What Is Restless Legs Syndrome (RLS)?

Restless legs syndrome (often called restless leg syndrome or RLS) is a disorder that causes an overwhelming urge to move the legs, usually to alleviate unpleasant sensations.

Also known as Willis-Ekbom disease, RLS occurs when the legs are at rest. It is typically most severe in the evening and night, potentially disrupting a person’s sleep and affecting daily activities.

There are two types of restless legs syndrome: primary and secondary.

• Primary, or idiopathic, RLS has no known cause, but it can run in families, meaning there’s a genetic component. People with familial RLS typically experience an earlier onset — before age 45 — and slower disease progression.
• Secondary RLS occurs as a complication of another disease or disorder, such as iron deficiency, diabetes, or chronic kidney disease, or as a medication side effect.

  [1]

People with RLS experience uncomfortable feelings in their legs when sitting or lying down.

People with RLS frequently describe these feelings as:

• Creeping
• Crawling
• Pulling
• Itching
• Tingling
• Burning
• Aching
• Painful
• Hard to describe

Some individuals experience symptoms throughout the day, but the symptoms will always be worse at night.

In general, getting up and walking will immediately relieve the symptoms; but they usually return as soon as you settle back into a restful state.

Dopamine is needed to produce smooth, purposeful muscle activity and movement. Disruption of these pathways frequently results in involuntary movements. Individuals with Parkinson’s disease, another disorder of the basal ganglia’s dopamine pathways, have an increased chance of developing RLS.

When the cause is unknown, the disorder is called primary RLS. When restless legs syndrome is caused by another disease or condition, or is a side effect of certain medications, the disorder is known as secondary RLS.

• Iron deficiency (with or without anemia)
• Kidney failure
• Diabetes
• Parkinson’s disease
• Damage to the nerves in the hands or feet (peripheral neuropathy)
• Rheumatoid arthritis
• Pregnancy

Medications that may aggravate RLS symptoms include:

• Antinausea drugs, such as prochlorperazine (Compazine) or metoclopramide
• Antipsychotic drugs, such as haloperidol (Haldol) or phenothiazine derivatives
• Some cold and allergy medications that contain older antihistamines like diphenhydramine
• In some cases, the use of antidepressants

There are no medical tests to diagnose RLS, but your doctor may perform blood tests and other exams to rule out other disorders.

Your doctor may also order blood tests to look for underlying conditions that can cause RLS, such as diabetes or kidney disease.

In addition, your doctor may use a neurological and a physical exam, information from your medical and family history, and a list of your current medications to make a diagnosis.

• Medications: Gabapentin enacarbil, Gabapentin, and Pregabalin are medications advised by the American Society of Sleep Medicine (AASM).

  [8]

• Iron: A trial of iron supplements is often recommended as a first treatment if your blood test indicates low or low-normal ferritin, a protein in the body that binds to iron.
• Intravenous ferric carboxymaltose: The AASM advises this for people with a serum ferritin level lower than 100 micrograms per liter (mcg/L).

  [8]

• Anti-seizure drugs: These can be effective in decreasing sensory disturbances such as creeping and crawling as well as nerve pain. The U.S. Food and Drug Administration (FDA) has approved gabapentin (Neurontin) for the treatment of moderate to severe RLS.
• Opioid drugs: Methadone (Dolophine), codeine, hydrocodone, or oxycodone (Oxycontin) are sometimes prescribed to treat individuals with more severe symptoms of RLS who do not respond well to other medications.
• Benzodiazepines Medications such as clonazepam (Klonopin) and lorazepam (Ativan) are sometimes prescribed to treat anxiety, muscle spasms, and insomnia.

• Ropinirole
• Pramipexole
• Rotigotine
• Levodopa
• Cabergoline

  [9]

• Bupropion
• Carbamazepine
• Clonazepam
• Valerian
• Valproic acid

Alternative and Complementary Therapies

Symptoms of RLS also can be alleviated by some lifestyle changes. You can try the following:

• Implement a regular exercise program.
• Maintain regular sleep patterns.
• Limit use of tobacco, alcohol, and caffeine.

Staying active throughout the day helps alleviate symptoms for some. This gives your muscles the chance to exert the energy that they would otherwise release at night.

Some people find that good sleep habits can also help with symptoms of RLS.

These habits can include:

• Only use your bedroom for sleep (not for watching TV or using a computer or cell phone).
• Go to bed at the same time every night and wake up at the same time every morning.
• Make sure you get enough sleep so that you feel rested when you wake up.

If RLS symptoms are mild, do not produce significant daytime discomfort, or do not affect an individual’s ability to fall asleep, the condition does not have to be treated.

That said, current therapies can control the disorder, minimize symptoms, and increase periods of restful sleep.

In cases of secondary RLS, when your RLS is caused by another disease or condition, symptoms usually go away when the disease or condition improves.

In addition, if your restless legs syndrome is triggered by medications or the use of caffeine, nicotine, or alcohol, the condition usually improves or goes away once you stop using the medications or substances.

RLS as a disorder is not dangerous or life-threatening, but it can be uncomfortable, making it hard to sleep and affecting your quality of life.

RLS occurs in both men and women, although women are more likely to have it than men.

• Restless legs syndrome (RLS) causes an overwhelming urge to move the legs. It is often accompanied by unpleasant sensations like tingling, itching, or burning, and it typically worsens at night, disrupting sleep.
• The exact cause is unknown, but RLS can be linked to problems with dopamine signaling in the brain, genetic factors, iron deficiency, kidney disease, and certain medications.
• Treatment usually centers around alleviating symptoms and improving sleep quality with a combination of medications and lifestyle changes. Some alternative therapies, such as acupuncture, may provide relief.