What to Know about Restless Legs Syndrome (RLS): Causes, Symptoms, Diagnosis, and Treatment

Restless Legs Syndrome can affect any person at any age. It is the condition when you have an urge to move your legs. This uncomfortable feeling of moving your legs typically happens at night or in the evening when you lie down to take a rest. Moving your legs due to the urge can ease the discomfort for a short time. This means moving your legs is not a permanent treatment for the discomfort you feel. You may be affected by this condition at any stage of life and this condition gets worse with your age. It is necessary to get rid of restless legs syndrome because it can disrupt your sleep schedule and sleep quality, leading to cause disruption in your daily activities. Immediate medical care such as medications and some self-care steps and lifestyle changes can help relieve the Restless Legs Syndrome Symptoms.

What is Restless Legs Syndrome?

You may hear about Willis-Ekbom disease, which is a common condition of the nervous system. This is also known as restless legs syndrome which causes an overwhelming, irresistible urge to move your legs. 

Research describes that RLS is a sleep, brain, and nerve condition that causes a strong urge to move our legs that is often relieved by moving your legs. Its symptoms appear more strongly when you are at rest in the evening or at night.

In addition, restless legs syndrome usually occurs as an uncomfortable aching sensation in your legs that seems throbbing in your legs. The continuous urge to move your legs ultimately makes it difficult for you to have a peaceful sleep and interferes with your ability to relax. 

According to studies, women are affected by restless legs syndrome more than men. This condition is found in 1 out of 10 people. People can be affected by the condition at any point in their life. However, evidence has been found that confirmed that this condition is common in middle age, but symptoms can appear at any age, including childhood.

Types of Restless Legs Syndrome

Two basic types of restless legs syndrome are:

• Idiopathic or Primary Restless Legs Syndrome.
• Secondary Restless Legs Syndrome.

Primary Restless Legs Syndrome

The majority of cases of restless leg syndrome belong to the primary type of condition. This type does not have a specific cause of the condition, studies say. However, research has concluded that this condition may be linked to a problem in a specific part of the brain called the basal ganglia. A special chemical, Dopamine, is found in this part of the brain that controls muscle movements and activities. The damage to the cells of basal ganglia reduces the amount of dopamine in the brain cells. This may lead to involuntary movements and muscle spasms. It naturally happens that till the end of that, your dopamine level falls. That’s why the symptoms of restless legs syndrome become worse in the evening and during the night.

Recent research has explored that certain genes also are associated with restless legs syndrome. This statement clears the fact that this condition runs in the families. The symptoms of the condition often occur after the age of 30.

Secondary Restless Syndrome

This type of restless legs syndrome usually occurs due to other health-related problems. Certain health conditions create complications that stimulate the restless legs syndrome and worsen its symptoms as well. The health-related conditions that can cause RLS, include:

• Rheumatoid arthritis.
• Fibromyalgia.
• Iron deficiency anemia.
• Diabetes.
• An underactive thyroid gland.
• Chronic kidney disease.
• Parkinson’s disease.

Another major cause of secondary restless legs syndrome is pregnancy. Pregnant women often develop this condition after 28 weeks of pregnancy. 

RLS is also sub-divided into 

• Early Onset RLS.
• Late Onset RLS.

The former is diagnosed usually before the age of 40 and is typically caused by your biological family history. This condition progresses slowly and shows its symptoms in the early stages.

The latter progresses more quickly than the Early-onset RLS and can be diagnosed after the age of 50. 

What is Periodic Limb Movement?

PLMS occurs in more than 80% of people who are affected by restless legs syndrome. Having periodic limb movement in sleep means your leg may jerk or twitch uncontrollably, usually while you are sleeping at night. These involuntary movements in your legs are repetitive and brief. They occur after every 15 to 40 seconds. Sometimes the PLMS is severe enough that it can disturb your sleep and wake up both you and your partner. This uncontrolled movement in the legs can also occur while you are awake and taking a test by sitting or lying down.

Is Restless Legs Syndrome a Common Condition?

RLS is a more common condition among white people. However, studies claim that 10 to 20 percent of the world population is affected by this syndrome and the risk of developing the RLS symptoms increases as you get older.

Causes and Symptoms

Causes of Restless Legs Syndrome

The exact cause of restless Legends syndrome is still unknown but research proposes that the dysfunction of a certain part of the brain, called basal ganglia, can cause the condition. Dopamine plays a crucial role in basal ganglia to control muscle and body movements. The basal ganglia use dopamine to regulate your body movements. The lower amount of dopamine causes a short supply of dopamine to your brain’s basal ganglia. That is why the part of the brain cannot regulate your body movements as effectively as it should. This inability results in RLS symptoms. 

However, research has suggested that some other factors also contribute to RLS, including:

Iron Deficiency: Lower levels of iron in your blood can cause RLS.

Medications: Certain medications you use for other health conditions, interact with your nervous system and thus cause RLS or worsen its symptoms. These medications include anti-nausea drugs, antihistamines, and antidepressants.

Genetics: Your parents may pass this genetic trait to you that causes RLS in you. This means you can inherit the condition from one of your biological parents.

Underlying Medical Conditions: Certain health-related problems also cause RLS, such as diabetes, and some nervous disorders.

Studies reveal that more causes of RLS also include, Substance use disorder and peripheral neuropathy.

Common Triggers of Restless Legs Syndrome

Triggers can affect the severity of the symptoms. The basic triggers for restless legs syndrome may vary but they include:

• Stress.
• Alcohol.
• Certain Medications.
• Nicotine.
• Caffeine.

If any of these triggers are used in your daily routine, avoid their use before your bedtime. Because they can worsen your symptoms. In addition, a disrupted or disturbed sleep schedule also leads to the condition. This means lack of rest and use or misuse of such substances can trigger worsening of symptoms. Talk to your doctor to diagnose the actual trigger of RLS symptoms in you. 

What Age Group can be Affected more Severely?

Restless legs syndrome can affect all age groups equally. This means the condition can target you at any point in life or any age. But it is clear from research that its symptoms get worse as you get older. Most people are diagnosed with RLS at the age of 45 or more.

Symptoms of Restless Legs Syndrome

Common symptoms of RLS, include:

• Leg jerks or twitching legs typically occur during sleep and in the evening during rest time.
• Uncomfortable sensation in the legs that forces you to move them aimlessly.
• Temporary relief from discomfort after moving the legs.
• Symptoms get worse when you are taking rest. 

The severity of these symptoms affects the equality of your sleep and can cause:

• Depression or anxiety.
• Difficulty paying attention and concentrating or remembering things.
• Mood swings or behavior changes.
• Difficulty falling asleep or staying asleep resulting in sleep disruption.
• Daytime sleepiness or fatigue.
• The high urge to get out of bed to move or stretch the legs.

How Do You Feel with RLS?

Restless legs syndrome makes you feel a desire to move your legs aimlessly. Typically, this sensation occurs in your legs but some cases are reported with such sensation in the arms or entire body. More feelings associated with RLS symptoms are:

• Tugging.
• Throbbing.
• Crawling.
• Pulling.
• Itching.
• Burning.
• Aching.

These sensations usually appear on one side of your body but some people experience them on both sides of the body. 

Diagnosis and Tests

Diagnosis of Restlessness of Legs

A thorough physical examination helps your healthcare provider to diagnose the RLS symptoms. They review your symptoms during the exam and then take a complete medical family history to diagnose the condition.

There is no test devised to diagnose RLS. Simply, certain neurological tests and blood tests are performed to determine the causes of RLS symptoms. Sometimes, you’re recommended to do an overnight sleep study so that the evaluation of your sleep conditions can be done accurately. However, a clinical diagnosis of RLS doesn’t need sleep testing. Following criteria are followed usually to confirm the diagnosis of  RLS symptoms:

• You experience the urge to move your legs, usually occurring with uncomfortable sensations, such as pulling or aching.
• Having total or partial relief after exercising, walking, or stretching your leg muscles.
• Worsening of symptoms during periods of inactivity or test.
• Occurring symptoms only at night or in the evening.

Is it Difficult to Diagnose Symptoms in Children?

Diagnosis of Restless Legs Syndrome Symptoms in children is hard because a child is not able to describe the feelings or sensations they may experience. Healthcare providers usually confuse the feelings of RLS with other health-related problems in children, such as:

• Growing pains.
• Attention-deficit or hyperactivity disorder (ADHD)

Management and Treatment

Treatment of Restlessness of Legs

Taking medications and simple lifestyle changes can help treat the symptoms of RLS. You can easily relieve RLS symptoms at home by changing your routine. For example, working with your healthcare provider to manage your other underlying health conditions can reduce the severity of symptoms. Your healthcare professional may help suggest the best treatment option that might be effective for you, as well as any side effects to look out for.

Medications for Restless Legs Syndrome

Although there is no specific test to diagnose the RLS symptoms certain medications are suggested that can help relieve your Restless Legs Syndrome Symptoms. Healthcare professionals typically prescribe the following medications for reducing the RLS symptoms:

• Medications that convert into dopamine or dopamine precursors.
• Iron supplements with vitamin C supplements.
• Dopamine agonists.
• Anti-seizure medications, such as pregabalin or gabapentin.

If all treatment options prove ineffective for the treatment of RLS, healthcare professionals may use certain medications including, methadone, buprenorphine, zolpidem, and benzodiazepines to treat the severe cases of RLS. However, these medications are associated with severe side effects, such as dependence on the medication. 

In the case of iron deficiency, iron infusions are the best remedy to treat RLS symptoms. Certain blood tests can help identify the iron deficiency in your blood.

Excessive use of medications that increase the dopamine level in your blood can worsen the RLS symptoms over time. The Major side effect of such medications appears as an augmentation problem, you may need close monitoring while taking Dopamine supplements.

At-Home Therapies to Relieve RLS Symptoms 

Having mild Restless Legs Syndrome Symptoms indicates that you need at-home therapies to help you feel more comfortable and fall asleep easily with restless legs. these at-home therapies include:

• Applying a heating pad or cold compress to your legs or soaking your legs in a warm tub. These therapies may provide temporary relief for your discomfort.
• Reducing your stress level can help you feel relaxed.
• Avoiding drinking caffeinated drinks like coffee near bedtime.
• Getting regular light exercises, ride a bicycle, or walk but avoid intense exercise for a good sleep. 
• Developing good sleep habits like avoiding reading, using a laptop, or computer, or watching TV. While lying in bed. Lack of good sleep can worsen the symptoms.

Conclusion

Restless legs syndrome is a nervous system disorder that causes unpleasant sensations in your legs. RLS raises an irresistible urge to move affected limbs when sensation occurs. The actual cause of RLS is still unknown but your healthcare provider may diagnose the condition based on your symptoms and family history information. However, there is no definite test to confirm the diagnosis of RLS. 

It may be a source of constant annoyance for the people who experience RLS symptoms because the condition directly affects your quality of life by interfering with your ability to fall asleep and stay asleep. Some lifestyle changes such as avoiding drinking coffee, reading books, watching TV, or doing intense exercise before bedtime can help relieve the symptoms temporarily. An exact cure for RLS is not available but you can manage the symptoms through treatment options recommended by your doctor. Some at-home therapies are also available for feeling better and getting back to a regular sleep routine.