS have trouble both falling asleep and staying
asleep and may experience extreme sleepiness during the day. As a
result of problems both in sleeping and while awake, people with
RLS may have difficulties with their job, social life, and
Some common symptoms of RLS include:
- Unpleasant sensations in the legs (sometimes the arms as well),
often described as creeping, crawling, tingling, pulling, or
- Leg sensations that are relieved by walking, stretching, knee
bends, massage, or hot or cold baths
- Leg discomfort that occurs when lying down or sitting for
prolonged periods of time
- Worsening of symptoms in the evening and during the night
Other possible characteristics include:
- Involuntary leg (and occasionally arm) movements while
- Difficulty falling asleep or staying asleep
- Sleepiness or fatigue during the daytime
- Cause of the leg discomfort not detected by medical tests
- Family members with similar symptoms
Although the cause is unknown in most cases, certain factors may
be associated with RLS:
- Family history.
RLS is known to run in some
families--parents may pass the condition on to their children.
Some women experience RLS during pregnancy,
especially in the last months. The symptoms usually disappear after
- Low iron levels or anemia
. Persons with these conditions
may be prone to developing RLS. The symptoms may improve once the
iron level or anemia is corrected.
- Chronic diseases.
Kidney failure quite often leads to
RLS. Other chronic diseases such as diabetes, rheumatoid arthritis,
and peripheral neuropathy may also be associated with RLS.
- Caffeine intake.
Decreasing caffeine consumption may
RLS occurs in both sexes. Symptoms can begin any time, but are
usually more common and more severe among older people. Young
people who experience symptoms of RLS are sometimes thought to have
"growing pains" or may be considered "hyperactive" because they
cannot easily sit still in school.
There is no laboratory test that can make a diagnosis of RLS
and, when someone with RLS goes to see a doctor, there is usually
nothing abnormal the doctor can see or detect on examination.
Diagnosis therefore depends on what a person describes to the
doctor. The history usually includes a description of the typical
leg sensations that lead to an urge to move the legs or walk. These
sensations are noted to worsen when the legs are at rest, for
example, when sitting or lying down and during the evening and
The person with RLS may complain about trouble sleeping or
daytime sleepiness. In some cases, the bed partner will complain
about the person's leg movements and jerking during the night. To
help make a diagnosis, the doctor may ask about all current and
past medical problems, family history, and current medications. A
complete physical and neurological exam may help identify other
conditions that may be associated with RLS, such as nerve damage
(neuropathy or a pinched nerve) or abnormalities in the blood
vessels. Basic laboratory tests may be done to assess general
health and to rule out anemia. Further studies depend on initial
findings. In some cases, a doctor may suggest an overnight sleep
study to determine whether PLMS or other sleep problems are
present. In most people with RLS, no new medical problem will be
discovered during the physical exam or on any tests, except the
sleep study, which will detect PLMS if present.
In mild cases of RLS, some people find that activities such as
massaging the legs
, using a
help alleviate symptoms. In more severe
cases, medications are prescribed to control symptoms.
Unfortunately, no one drug is effective for everyone with RLS.
Individuals respond differently to medications based on the
severity of symptoms, other medical conditions, and other
medications being taken. A medication that is initially found to be
effective may lose its effectiveness with nightly use.Thus, it may
be necessary to alternate between different categories of
medication in order to keep symptoms under control. Although many
different drugs may help RLS, those most commonly used are found in
the following three categories:
are central nervous system depressants
that do not fully suppress RLS sensations or leg movements, but
allow patients to obtain more sleep despite these problems. Some
drugs in this group may result in daytime drowsiness.
Benzodiazepines should not be used by people with sleep apnea.
agents are drugs used to treat Parkinson's
disease and are also effective for many people with RLS and PLMS.
These medications have been shown to reduce RLS symptoms and
nighttime leg movements.
are pain-killing and relaxing drugs that can
suppress RLS and PLMS in some people. These medications can
sometimes help people with severe, unrelenting symptoms. Although
there is some potential for benzodiazepines and opioids to become
habit forming, this usually does not occur with the dosages given
to most RLS patients.
A nondrug approach called transcutaneous electric nerve
stimulation may improve symptoms in some RLS sufferers who also
have PLMS. The electrical stimulation is applied to an area of the
legs or feet, usually before bedtime, for 15 to 30 minutes. This
approach has been shown to be helpful in reducing nighttime leg
jerking. Due to recent advances, doctors today have a variety of
means for treating RLS. However, no perfect treatment exists and
there is much more to be learned about the treatments that
currently seem to be successful.