restless legs syndrome
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.
Effects of RLS
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:
Not getting enough sleep can also make you feel depressed or have mood swings.
RLS can range from mild to severe, based on:
Types of RLS
There are two types of RLS:
Periodic limb movement disorder
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:
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:
Certain substances can trigger RLS symptoms or make them worse. These substances include:
Who is at risk?
Restless legs syndrome (RLS) may affect as many as 12 million people in the United States.
RLS affects both men and women. The disorder occurs more often in women than in men.
The number of cases of RLS rises with age. Many people with RLS are diagnosed in middle age. But in up to two out of every five cases, the symptoms of RLS begin before age 20. People who develop RLS early in life usually have a family history of the disorder.
RLS can affect people of any race or ethnic group. The disorder is more common in persons of northern European descent.
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.
Signs and symptoms
Restless legs syndrome (RLS) has several major signs and symptoms:
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:
The urge to move the legs usually is due to unpleasant feelings in the legs. People with RLS describe these feelings as:
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:
The unpleasant feelings also:
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:
The diagnosis of RLS usually requires the following four conditions be present:
Your doctor will take a medical history and ask questions such as:
Your doctor will also ask about your sleep habits, such as:
Your doctor will ask about how you feel during the day, including whether:
Your doctor will ask questions to find out if your symptoms are a result of a possible underlying condition. Questions might include:
A physical exam is done to:
Your doctor also will pay special attention to:
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:
The goals of treatment for restless legs syndrome (RLS) are to:
Types of treatment include:
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:
- Antidepressants (most of them)
- Antinausea medicines
- Antipsychotic medicines
- 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.
Other activities that also may help relieve symptoms include:
MedicinesMedicines can help relieve some symptoms of RLS. Doctors prescribe medicines to treat RLS in people:
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 working.
Some medicines may not be safe for pregnant women.
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
- Are used to treat moderate and severe cases of RLS
- Are used to treat mild cases of RLS if levodopa stops working
- Are long-acting
The US Food and Drug Administration recently approved ropinirole to treat moderate to severe RLS.
Other medicines may be used to treat RLS, including:
-Used most often when symptoms are severe
-May be used in people who don't respond to dopamine agonists
- Help with falling asleep
-May cause daytime sleepiness
-Are not recommended for people with sleep apnea and for older persons
- 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.
Living with restless legs syndrome
Restless legs syndrome (RLS) is often a lifelong condition. The symptoms may come and go frequently or disappear completely for long periods of time. They may get worse over time. Lifestyle changes and medicines can help control and relieve the symptoms of RLS. For severe symptoms, ongoing medicines may be needed. Talk with your doctor about lifestyle changes and medicines that might help your symptoms. New treatments are being developed as research continues.
RLS that occurs during pregnancy usually improves or disappears within a few weeks after delivery.