What Is Restless Legs Syndrome (RLS)?

Restless Legs Syndrome (RLS) is a sleep disorder that can cause the patient in the night, an urge to move their legs as it may cause a strange or unpleasant feeling, and moving them helps in relieving this feeling. The RLS can start as early as 20 years of age but it is usually due to hereditary factors.

Restless legs syndrome (RLS) and periodic limb movements during sleep (PLMS) should not be confused with each other. Indeed, restless legs syndrome is a neurological disorder with established effects on the quality of life and health. In contrast, periodic leg movements during sleep are a polysomnographic finding of unknown clinical significance. While the majority of RLS patients also have PLMS witnessed during nocturnal polysomnography, many patients with PLMS do not have restless legs syndrome.

RLS is increasingly recognized as an important neurological disorder. It is about twice more common in women versus men and increases with aging. Awareness has come from public education efforts by the RLS Foundation and the realization by the pharmaceutical industry that a significant part of the population is affected by restless legs syndrome (3% severely affected). Despite these efforts, the disorder is often not considered by neurologists, academia, and funding agencies as an important condition.

Causes of Restless Legs Syndrome (RLS)
  • Presence of some current diseases, or conditions like improper kidney functioning, diabetes, rheumatoid arthritis, deficiency of iron, pregnancy, or Parkinson’s disease.
  • Taking specific medicines
Symptoms of Restless Legs Syndrome (RLS)

RLS symptoms can range from the very mild or transient (for example a few times during pregnancy) to severe, occurring every evening and being excruciatingly painful. RLS symptoms start or become worse when resting. RLS symptoms are worse in the evening, especially when lying down. The longer patients are resting, the greater the chance the symptoms will occur and the more severe they are likely to be. RLS symptoms get better when the patient moves the legs. The relief can be complete or only partial but generally starts very soon after starting an activity (for example walking). Relief persists if the motor activity continues.

The patients may display one or more of the following symptoms during RLS:

  • A strong urge to move the legs, which may be irresistible
  • Uncomfortable sensations in the legs such as a sensation of pain, creeping, itching, pulling, creepy-crawly, tugging, or gnawing
  • RLS can cause difficulty in falling or staying asleep which can be one of the chief complaints of the syndrome
Treatment of Restless Legs Syndrome (RLS)

Sleep specialists normally treat RLS with a combination of pharmacological treatments and behavioral advice. The Restless Legs Foundation provides patient education and support.

Non-drug treatments for RLS

Iron and vitamin supplementation (especially if anemia or iron deficiency), removing treatments that can make RLS worse (for example neuroleptic, antihistamine, antidepressants), eliminating alcohol or caffeine intake, exercise, walking, stretching, taking a hot or cold bath, massaging, acupressure, or relaxation/mind engagement techniques.

If you are suffering from a mild case of RLS, it can be also be treated with simple lifestyle changes like sleeping on time and some simple medication.

Drug treatments for RLS

Dopaminergic agents (L-DOPA or Dopaminergic agonists drugs also used for Parkinson’s disease), gabapentin, and opiates. Other sleeping aids, anticonvulsants, and pain relievers may also be used. Treatment duration varies and could require frequent adjustment of medications to get the best response.

Although dopaminergic stimulants such as ropinirole (Requip) and pramipexole (Mirapex) are the only drugs approved by the Food and Drug Administration (FDA) for the treatment RLS, the other treatments are also effective. All these drugs may produce side effects and must be prescribed by a doctor.

The decision to treat of RLS should not be taken lightly, especially if a Dopaminergic drug is prescribed, as chronic treatment with L-DOPA or Dopaminergic agonists can lead to a worsening of RLS called augmentation.

If augmentation occurs, the usual dose of a dopaminergic agent will relieve symptoms helping to sleep at night, but eventually, the unpleasant sensations will develop earlier in the day. Augmentation of RLS symptoms may occur after an initial period of relief with dopaminergic agents, and unfortunately, increasing your dosage will probably worsen your symptoms.

Once augmentation has occurred, it is difficult to stop the drug, as it typically exacerbates the symptoms. If augmentation occurs, you and your doctor must work together to find a new drug regimen that will work for you.