Restless Legs Syndrome

Restless legs syndrome (RLS), now known as restless legs syndrome/Willis-Ekbom disease (RLS/WED), is a condition in which you have an uncontrollable urge to move your legs, usually due to leg discomfort.

RLS can begin at any age and generally worsens as you age. It can disrupt sleep, leading to daytime drowsiness, and make traveling difficult.

It typically happens at night or in the evenings while you're sitting or lying down although moving temporarily relieves the unpleasant feeling.

Medications can offer help with restless legs syndrome based on the presenting symptoms but mostly simple self-care measures and lifestyle adjustments are of primary help.

People typically describe restless legs syndrome symptoms as abnormal, unpleasant sensations in their legs or feet, usually on both sides of the body.

The name restless legs syndrome came from the fact that suffering from this compels the person to desire movement of the affected extremity.

Common characteristics of RLS signs and symptoms include:

(a) Nighttime leg twitching. RLS/WED 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.

(b) The sensation typically begins after being at rest such as after you've been lying down or sitting for an extended time, such as in an airplane, movie theater or even in a car.

(c) Relief by movement. The sensation of RLS/WED lessens with movement, such as by pacing or walking, stretching, and jiggling your legs.

Also, symptoms worsen in the evening or symptoms mainly occur at night. Although, restless legs syndrome commonly happen in the lower extremities it less commonly affect the arms as well in which the sensations, which generally occur within the limb rather is felt on the skin.

Affected people usually don't describe the condition as a muscle cramp or numbness, instead they describe the sensation as crawling, creeping, pulling, throbbing, aching or itching, even sometimes it is indescribable.

They do, however, consistently describe the desire to move their legs. In some cases, symptoms disappear for periods of time then would just recur hence occurrence of symptoms fluctuate in severity.

RLS/WED has received attention and focus from the media and medical community in recent years, as previously it cause hesitation from the patient suffering from RLS to seek medical attention as they fear they won’t be taken seriously. Hence, if you feel signs and symptoms of restless legs syndrome as described above best to contact your doctor.

Restless legs syndrome currently has an unknown cause. Some researchers offer some physiological explanation on their suspected cause but are still being studied and further proven.

Researchers have identified sites on the chromosomes where genes for RLS/WED may be present due to the heredity nature of this condition as sometimes RLS/WED runs in families, especially if the condition starts before age 50.

Researchers also suspect the condition may be due to an imbalance of the brain chemical dopamine, which sends messages to control muscle movement.

Signs and symptoms of RLS/WED may worsen temporarily due to hormonal changes common with pregnancy. Some women first experience RLS/WED during pregnancy, particularly in the last trimester.

However, signs and symptoms usually disappear after delivery and has the potential to recur in later years.

Be aware of the signs and symptoms of restless legs syndrome and immediately seek a medical attention once these symptoms start to arise to receive a diagnosis.

After initial evaluation, you may be referred to a neurologist, which is a doctor who specializes conditions of the nervous system, or a sleep specialist since the discomfort happens mostly at night which disrupt the person’s sleep.

Here are some information that you would need to prepare prior to go into your doctor’s appointment since the time spent with the doctor may be limited. List down all the symptoms you are experiencing especially if there is a specific time of day they occur or any triggering factor, best to also observe how long each sensation is felt and if there is any specific activity that offers relief of the said sensation.

Also, write down pertinent medical information such as previous or current medical condition, medications taken and is still taking including over-the-counter drugs and dosages and if you have any relative who has had or may have restless legs syndrome.

Have a family member or trusted friend accompany you in your doctor’s appointment as they can provide assistance in remembering information that you might miss or forgot and even help retain information mentioned by the doctor.

Here are some common questions that you can ask your doctor to help you under restless legs syndrome:

• What is the most likely cause of my signs and symptoms?
• Are there other possible causes?
• What tests do I need?
• What treatment options are available for this condition?
• I have other health conditions. How can I best manage them together?
• What self-care steps might improve my symptoms?
• Do you have educational materials I can have?
• What websites do you recommend?
• Where can I find a support group for people with restless legs syndrome?

Part of the doctor’s responsibility in completing your medical history is to ask you questions that may be related to the condition, such questions are as follows:

• Do you get an irresistible urge to move your legs?
• What words describe your symptoms?
• Do your symptoms start while you're sitting or lying down?
• Are your symptoms worse at night?
• Does movement make you feel better?
• Have you been told that you kick, shake or otherwise move your legs while sleeping?
• Do you often have trouble falling or staying asleep?
• Are you tired during the day?
• Does anyone else in your family have restless legs?
• How much caffeine do you have daily?
• What is your typical exercise program?

After the doctor has taken your medical history and asked you questions related to the description of your symptoms several diagnostic tests will be performed to help diagnose the condition. Blood tests, particularly for iron deficiency, may be ordered to exclude other possible causes for your symptoms.

In addition, your doctor may refer you to a sleep specialist. This may involve an overnight stay at a sleep clinic, where doctors can study your sleep if another sleep disorder such as sleep apnea is suspected.

A diagnosis of RLS/WED is based on the following criteria, established by the International Restless Legs Syndrome Study Group:

• You have a strong, often irresistible urge to move your legs, usually accompanied by uncomfortable sensations typically described as crawling, creeping, cramping, tingling or pulling.
• Your symptoms start or get worse when you're resting, such as sitting or lying down.
• Your symptoms are partially or temporarily relieved by activity, such as walking or stretching.
• Your symptoms are worse at night. Symptoms can't be explained solely by another medical or behavioral condition.

There are some helpful self-care measures you can take to help ease some of your symptoms, such as massaging your legs while soaking in a warm bath and cutting back on or eliminating caffeine, alcohol and tobacco.

Treatment of restless legs syndrome oftentimes involve treating an underlying condition as it greatly helps in the alleviation of symptoms of RLS.

Typically, an underlying condition associated with RLS is iron deficiency hence treatment may involve taking iron supplements and taking iron-rich foods. However, your doctor would need to prescribe the iron supplements after checking your blood iron levels.

Several prescription medications, most of which were developed to treat other diseases, are available to reduce the restlessness in your legs. These medications reduce motion in your legs by affecting the level of the chemical messenger dopamine as the medication aims to increase dopamine level in the brain.

Ropinirole (Requip), rotigotine (Neupro) and pramipexole (Mirapex) are approved by the Food and Drug Administration for the treatment of moderate to severe RLS/WED.

Short-term side effects of these medications are usually mild and include nausea, lightheadedness and fatigue. However, they can also cause impulse control disorders, such as compulsive gambling, and daytime sleepiness.

Narcotic medications can relieve mild to severe symptoms, but they may be addicting if used in high doses. Some examples of these medications include codeine, oxycodone (Oxycontin, Roxicodone), combined oxycodone and acetaminophen (Percocet, Roxicet), and combined hydrocodone and acetaminophen (Norco) which serve as muscle relaxants and sleep medications.

This class of medications, known as benzodiazepines, helps you sleep better at night, but they don't eliminate the leg sensations, and they may cause daytime drowsiness.

Commonly used sedatives for RLS/WED include clonazepam (Klonopin), eszopiclone (Lunesta), temazepam (Restoril), zaleplon (Sonata) and zolpidem (Ambien).

Certain medications such as those affecting calcium channels, such as gabapentin (Neurontin) and pregabalin (Lyrica), work for some people with RLS/WED.

You must closely work with your doctor to find the right combination of medications that would best work for you, hence it is essential to have regular follow-ups with the doctor in which you would need to discuss desired and side effects of the different medications that you have been taking.

You must also be aware of what you should be cautious about with the medications given such as for dopamine. Sometimes dopamine medications that have worked for a while to relieve your RLS/WED become ineffective or you notice your symptoms returning earlier in the day, this is called augmentation.

Your doctor would need to be notified of this change as a substitute medication can be given to combat the problem. Most drugs prescribed to treat RLS/WED may be detrimental to pregnancy, instead, your doctor may recommend self-care techniques to relieve symptoms.

However, if the sensations are particularly bothersome during your last trimester, your doctor may approve the use of certain drugs. Some medications may worsen symptoms of RLS/WED. These include some antidepressants, some antipsychotic medications, some anti-nausea drugs and some cold and allergy medications.

Your doctor may recommend that you avoid these medications, if possible. However, if you need to take these medications, talk to your doctor about adding drugs that to help manage your RLS/WED. Although, certain medications offer relief from symptoms of RLS but treatment would be more effective if you are to implement some healthy lifestyle changes as well.

Since the etiology of restless legs syndrome is unknown there is less information as to its prevention.

The best way to prevent further aggravation of symptoms, especially during pregnancy, make sure that you follow your regular pre-natal check ups so that possible changes or signs may be detected by your doctor.

The homeopathic remedies for restless legs syndrome are:

• Arsenicum album for cramps and tiredness.
• Causticum for restless legs at night with numbness and tearing pains in joints.
• Kali carbonicum for twitching, jerking or tearing pains.
• Lycopodium
• Magnesia carbonica for sharp pains, jerking of the legs and weakness of the calves.
• Phosphorus for cramping of the toes and numbness or stiffness of the joints.
• Rhus tox for increased susceptibility to infections.
• Sepia for restlessness and jerking in the limbs.
• Tarentula hispanica for numbness, jerking and twitching.

The most effective way of treating and coping with restless legs syndrome is the combination of certain medications and implementing simple lifestyle changes.

Try relaxation techniques, such as meditation or yoga. Stress can aggravate RLS/WED. Learn to relax, especially before bedtime.

Soaking in a warm bath and massaging your legs can relax your muscles. Establish good sleep hygiene. Fatigue tends to worsen symptoms of RLS/WED, so it's important that you practice good sleep hygiene.

Ideally, have a cool, quiet, comfortable sleeping environment, go to bed and rise at the same time daily, and get adequate sleep.

Some people with RLS/WED find that going to bed later and rising later in the day helps in getting enough sleep. Exercise. Getting moderate, regular exercise may relieve symptoms of RLS/WED, but overdoing it or working out too late in the day may intensify symptoms.

Avoid caffeine. Sometimes cutting back on caffeine may help restless legs. Apply warm or cool packs. Use of heat or cold, or alternating use of the two, may lessen your limb sensations.

Try to avoid caffeine-containing products, including chocolate and caffeinated beverages, such as coffee, tea and soft drinks, for a few weeks to see if this helps. RLS/WED is generally a lifelong condition hence you must find ways to integrated lifestyle changes that can help alleviate symptoms of RLS/WED incorporated permanently into your daily routine.

You must also be patient in exploring and developing coping strategies that would best suit you as it would need to work well with your social and personal activities including work and leisure.

Having ample emotional support can also ease in coping with this condition, hence look for ways to tell your trusted friends and family of your condition.

Share information about RLS/WED with your family members, friends and co-workers to help them understand why you are starting to have some lifestyle changes including you pacing the halls, standing at the back of the theater, or walking to the water cooler many times throughout the day.

Do not hesitate to move or do not restrict your movement as doing so may make your symptoms worse. Stretch and massage. Begin and end your day with stretching exercises or gentle massage and even in between while you are on your lunch break.

Keep track of the medications and strategies that help or hinder your battle with RLS/WED, and share this information with your doctor.

Keep a sleep diary as not having enough rest and sleep will aggravate your symptoms brought by restlessness and anxiety. Seek support and help by participating in a group, your insights not only can help you but also may help someone else.

A group may be able to provide you the additional support you would need to better cope with the lifelong condition as they may better understand what you are going through as they go through the same things as well.

There are several risks and complications associated with restless legs syndrome.

There is no specific age in which RLS/WED may develop as it can start at any age even during childhood. Although, the condition is commonly observed with increasing age but it is typically more prevalent in women than in men.

Oftentimes, Restless legs syndrome isn't related to a serious underlying medical problem. However, RLS/WED sometimes accompanies other conditions, such as:

• Peripheral neuropathy, which is a damage to the nerves in your hands and feet that is due to chronic diseases such as diabetes and alcoholism.
• Iron deficiency, even without anemia, iron deficiency can cause or worsen RLS/WED. If you have a history of bleeding from your stomach or bowels, experience heavy menstrual periods or repeatedly donate blood, you may have iron deficiency.

Also, if you have kidney failure, you may also have iron deficiency, often with anemia. When kidneys don't function properly, iron stores in your blood can decrease. This, with other changes in body chemistry, may cause or worsen RLS/WED.

Although RLS/WED doesn't lead to other serious conditions, symptoms can range from barely bothersome to incapacitating. Hence, severe RLS/WED can cause marked impairment in life quality and can result in depression hence implementing several lifestyle changes in beneficial to cope with the condition. Many people with RLS/WED find it difficult to fall or stay asleep.

Insomnia may lead to excessive daytime drowsiness, but RLS/WED may prevent you from daytime napping hence a sleep specialist may sometimes be recommended to offer additional comfort and not further aggravate the symptoms of RLS brought by sleeplessness.