Understanding Restless Leg Syndrome

Restless legs syndrome (RLS), also known as Willis-Ekborn disease is a condition that causes an uncontrollable urge to move your legs, and often occurs due to an uncomfortable sensation. RLS typically only happens in the evening or nighttime hours when sitting or lying down. Moving can ease the unpleasant feeling temporarily, but it often returns. Although uncontrollable movements can happen more regularly at night, restless leg syndrome can occur in situations when you are sitting still for long periods.

Symptoms and Causes

     The most prevalent symptom of  restless leg syndrome is the uncontrollable urge to move legs, but can be accompanied by other symptoms and characteristics, such as:

  • Sensations that begin shortly after rest. This sensation typically begins after you have been lying down or sitting for an extended time. This could occur in a car, airplane, or any situation where you might have to sit still for lengthy amounts of time.
  • Relief with movement. The sensation of RLS typically lessens with movement, such as when stretching, adjusting your legs, pacing, or walking.
  • Worsening of symptoms in evening. Symptoms occur mainly at night, and likely as you wind down and settle down for evening relaxation.
  • Nighttime leg twitching. RLS may be associated with another, more common condition called periodic limb movement of sleep, which causes your legs to twitch and kick, possibly throughout the night, while you sleep.

    Though the exact sensations can be difficult to explain by those who experience them, there are also some key sensations that you might experience with restless leg syndrome and are described as occurring within the leg. These can include sensations that feel like:

    • Crawling                        
    • Creeping         
    • Pulling
    • Throbbing
    • Aching
    • Itching
    • Tingling

    The predominant causes for restless leg syndrome are not well known. Many doctors and researchers suspect that the condition is caused by imbalances with the brain chemical dopamine. Dopamine is largely responsible for sending signals which control movement of muscles. Some other suspected causes have been linked to sites on certain chromosomes where genes associated with restless leg syndrome may be present. Pregnancy can also cause changes, such as hormonal shifts, which may temporarily worsen signs and symptoms of RLS. In fact, some women can get restless leg syndrome for the first-time during pregnancy, especially during their last trimester, with symptoms disappearing after delivery.

    Risk Factors

    RLS can develop at any age, even during childhood. The disorder is more common with increasing age and more common in women than in men.

    RLS is not usually related to a serious underlying medical problem. However, it sometimes accompanies other conditions, such as:

    • Peripheral neuropathy: damage to nerves in your hands and feet. This nerve damage is sometimes due to chronic diseases such as diabetes or alcoholism.
    • Iron deficiency: this may cause or worsen RLS. You could have iron deficiency if you have a history of stomach or bowel bleeding, experience heavy menstrual periods, or donate blood.
    • Kidney failure: this occurs when your kidneys stop functioning properly and may cause or worsen RLS. If you have kidney failure, you may also have iron deficiency, often with anemia. When kidneys do not function properly, iron stores in your blood can decrease.
    • Spinal cord conditions: These could be linked to lesions on the spinal cord and have been linked to RLS as well. Having had anesthesia to the spinal cord, such as a spinal block, also increases the risk of developing RLS.

    Complications

    RLS does not normally lead to other serious conditions, but symptoms can range from mildly bothersome to incapacitating. Many people with RLS find it difficult to fall or stay asleep. This is what makes this condition classified as a sleep disorder similar to insomnia or narcolepsy.

    Severe RLS can lead to impairment and disruption of life quality, potentially resulting in mental disorders such as depression or anxiety. Insomnia may lead to excessive daytime drowsiness, but RLS may interfere with napping. A person with both RLS and insomnia may find it particular difficult to cope with poor sleep quality and quantity.

    Prevention and Treatment

    As with many other medical conditions, treatment for restless leg syndrome can sometimes be found by treating and underlying condition. For instance, addressing a condition such as an iron deficiency can greatly reduce or relieve symptoms of restless leg syndrome. This can be done by simply taking an iron supplement.

    If this does not relieve symptoms, there are also medication options available. The medications for restless leg syndrome can include some of the following:

    • Medications that increase dopamine in the brain, such as Ropinirole (Requip), rotigotine (Neupro) and pramipexole (Mirapex). These are approved by the Food and Drug Administration for the treatment of moderate to severe RLS.
    • Drugs affecting calcium channels, such as gabapentin (Neurontin, Gralise), gabapentin enacarbil (Horizant) and pregabalin (Lyrica), work for some people with RLS.
    • Opioids can relieve mild to severe symptoms of RLS, but they may be addicting if used in high doses. Some examples include tramadol (Ultram, ConZip), codeine, oxycodone (Oxycontin, Roxicodone, others) and hydrocodone (Hysingla ER, Zohydro ER).
    • Muscle relaxants and sleep medications can help you sleep better at night, but they do not eliminate the leg sensations, and they may cause daytime drowsiness. These medications are generally only used if no other treatment provides relief.

    Alternatively, if medications or conventional treatments appear unable to treat the condition, some lifestyle changes or home remedies may be in order. These can range from simple substance avoidance to good nighttime routines. Possible routine changes and remedies include:

    • Baths and massages can relax the muscles in your legs.
    • Warm or cool packs may lessen your limb sensations.
    • A bedtime routine and relaxing sleep environment can help prevent fatigue which tends to worsen symptoms of RLS. Ideally, a comfortable sleeping environment, a consistent routine, and getting at least seven hours of sleep nightly should be your goal.
    • Exercising moderately on a regular basis may relieve symptoms of RLS but overdoing it or working out too late in the day may intensify symptoms.
    • Avoiding caffeine may help restless legs syndrome. Try to avoid caffeine-containing products, including chocolate, coffee, tea, and soft drinks, for a few weeks to see if this helps.
    • A Foot wrap designed for people with RLS puts pressure under your foot and may help relieve your symptoms.

    Though restless leg syndrome might seem like a lessor sleep disorder, it should be taken seriously. Having quality sleep is crucial to having a productive and positive life. Having restless leg syndrome in conjunction with any other sleep disorder could be especially difficult to cope with and cause serious complications with daily living.

     

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