Restless legs syndrome (RLS) is a sensory disorder causing an almost irresistible urge to move the legs. The urge to move is usually due to unpleasant feelings in the legs that occur when at rest. People with RLS use words such as creeping, crawling, tingling, or burning to describe these feelings. Moving the legs eases the feelings, but only for a while. The unpleasant feelings may also occur in the arms.
RLS can make it hard to fall asleep and stay asleep. People with RLS often don’t get enough sleep and may feel tired and sleepy during the day. This can make it difficult to:
- Concentrate, making it harder to learn and remember things
- Carry out other usual daily activities
- Take part in family and social activities
Not getting enough sleep can also make you feel depressed or have mood swings.
RLS can range from mild to severe, based on:
- How much discomfort you have in your legs and arms
- Whether you feel the need to move around
- How much relief you get from moving around
- How much sleep disturbance you have
- How tired or sleepy you are during the day
- How often you have symptoms
- How severe your symptoms are on most days
- How well you carry out daily activities
- How angry, depressed, sad, anxious, or irritable you feel
There are two types of RLS:
- Primary RLS is the most common type of RLS. It is also called idiopathic RLS. “Primary” means the cause is not known. Primary RLS, once it starts, usually becomes a lifelong condition. Over time, symptoms tend to get worse and occur more often, especially if they began in childhood or early in adult life. In milder cases, there may be long periods of time with no symptoms, or symptoms may last only for a limited time.
- Secondary RLS is RLS that is caused by another disease or condition or, sometimes, from taking certain medicines. Symptoms usually go away when the disease or condition improves, or if the medicine is stopped.
Most people with RLS also have a condition called periodic limb movement disorder (PLMD). PLMD is a condition in which a person’s legs twitch or jerk uncontrollably about every 10 to 60 seconds. This usually happens during sleep. These movements cause repeated awakenings that disturb or reduce sleep. PLMD usually affects the legs but can also affect the arms.
RLS can be unpleasant and uncomfortable. However, there are some simple self-care approaches and lifestyle changes that can help in mild cases. RLS symptoms often improve with medical treatment. Research is ongoing to better understand the causes of RLS and to develop better treatments.
In most cases of restless legs syndrome (RLS), no cause can be found. When no cause can be found, the condition is called primary RLS. It is known, however, that primary RLS tends to run in families. People whose parents have RLS are more likely to develop the disorder. This suggests that there may be a genetic link that increases the chance of getting RLS.
Secondary RLS is RLS that is caused by another disease or condition, or as a side effect of certain medications. Some of the diseases and conditions that can cause RLS are:
- Iron deficiency (with or without anemia)
- Kidney failure
- Parkinson’s disease
- Damage to the nerves in the hands or feet (peripheral neuropathy)
- Rheumatoid arthritis
RLS is common in pregnant women. It usually occurs during the last 3 months of pregnancy and usually improves or disappears within a few weeks after delivery. However, some women may continue to have symptoms after giving birth or may develop RLS again later in life.
Some of the types of medicines that can cause RLS are:
- Antiseizure medicines
- Antinausea medicines
- Some cold and allergy medicines
RLS symptoms usually go away when the medicine is stopped.
Certain substances can trigger RLS symptoms or make them worse. These substances include:
Restless legs syndrome (RLS) has several major signs and symptoms:
- An almost irresistible urge to move the legs or arms when sitting or lying down
- An unpleasant feeling in the legs
- Difficulty falling asleep or staying asleep because of the unpleasant feelings in the legs or arms
- Daytime sleepiness, which results from a lack of restful sleep due to the repeated limb movements
Urge To Move
RLS gets its name from the urge to move the legs when sitting or lying down. This urge is due to unpleasant feelings in the legs that are relieved by movement. Typical movements are:
- Pacing and walking
- Jiggling the legs
- Stretching and flexing
- Tossing and turning
- Rubbing the legs
The urge to move the legs usually is due to unpleasant feelings in the legs. People with RLS describe these feelings as:
- Hard to describe
Children may describe RLS symptoms differently than adults.
The unpleasant feelings in RLS usually occur in the lower leg (calf). But the feelings can occur at any place between the thigh and the ankle and also in the arm. The feelings are worse:
- When lying down or sitting for a long period of time
- During the evening or night, more so than during the day
The unpleasant feelings also:
- Make it hard to fall asleep or stay asleep
- Are not as bad or go away when you move
Duration and Severity
RLS symptoms tend to get worse over time. They may begin in childhood and develop slowly over several years. People with early symptoms are more likely to have other family members with RLS than people who develop RLS later in life.
Symptoms tend to worsen faster when RLS occurs later in life. RLS that occurs later in life is also more likely to result from an underlying condition or illness than RLS that occurs early in life.
People with mild symptoms may only notice them when they are still or awake for a long time, such as on a long airplane trip.
The way that you describe your symptoms is very important in diagnosing restless legs syndrome (RLS). Your doctor will:
- Take a complete medical history
- Do a complete physical examination
- Order other tests
The diagnosis of RLS usually requires the following four conditions be present:
- An urge to move the legs due to an unpleasant feeling in the legs.
- The urge to move the legs, or the unpleasant feelings in the legs, begins or gets worse when you are at rest or not moving around frequently.
- The urge to move the legs, or the unpleasant feelings in the legs, is partly or completely relieved by movement (such as walking or stretching) for as long as the movement continues.
- The urge to move the legs, or the unpleasant feelings in the legs, is worse in the evening and at night, or only occurs in the evening or at night.
Your doctor will take a medical history and ask questions such as:
- Can you describe your symptoms?
- When did your symptoms first begin?
- When during the day or night do the symptoms usually occur?
- When are your symptoms worse?
- Do symptoms interfere with your sleep?
Your doctor will also ask about your sleep habits, such as:
- The time you go to bed and get up
- Your routine before going to bed
- Noise, light, and interruptions in the room where you sleep
- Whether you snore
Your doctor will ask about how you feel during the day, including whether:
- You are tired and sleepy when you wake up and during the day.
- You have trouble concentrating.
- You doze off or have difficulty staying awake doing routine tasks, especially driving.
Your doctor will ask questions to find out if your symptoms are a result of a possible underlying condition. Questions might include:
- Do members of your family have similar symptoms?
- What medicines (over-the-counter and prescription) do you take?
- Do you snore loudly and frequently?
- Do you gasp for air during sleep?
- Do you use caffeine, tobacco, or alcohol?
A physical exam is done to:
- Identify any underlying condition that may cause RLS
- Rule out other disorders
Your doctor also will pay special attention to:
- The nerves in your spinal cord (especially) and legs and arms
- The blood flow in your legs and arms
There is no test currently available to diagnose RLS.
However, blood tests can be used to look for underlying conditions that can cause RLS. These tests check for:
- Low iron stores or iron deficiency
- Kidney disease
- Other vitamin and mineral deficiencies
The goals of treatment for restless legs syndrome
(RLS) are to:
- Relieve symptoms
- Increase the amount and quality of sleep
- Treat or correct any underlying condition that
may cause RLS
Types of treatment include:
- Lifestyle changes and other nondrug
Lifestyle Changes and
Other Nondrug Treatments
Lifestyle changes can improve and relieve symptoms
of RLS. Lifestyle changes may be the only treatment needed for mild RLS. Some
lifestyle changes that may help include:
- Avoid things that can make symptoms of RLS worse:
- Caffeine—Chocolate, coffee, tea, and
some soft drinks contain caffeine. Although it may seem to help overcome
daytime sleepiness, caffeine usually only delays or masks RLS symptoms, and
often makes them worse.
- Some medicines—Some types of
over-the-counter and prescription medicines can also make RLS symptoms worse.
- Antidepressants (most of them)
- Antinausea medicines
- Antipsychotic medicines
- Adopt good sleep habits:
- Keep your bedroom or sleep area cool, quiet,
comfortable, and free of unnecessary light.
- Use your bedroom for sleeping, not for
watching TV or using computers or cell phones.
- Go to bed every night at the same time and
wake up at the same time every morning. Some people with RLS find it helpful to
go to bed later in the evening and get up later in the morning. The important
thing is to get enough sleep so that you feel rested when you wake up.
- Follow a program of moderate exercise
Other activities that also may help relieve symptoms
- Walking or stretching
- Taking a hot or cold bath
- Massaging the leg or arm
- Using heat or ice packs
Medicines can help relieve some symptoms of RLS.
Doctors prescribe medicines to treat RLS in people:
- With clearly defined symptoms
- Whose symptoms cannot be controlled by lifestyle
and nondrug treatments
No single medicine is helpful in all persons with
RLS. It may take several changes in medicines and dosages to find the best
approach. Sometimes, a medicine will work for a while and then stop
Some medicines may not be safe for pregnant
Always talk with your doctor before taking any
medicines, even over-the-counter medicines.
Medicines used to treat Parkinson’s disease
also are used to treat RLS. Even though these medicines help reduce RLS
symptoms, RLS is not a form of Parkinson’s disease. The medicines help
reduce the amount of motion in the legs. They include:
- Is best used to treat mild cases of RLS
- Is short-acting
- Works for a while but does not work long term
in most people
- Dopamine agonists (pergolide,
- Are used to treat moderate and severe cases
- Are used to treat mild cases of RLS if
levodopa stops working
- Are long-acting
The U.S. Food and Drug Administration recently
approved ropinirole to treat moderate to severe RLS.
Other medicines may be used to treat RLS,
- Strong pain-relieving medicines (narcotics).
- Used most often when symptoms are severe
- May be used in people who don’t respond
to dopamine agonists
- Sedatives (benzodiazepines).
- Help with falling asleep
- May cause daytime sleepiness
- Are not recommended for people with sleep
apnea and for older persons
- Medicines used to treat epilepsy
valproate). These types of medicines are:
- Considered when dopamine agonists fail
- Most effective in persons with daytime and
evening symptoms, as well as sleep-onset symptoms, and in those who describe
the unpleasant feelings in the legs as painful.
- Iron supplements, if iron deficiency appears to
be contributing to RLS. Iron supplements should only be used if recommended by