Restless legs syndrome
Posted in Sleep disorders

Restless legs syndrome

Restless legs syndrome (RLS) causes a powerful urge to move skeletal muscles such as those in your legs, although it is not limited to legs.

What are symptoms of restless legs syndrome?

Some people describe it as a creeping, crawling, tingling, or burning sensation. Moving makes your legs feel better, but not for long. RLS can make it hard to fall asleep and stay asleep.

What are the different types of RLS?

Based on what causes it, RLS can be classified as primary or secondary.

Primary restless legs syndrome means that cause is not known.

Secondary RLS means that some other medical condition such as such as anemia or pregnancy. Some medicines can also cause temporary RLS. Caffeine, tobacco, and alcohol may make symptoms worse.

Is RLS considered a sleep or neurological disorder?

RLS is classified as a sleep disorder since the symptoms are triggered by resting and attempting to sleep, and as a movement disorder, since people are forced to move their legs in order to relieve symptoms. It is, however, best characterized as a neurological sensory disorder with symptoms that are produced from within the brain itself.

restless legs

restless legs

How do the patients with RLS present?

RLS is one of several disorders that can cause exhaustion and daytime sleepiness, which can strongly affect mood, concentration, job and school performance, and personal relationships. Many people with RLS report they are often unable to concentrate, have impaired memory, or fail to accomplish daily tasks. Untreated moderate to severe RLS can lead to about a 20 percent decrease in work productivity and can contribute to depression and anxiety. It also can make traveling difficult.

How common is RLS?

It is estimated that up to 7-10 percent of the U.S. population may have RLS. RLS occurs in both men and women, although women are more likely to have it than men. It may begin at any age. Many individuals who are severely affected are middle-aged or older, and the symptoms typically become more frequent and last longer with age.

What is the difference between RLS and PLMS?

PLMS is characterized by involuntary leg (and sometimes arm) twitching or jerking movements during sleep that typically occur every 15 to 40 seconds, sometimes throughout the night. Although many individuals with RLS also develop PLMS, most people with PLMS do not experience RLS.

Fortunately, most cases of RLS can be treated with non-drug therapies and if necessary, medications.

What causes restless legs syndrome?

In most cases, the cause of RLS is unknown (called primary RLS). However, RLS has a genetic component and can be found in families where the onset of symptoms is before age 40. Specific gene variants have been associated with RLS. Evidence indicates that low levels of iron in the brain also may be responsible for RLS.

Considerable evidence also suggests that RLS is related to a dysfunction in one of the sections of the brain that control movement (called the basal ganglia) that use the brain chemical dopamine. 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 increased chance of developing RLS.

RLS also appears to be related to or accompany the following factors or underlying conditions:

  • end-stage renal disease and hemodialysis
  • iron deficiency
  • certain medications that may aggravate RLS symptoms, such as antinausea drugs (e.g. prochlorperazine or metoclopramide), antipsychotic drugs (e.g., haloperidol or phenothiazine derivatives), antidepressants that increase serotonin (e.g., fluoxetine or sertraline), and some cold and allergy medications that contain older antihistamines (e.g., diphenhydramine)
  • use of alcohol, nicotine, and caffeine
  • pregnancy, especially in the last trimester; in most cases, symptoms usually disappear within 4 weeks after delivery
  • neuropathy (nerve damage).
  • Sleep deprivation and other sleep conditions like sleep apnea also may aggravate or trigger symptoms in some people. Reducing or completely eliminating these factors may relieve symptoms.

How is restless legs syndrome diagnosed?

Since there is no specific test for RLS, the condition is diagnosed by a doctor’s evaluation. The five basic criteria for clinically diagnosing the disorder are:

A strong and often overwhelming need or urge to move the legs that is often associated with abnormal, unpleasant, or uncomfortable sensations.

The four cardinal symptoms of RLS include:

  1. A feeling of being uncomfortable when you are lying down or sitting with an urge to move at least 3 times or more per week.
  2. The symptoms are worse in the evening or night.
  3. The symptoms are partially or temporarily relieved by activity, such as walking or stretching.
  4. The symptoms can’t be explained solely by another medical or behavioral condition.

A sleep physician will focus largely on the individual’s descriptions of symptoms, their triggers and relieving factors, as well as the presence or absence of symptoms throughout the day.

Treatment options for RLS depends on the cause.

If there is a known cause of RLS, such as anemia, medication induced, kidney disease etc, then treating that condition when possible is recommended.

What is the prognosis for people with restless legs syndrome?

RLS is generally a lifelong condition for which there is no cure. However, current therapies can control the disorder, minimize symptoms, and increase periods of restful sleep.

How can W8MD help?

Sleep Medicine Program uses state of the art technology including the convenient home sleep studies or in lab sleep diagnostic studies to diagnose and treat over 80 different sleep disorders including sleep apnea, narcolepsy, restless leg syndrome, insomnia to name a few. Learn More…

Prab R. Tumpati, MD. Dr. Tumpati is the founder and medical director of W8MD Weight Loss, Sleep and MedSpa Centers. Dr Tumpati is board certified physician practicing sleep medicine, obesity medicine, aesthetic medicine and internal medicine. Dr. Tumpati’s passion is to educate patients and get to the root of the problem rather than "band aid medicine". As a physician with fellowship training in Obesity Medicine, Dr. Tumpati has a unique approach to wellness, weight loss, and medical aesthetics with a focus on prevention rather than cure. Dr. Tumpati takes pride in helping patients come of many chronic life style medications such as blood pressure, cholesterol or diabetes medications by helping them lose weight and change their life style. Dr Tumpati believes in evidence based medicine rather than fad diets that do not work and works with each patient taking their unique situation in to consideration that causes them to gain weight so he can find a customized solution. Serving as the medical director of the W8MD's New York City, Cherry Hill NJ and greater Philadelphia offices, Dr Tumpati is the leading weight loss, sleep and aesthetic medicine physician in the tristate areas of Pennsylvania, New Jersey and New York.

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