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Introduction

Restless Legs Syndrome (RLS), aka Willis-Ekbom Disease, aka RLS/WED, arises from neurological dysfunction and is a common sleep disorder. It’s a condition wherein the patient experiences an uncontrollable stimulus/urge to move their legs, due to an uncomfortable tingle or feeling.

The urge usually arises during the evening or night hours, when the body is still or is trying to sleep. The movement of the legs eases the uncomfortable tingle temporarily.[1] The disease can manifest at any age and in any gender, though middle-aged women are at the highest risk of RLS. In general, RLS is chronic and has no permanent treatment.

Lifestyle changes help more for alleviating symptoms than medication. The biggest concern for patients suffering from RLS is that they start showing signs of excessive daytime sleepiness, or hypersomnia, because of their nocturnal restlessness. Depression is a secondary symptom of hypersomnia and RLS.

The Cause

The root cause of RLS is not yet completely known; however, experts believe that it is either genetic or due to environmental factors, or a mix of both. Both of these factors cause a neurological imbalance in the brain that involves dopamine, which is responsible for sending messages to control muscle movement.

Restless Legs Syndrome is sometimes seen in patients who are prescribed antidepressants for extended periods of time.[2]

Are you at Risk?

A family history of RLS, hypersomnia, depression, Parkinson’s or Alzheimer’s, low iron levels in the brain,[3] being of Northern European descent,or having diabetes can put one at a higher risk of developing Restless Legs Syndrome.[4]

Symptoms

While the patient’s primary symptom may be moving their legs while lying still, accompanying symptoms can aid in the diagnosis of RLS. If one experiences any of the following, one must consult a doctor:

Comfort upon movement of legs
Aggravation of symptoms during nighttime
The sensation of movement occurs in the limb rather than on the skin
Leg twitching at night
A sensation of crawling, creeping, pulling, throbbing, aching, itching, or electrification within the legs repeatedly, while in a state of rest

Diagnosis

RLS is usually diagnosed based on symptoms. One must know that there is no definitive test to date that can diagnose RLS. Some blood or neurological tests can be used to diagnose the condition but these tests are not entirely conclusive.

It’s suggested that patients document their symptoms as precisely as possible before their consultation with a doctor. The most crucial indicator in diagnosis remains the same: an unstoppable urge to move the legs that ease with movements. RLS may affect the arms as well.

Treatments

The treatment in Primary RLS—RLS that is not related to other medical conditions or medications is usually treated with medications and lifestyle changes.

The treatment in Secondary RLS—RLS that is related to another disease or medication—is usually done by first treating conditions that may be causing or making RLS worse. Alternately, medications that are known to cause or exacerbate RLS should be ceased, for example, Prozac, Zoloft, and Paxil, which are used to treat anxiety and depression.

Lifestyle Changes

Exercise, 3 to 5 days a week, 25-40 minutes in each session
Eat a well-balanced nutritional meal that includes minerals, vitamins, protein, carbohydrates, and fiber: fruits, salads, nuts, beans, and green leafy vegetables
Avoid alcohol and caffeine before bedtime
Support therapies, like meditation, breathing exercises, and yoga

Medication

Medications can provide relief for serious RLS symptoms. Rest assured, your sleep doctor will adjust your drug and dosage to help you manage symptoms. Commonly prescribed drugs include:

1. Dopamine agonist drugs like Pramipexole, Ropironole or Rotigotine
2. Certain anticonvulsant drugs, like Gabapentin or Pregabalin
3. Opioids/Narcotics, such as Tramadol, Codeine, Oxycodone, or Methadone are only for severe cases of RLS
4. Benzodiazepines, like Clonazepam, have been found to be useful in certain cases

Common Home Remedies

Conservative home remedies are often used to help manage the symptoms of RLS,[5] including:

Following a strict and regular bedtime schedule: reading a book before going to sleep or listening to relaxing music
Sleeping and waking at the same time
Massaging the legs with lukewarm essential oils before bedtime
Enjoying hot baths before bedtime
Placing vibrating pads on legs while sleeping

Conclusion

If you’re experiencing symptoms of RLS, you’re not alone. Make an appointment to see your primary care doctor to talk about possible treatment plans.

References:

Office of Communications and Public Liaison, N. (2020, March 17). Restless Legs Syndrome Fact Sheet. Retrieved from https://www.ninds.nih.gov/: https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Restless-Legs-Syndrome-Fact-Sheet
Kolla, B. P., Mansukhani, M. P., & Bostwick, J. M. (2018). The influence of antidepressants on restless legs syndrome and periodic limb movements: A systematic review. Sleep medicine reviews, 38, 131–140. https://doi.org/10.1016/j.smrv.2017.06.002
Erica R. Sun, C. A. (1998, June 1). Iron and The Restless Legs Syndrome. Retrieved from https://academic.oup.com/: https://academic.oup.com/sleep/article/21/4/381/2731968
Mirghani H. (2020). Restless Legs Syndrome Among Sudanese Patients With Type 2 Diabetes Mellitus: A Case-Control Study. Cureus, 12(8), e9635. https://doi.org/10.7759/cureus.9635
Allen, R. P., Bharmal, M., & Calloway, M. (2011). Prevalence and disease burden of primary restless legs syndrome: results of a general population survey in the United States. Movement disorders : official journal of the Movement Disorder Society, 26(1), 114–120. https://doi.org/10.1002/mds.23430

Restless Legs Syndrome