Do You Have Restless Legs?
You may know the feeling. You’re relaxing on the couch, watching some Netflix, and suddenly you get the overwhelming urge to move your legs. You may even feel some pain or a prickling sensation. Moving your legs around helps some, but once you stop, the urge starts up again. Or perhaps you experience it while you’re lying in bed, making it difficult to sleep. The phenomenon is known as restless legs syndrome (RLS), and it affects one in ten Americans. Restless legs syndrome, also called Willis-Ekbom disease, is a sleep disorder that causes an intense, often irresistible urge to move your legs, arms, or other parts of the body. Most people reach out to their healthcare providers for sleep difficulties.
Symptoms of RLS :
Leg or arm discomfort: uncomfortable limb sensations - creeping, itching, pulling, crawling, tugging, throbbing, burning, or gnawing. The "creepy-crawlies."Most common at bedtime but can happen during the day at other times of limb inactivity (like a long car or plane ride, sitting for a long time).
Urge to move legs or arms: an uncontrollable urge to move limbs, especially when sitting or lying down. Movements occur every 20 to 40 seconds for a few minutes or a few hours at a time.
Sleep disruption: The leg sensations caused by RLS make it harder to fall asleep or return to sleep after awakening by the leg sensations. Many times people get out of bed and try to walk it off, unsuccessfully. Sleeping partners can also suffer, as most people with RLS also experience involuntary muscle movements called periodic leg movements of sleep (PLMS). These typically occur in the foot, ankle, or knee every 15 to 30 seconds, lasting for about two seconds and sometimes longer. People without RLS can also experience PLMS.
Bedtime behavior problems: overwhelming urge to get out of bed
Daytime sleepiness: sleep deprivation usually leads to daytime tiredness.
Behavior and work performance problems: nighttime sleep disruption may cause daytime irritability, moodiness, difficulty concentrating, hyperactivity, and compromised work performance.
Why does RLS happen?
Inherited: Up to 92% of patients with RLS have a first-degree relative with the disorder. These patients tend to develop symptoms earlier in life (before age 45) than those with RLS without the genetic link.
Medical problems are closely associated with the development of RLS, including:
Iron deficiency.
Underactive thyroid.
Depression.
Fibromyalgia.
Parkinson's disease.
Kidney disease.
Diabetes.
Rheumatoid arthritis.
Nerve disorders.
Sleep Apnea.
Pregnancy. (especially in the last trimester; in most cases, symptoms usually disappear within 4 weeks after delivery)
Dialysis.
Medications: certain medications that may aggravate RLS symptoms, such as anti-nausea 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)
Caffeine, nicotine, and alcohol can also make symptoms worse.
How to get rid of RLS?
During the day, drink adequate fluids. Drink a little extra when working or playing in hot weather or take medications that cause you to excrete excess water, such as diuretics. Build-in frequent walking and stretching the time between periods of sitting or resting. Wearing supportive shoes with firm arch support and laces or secure fastenings.
Before going to bed, massage your leg muscles, gently stretch your legs or slowly pedal a stationary bike for a few minutes, or take a short walk, take a warm bath, or apply heating pads.
Avoid caffeine, nicotine, and alcohol, especially within several hours of bedtime.
Daily exercises may help to decrease RLS symptoms.
Schedule activities that require prolonged sitting or reclining—like car and plane travel and medical appointments—in the morning rather than the afternoon.
Dietary iron may sometimes be enough to treat RLS. Iron is an essential mineral that we get from our diets, such as red meat, cooked soybeans, cooked lentils, ground turkey, and fortified bread and breakfast cereals. We need only a small amount of dietary iron each day: 8 milligrams per day for adult men and women after menopause.
Oral iron supplements may be used when iron stores are deficient. The usual starting dose is one tablet of 325 milligrams of ferrous sulfate once per day. It's best absorbed when your stomach is acidic, so take it on an empty stomach or take it with vitamin C to acidify the stomach. Oral iron can cause stomach upset and constipation, so it may help take it every other day rather than daily. In some cases, an iron infusion may be needed.
Magnesium deficiency may make RLS worse. If magnesium level is on the lower side, magnesium supplementation may be helpful.
Medication may also be used when there is no iron deficiency and symptoms are troubling. There are now five FDA-approved medications for people with severe and frequent symptoms of RLS.
What is the prognosis?
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. Symptoms may gradually worsen with age, although the decline may be somewhat faster for individuals who also suffer from an associated medical condition. RLS diagnosis does not indicate the onset of another neurological disease, such as Parkinson’s disease. Besides, some individuals have remissions—periods in which symptoms decrease or disappear for days, weeks, months, or years—although symptoms often eventually reappear. 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.
See your healthcare provider if your condition bothers you or if it keeps you from getting a good night's sleep.
References:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6280211/
https://www.mp.pl/paim/en/node/4148/pdf
Published 8/13/20
Dr. Amar Singh, MD, and Dr. Poonam Singh, MD, are board-certified by the American Board of Internal Medicine and American Board of Obesity Medicine. They specialize in preventing, treating, and reversing chronic diseases using an evidence-based holistic approach. They are specifically interested in weight management, hormone re-balancing, and longevity. The American College of Physicians has recognized them as Fellows, FACP, for their excellence and contributions made to both medicine and the broader community. They enjoy teaching, volunteering, and advocating for their patients. Their mission is to share simple, effective, and proven strategies that lead to meaningful, sustainable, and long-lasting well-being.