According to the International Classification of Sleep Disorders , the words and phrases most commonly used by RLS patients to describe the feelings are:. Learn more about RLS symptoms here. RLS symptoms often appear shortly after laying down at night and patients will kick, squirm, or massage their legs to lessen the sensation. Some people with RLS are compelled to get out of bed and pace or stretch. As a result of the sleep disturbances associated with RLS, patients often experience fatigue and daytime sleepiness.
Sleep deficiency is associated with depression, anxiety, heart disease, and obesity. RLS patients are at greater risk for these issues as well. Concerns about sleep are the main reason RLS patients seek medical care for their condition. PLMD involves repetitive flexing or twitching of the limbs while asleep at night.
It is different from RLS in that these movements are not accompanied by uncomfortable sensations and because they occur during sleep, patients are often not aware of them. However, PLMD-associated movements can cause a person to wake up and therefore can compound sleep issues in patients who also have RLS.
The symptoms of RLS typically decline after delivery. However, the cause of most RLS cases is unknown. RLS may have a genetic component. Researchers have identified some genetic changes that increase risk for RLS, but it is likely that more have yet to be discovered.
Sitting or resting are common triggers for RLS symptoms. Additionally, some substances can make symptoms worse. These include:. Incidentally, most of these substances when taken in excess or too close to bedtime can also adversely affect our sleep architecture.
The goals of treatment for RLS are to stabilize symptoms and improve sleep consistency. There are both non-medicinal approaches and drug treatments available to manage RLS. The following approaches can reduce symptoms in patients with mild or moderate RLS and may be used in combination with medication in RLS patients who have severe symptoms. Learn more about treating RLS here.
Alexa Fry is a science writer with experience working for the National Cancer Institute. She also holds a certificate in technical writing. Wright, M. She has a decade of experience in the study of disease. There are new medical devices that have been cleared by the U.
Aerobic and leg-stretching exercises of moderate intensity also may provide some relief from mild symptoms. For individuals with low or low-normal blood tests called ferritin and transferrin saturation, a trial of iron supplements is recommended as the first treatment.
Iron supplements are available over-the-counter. A common side effect is upset stomach, which may improve with use of a different type of iron supplement.
Because iron is not well-absorbed into the body by the gut, it may cause constipation that can be treated with a stool softeners such as polyethylene glycol. Others may require iron given through an IV line in order to boost the iron levels and relieve symptoms. Anti-seizure drugs. Anti-seizure drugs are becoming the first-line prescription drugs for those with RLS. The FDA has approved gabapentin enacarbil for the treatment of moderate to severe RLS, This drug appears to be as effective as dopaminergic treatment discussed below and, at least to date, there have been no reports of problems with a progressive worsening of symptoms due to medication called augmentation.
Other anti-seizure drugs such as the standard form of gabapentin and pregabalin can decrease such sensory disturbances as creeping and crawling as well as nerve pain. Dizziness, fatigue, and sleepiness are among the possible side effects.
Recent studies have shown that pregabalin is as effective for RLS treatment as the dopaminergic drug pramipexole, suggesting this class of drug offers equivalent benefits. Dopaminergic agents. These drugs, which increase dopamine effect, are largely used to treat Parkinson's disease. They have been shown to reduce symptoms of RLS when they are taken at nighttime. These drugs are generally well tolerated but can cause nausea, dizziness, or other short-term side effects.
Levodopa plus carbidopa may be effective when used intermittently, but not daily. Although dopamine-related medications are effective in managing RLS symptoms, long-term use can lead to worsening of the symptoms in many individuals.
With chronic use, a person may begin to experience symptoms earlier in the evening or even earlier until the symptoms are present around the clock. Over time, the initial evening or bedtime dose can become less effective, the symptoms at night become more intense, and symptoms could begin to affect the arms or trunk.
Fortunately, this apparent progression can be reversed by removing the person from all dopamine-related medications. Another important adverse effect of dopamine medications that occurs in some people is the development of impulsive or obsessive behaviors such as obsessive gambling or shopping.
Should they occur, these behaviors can be improved or reversed by stopping the medication. Drugs such as methadone, codeine, hydrocodone, or oxycodone are sometimes prescribed to treat individuals with more severe symptoms of RLS who did not respond well to other medications.
Side effects include constipation, dizziness, nausea, exacerbation of sleep apnea, and the risk of addiction; however, very low doses are often effective in controlling symptoms of RLS.
These drugs can help individuals obtain a more restful sleep. However, even if taken only at bedtime they can sometimes cause daytime sleepiness, reduce energy, and affect concentration. The causes of PLMD are not clear. Some research suggests that it may be due to abnormalities in the autonomic nervous system, which regulates the involuntary actions of the smooth muscles, heart, and glands.
The central nervous system includes the brain and spinal cord. The peripheral nervous system includes all peripheral nerves. People with RLS often have a family history of the disorder. There are at least six genetic factors that may play a part.
Two of the genes are linked to spinal cord development. However, more research is needed to show a link between these genetic factors and dopamine or iron-regulating systems. Several studies support the theory that an imbalance in neurotransmitters chemical messengers in the brain , notably dopamine, may play a part in RLS. Dopamine triggers numerous nerve impulses that affect muscle movement.
The effect is similar to that seen in Parkinson disease. In addition, drugs that increase dopamine levels treat both disorders. Other research suggests that RLS may be due to nerve impairment in the spinal cord. Researchers had thought that such abnormalities began in nerve pathways in the lower spine. However, some patients with RLS have symptoms in the arms, which indicates that the upper spine may also be involved.
A disorder of the peripheral nerves is known as neuropathy. RLS may be more common in some forms of neuropathy, especially neuropathy that one is born with hereditary neuropathy.
Some experts suggest that RLS, particularly if it occurs in older adults, may be a form of neuropathy, which is an abnormality in the nervous system outside the spine and brain. So far, there is no evidence to support a cause and effect relationship between neuropathy and RLS.
Neuropathy due to other medical problems like diabetes is also associated with increased risk of RLS. Iron deficiency, even at a level too mild to cause anemia, has been linked to RLS in some people. Some research suggests that RLS in some people may be due to a problem with getting iron into cells that regulate dopamine in the brain. Some studies have reported RLS in a quarter to a third of people with low iron levels. Other research suggests that low levels of the hormone cortisol in the evening and early night hours may be related to RLS.
Low-dose cortisol injections have reduced symptoms in some people. The exact cause of this is not known but may be related to co-existing anemia and iron deficiency as above. A loss of opioid receptors in the brain may also contribute to RLS in those with kidney disease. It is more common in women than in men. In North America and Europe, its frequency increases with age.
As many as two-thirds of people with RLS have a family history of the disorder and are more likely to develop RLS before they turn People who develop the condition at a later age are less likely to have a family history of RLS.
RLS is also more common in people from northern and western Europe, adding support for the theory that some cases have a genetic basis. These conditions may actually contribute to inattentiveness and hyperactivity. The disorders have much in common, including poor sleep habits, twitching, and the need to get up suddenly and walk about frequently. Some evidence suggests that the link between the diseases may be a deficiency in the brain chemical dopamine.
About 1 in 5 pregnant women reports having RLS. The condition usually goes away within a month of delivery. RLS in pregnancy has been linked to deficiencies in iron and the B-group vitamin folate. RLS is relatively common in people with chronic kidney disease undergoing kidney dialysis. Up to two-thirds of patients report this problem. Symptoms often disappear after a kidney transplant. Anxiety can cause restlessness and agitation at night.
These symptoms can cause RLS or strongly resemble the condition. The following medical conditions are also associated with RLS, although the relationships are not clear. In some cases, these conditions may contribute to RLS. Others may have a common cause, or they may coexist due to other risk factors:.
Studies suggest that PLMD may be especially common in older women. They include sleep apnea, spinal cord injuries, stroke, narcolepsy, and diseases that destroy nerves or the brain over time.
Certain drugs, including some antidepressants and anti-seizure medications, may also contribute to PLMD. RLS rarely results in any serious consequences. However, recurring severe symptoms may cause mental distress, loss of sleep, and daytime sleepiness. Because the condition is worse while resting, people with severe RLS may avoid activities that involve extended periods of sitting, such as attending movies or traveling long distances.
Inability to sleep during the night due to RLS symptoms and subsequent daytime sleepiness can cause mood changes. Lack of sleep can also contribute to workplace errors and car crashes. Sleeplessness has a negative effect on the ability to function while awake. Areas that can be affected include:. People with RLS are more likely to suffer problems such as social isolation, frequent daytime headaches, and depression.
They may also complain of lower sex drive and other problems related to insufficient sleep. RLS can contribute to insomnia. Insomnia itself can increase the activity of hormones and pathways in the brain that produce emotional problems.
Even modest changes in waking and sleeping patterns can have significant effects on a person's mood. In some cases, ongoing insomnia may even predict mood disorders in the future. Anxiety can cause agitation and leg restlessness that resemble RLS. Depression and RLS symptoms also overlap.
Certain types of antidepressant drugs, such as serotonin reuptake inhibitors, can increase periodic limb movements during sleep. Medicines used to treat RLS can cause or increase existing psychiatric conditions.
Dopamine agonists, for example, can increase compulsive behaviors, such as gambling. Some studies have shown patients with RLS have an increased risk of suicide or harming themselves. A diagnosis of RLS often relies mainly on the person's description of symptoms. The first step in diagnosis is usually to gather information on a person's sleep and personal history.
The doctor may ask the following questions:. To help answer some of these questions, the person may need to keep a sleep diary for 2 weeks. The person should record all sleep-related information, including responses to the questions listed above on a daily basis.
A bed partner can help provide information based on observations of the person's sleep behavior. The criteria stress the understanding of specific words used by children in describing pain. Some people may need to consult a sleep specialist or go to a sleep disorders center in order for the problem to be diagnosed. At most centers, people undergo in-depth testing supervised by a team of consultants from various specialties, who can provide both physical and psychiatric evaluations.
Centers should be accredited by the American Academy of Sleep Medicine. Overnight polysomnography involves a series of tests to measure different functions during sleep. This type of evaluation is typically performed in a sleep center.
It can help rule out sleep apnea when this problem is suspected or evaluate the effectiveness of RLS treatments. To undergo the test, the patient arrives about 2 hours before bedtime without having made any changes in daily habits. This test electronically monitors the person through the various sleep stages. Polysomnography tracks the following:. There are simpler sleep studies that can be performed in one's own home and may provide information that excludes a sleep disorder or necessitates further confirmation.
Actigraphy uses a small wristwatch-like device such as Actiwatch worn on the wrist or ankle. The device monitors the sleep quality in people suspected of having RLS, PLMD, insomnia, sleep apnea, and other sleep-related conditions. It measures and records muscle movements during sleep. For example, with PLMD, actigraphy can provide information on how long movements last and the number of times they occur. It can also track whether PLMD occurs in both legs at the same time, and the effect it has on sleep.
Actigraphy is not as accurate as polysomnography because it cannot measure all the biological effects of sleep. It is more accurate than a sleep log, however, and very helpful for recording long periods of sleep.
The Epworth Sleepiness Scale uses a simple questionnaire to measure excessive sleepiness during common situations, such as sitting or watching TV. Because of the high association between RLS and iron deficiency, a test for low iron stores should be part of the diagnostic workup in RLS.
There are two steps in making this diagnosis:. The following laboratory tests may be helpful in determining causes of RLS or identifying conditions that rule it out.
In addition to other sleep-related leg disorders, many other medical conditions may have features that resemble RLS. The doctor will need to consider these disorders in making a diagnosis. Peripheral neuropathies are nerve disorders in the hands or feet, which can produce pain, burning, tingling, or shooting sensations in the arms and legs. Several conditions can cause these disorders. Diabetes is a very common cause of painful peripheral neuropathies. Other causes include:.
Symptoms of peripheral neuropathies may mimic RLS. However, unlike RLS, these disorders are not usually associated with restlessness. Also, movement does not relieve the discomfort, and the problem does not worsen at bedtime. Akathisia is a state of restlessness or agitation, and feelings of muscle quivering. A condition called hypotensive akathisia is caused by failure in the autonomic nervous system.
Unlike RLS, it occurs at any time of the day, and only when the patient is sitting -- not lying down. Drugs that are used to treat nausea, schizophrenia and other psychoses can cause akathisia. The condition also occurs when drugs to treat Parkinson disease are stopped.
This is a rare disorder that affects one or both legs. Painful legs and moving toes syndrome is marked by a constant, deep, throbbing ache in the limbs and involuntary toe movements. The discomfort may be mild or severe. The problem gets worse with activity and usually stops during sleep. Most of the time, the cause is unknown, although it may arise from spinal injuries or herpes zoster infection.
The condition is difficult to treat, but the drug baclofen, combined with either clonazepam or carbamazepine, has shown some success. Other treatments that may help include orthotic shoe inserts and therapy using transcutaneous electrical nerve stimulation TENS. An uncommon nerve condition, meralgia paresthetica causes numbness, pain, tingling, or burning on the front and side of the thigh.
It usually occurs on one side of the body. The condition may be caused by compression of the thigh nerve as it passes through the pelvis. The problem typically occurs in those with diabetes, obesity or both, and can affect people of all ages.
It often goes away on its own. Benign nocturnal leg cramps Charley horse are muscle spasms in the calf. Nocturnal leg cramps can be very painful and may cause the person to jump out of bed in the middle of the night.
They typically affect a specific area of the calf or the sole of the foot. Initially, doctors normally try to achieve these goals without the use of drugs. A non-drug approach is a particularly important first step for older people. If the cause cannot be determined, measures to improve sleep habits and relaxation techniques are the best first steps. These approaches may help, even if medicines may be needed later on.
Some people have tried alternative treatments for RLS, such as acupuncture and massage. To date, however, there is not enough data on the effectiveness of these treatments. RLS is often associated with iron deficiency, so people with RLS related to iron deficient should make sure they get enough iron in their diet.
For more information, see In-Depth Report 57 : Anemia. Iron is found in foods either in the form of heme or non-heme iron:. It can complicate the simplest activities, like going to the movies. A long plane ride can also be difficult. People with RLS are likely to have trouble falling asleep or staying asleep because symptoms are worse at night. Daytime sleepiness, fatigue, and sleep deprivation can harm your physical and mental health.
Symptoms usually affect both sides of the body, but some people have them on only one side. In mild cases, symptoms may come and go. RLS can also affect other parts of the body, including your arms and head.
For most people with RLS, symptoms worsen with age. People with RLS often use movement as a way to relieve symptoms. That might mean pacing the floor or tossing and turning in bed. If you sleep with a partner, it may well be disturbing their sleep as well. More often than not, the cause of RLS is a mystery. There may be a genetic predisposition and an environmental trigger. More than 40 percent of people with RLS have some family history of the condition.
In fact, there are five gene variants associated with RLS. When it runs in the family, symptoms usually start before age There may be a connection between RLS and low levels of iron in the brain, even when blood tests show that your iron level is normal.
RLS may be linked to a disruption in the dopamine pathways in the brain. Some of the same medications are used to treat both conditions. Research on these and other theories is ongoing. Other potential causes include medications to treat:. But RLS can actually be an offshoot of another health problem, like neuropathy, diabetes, or kidney failure.
Learn more about the causes of restless leg syndrome ». There are certain things that may put you in a higher risk category for RLS. Having RLS can affect your overall health and quality of life. If you have RLS and chronic sleep deprivation, you may be a higher risk of:. A large part of the diagnosis will be based on your description of symptoms. Your doctor will want to check for other neurological reasons for your symptoms.
Be sure to provide information about any over-the-counter and prescription medications and supplements you take. And tell your doctor if you have any known chronic health conditions.
Blood tests will check for iron and other deficiencies or abnormalities. Home remedies, while unlikely to completely eliminate symptoms, may help reduce them. It may take some trial and error to find the remedies that are most helpful. When scheduling things that require prolonged sitting, such as a car or plane trip, try to arrange them for earlier in the day rather than later. If you have an iron or other nutritional deficiency, ask your doctor or nutritionist how to improve your diet.
Talk to your doctor before adding dietary supplements.
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