Restless Leg Syndrome

Ever felt an uncontrollable urge to move your legs or arms? Usually the legs, at night, when you’re trying to sleep? Maybe not because of pain, per se, but just an uncomfortable feeling often described as a crawling, pulling, throbbing, aching, itchy feeling deep in the limbs not on the skin, that won’t stop until you move? But even that only helps temporarily.

It’s considered both a sleep disorder, because it interferes with sleep, and a movement disorder because it forces activity to resolve. An estimated 10% of the U.S. population suffers from this condition, women more likely than men.

You may have restless leg syndrome (RLS) also known as Willis-Ekborn disease. It can start at any age and generally worsens as we get older, disrupting sleep and ultimately daily activities.

There are two types:

Primary or idiopathic: Usually starts by age 40 but can begin in childhood and be a lifelong disease. Symptoms can be intermittent or progress over time.

Secondary: Caused by another etiology. Usually, this type has a sudden onset of symptoms by age 45, that doesn’t worsen over time but does tend to be more severe than those caused by a primary disorder.

Symptoms

Symptoms and severity can fluctuate, sometimes even disappearing for long periods of time.

• They usually start at rest after sitting or lying down for an extended period of time e.g. at night in bed, long car rides, at the movies.
• It resolves with shaking out, stretching or moving the affected limb.
• Most report the worst symptoms occur at night necessitating pacing or walking to resolve.
• RLS can affect just one limb or the arms but the majority of sufferers have symptoms in both legs.
• More than 80 percent of those who have restless leg syndrome also experience periodic limb movement of sleep (PLMS). A common disorder that causes the legs to twitch and kick during sleep often up to every 15-40 seconds.
• Restless leg syndrome can lead to sleep deprivation issues that often impact daytime activities and fatigue levels.
  

Risk Factors

• In the majority of cases, an underlying cause has not been found.
• More than 40% have a family history. Specific gene variants have been seen in this population who have the condition.
• Dysfunction of the basal ganglion, the part of the brain that controls movement. In Parkinson’s the brain chemical the basal ganglion uses to insure smooth, purposeful movements- dopamine- is disrupted, resulting in involuntary movements. Parkinson’s patients have a higher risk of developing RLS.
• End stage renal disease and those on dialysis. Due to the buildup of urea from urine that can’t be cleared properly when the kidneys no longer function normally. It is estimated 20-25% of patients have RLS as well.
• Underlying neuropathies can increase risk from any source. The ultimate damage caused by a neuropathy in any limb can increase the risk.
• Sleep disorders such as obstructive sleep apnea (OSA).
• Hormonal changes, especially the last trimester of pregnancy, can increase the risk of having restless leg syndrome. Symptoms occur in 25% of pregnant women but they usually resolve within a month of delivery.
• Alcohol, tobacco, caffeine use all increase risk.
• Some medications may aggravate underlying restless leg symptoms. Anti-psychotics, anti-nausea, serotonin release inhibitors, and anti- histamines.
• It appears there may be a connection between low iron levels in the brain and restless leg syndrome even when circulating blood levels of iron are normal.
• Diabetes can result in uncontrolled sugars, which can damage nerves leading to peripheral neuropathy which is a can increase the risk for RLS.
• Rheumatoid arthritis. 30% of patients may also have restless leg complaints thought to be due to the immune response this disease process causes.
• Thyroid issues. Some studies suggest this is because thyroid hormone imbalances can affect the dopamine system.

Diagnosing restless leg syndrome

The symptoms alone are enough to diagnose the condition. A thorough exam must be done to rule out any other issues such as renal disease, iron deficiency, sleep apnea, diabetes, arthritis, and pregnancy.

What is the treatment?

There are no cures for RLS but symptoms can often be abated through a variety of options.

Medications

• Correct underlying medical conditions such as diabetes, thyroid issues, or anemia from iron deficiency.
• First line medication treatment for RLS are anti- seizure drugs such as gabapentin, enacarbil, and lyrica. They can decrease the pain and sensation changes that occur.
• If iron deficient, add supplements.
• Medications that increase dopamine in the brain such as ropinirole, pramipexole, levidopa plus carbidopa.
• Opioids in severe cases where nothing else helps.
• Benzodiazepines to decrease anxiety, muscle spasms and insomnia.

Non medication

• Maintain a healthy weight.
• Eat a balanced diet.
• Stop alcohol, caffeine, tobacco.
• Improve sleep hygiene e.g. sleep the same hours every night, turn off digital devices an hour before bedtime, minimize light exposure, stop stimulants in the afternoon.
• Moderate aerobic and stretching exercises on a regular bass, but not at night.
• Take a warm bath a night to relax muscles.
• Message the calves and feet.
• Wear knee high stockings to keep the legs warm at night or foot wars, vibration pads sold for RLS.
• Stop activities that worsen symptoms.
• Use relaxation techniques such as yoga, tai chi to reduce stress.
• Small but unproven studies have recommended adding a magnesium/ iron supplement. Too often this leads to abnormally high levels in individuals not deficient. Always ask your healthcare provider.
• Hydrate.
• Acupuncture/ Accupressure

Diet

Although there aren’t any specific guidelines, eating healthy to ensure you’re getting adequate amounts of nutrients and vitamins is essential. Cut highly processed and sugary foods.

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Restless leg syndrome can affect over health and quality of life. Those who also have chronic sleep deprivation as a result of their RLS are at higher risk for heart disease, stroke, diabetes, renal issues, depression and early death. There may not be a cure but there’s no reason you have to suffer. Make necessary lifestyle changes, talk to your provider about treating any underlying concerns and starting appropriate medications that can help.

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https://medlineplus.gov/restlesslegs.html

-https://www.ninds.nih.gov/health-information/disorders/restless-legs-syndrome

-https://www.hopkinsmedicine.org/health/conditions-and-diseases/restless-legs-syndrome-rls

-https://my.clevelandclinic.org/health/diseases/9497-restless-legs-syndrome

-https://www.nhs.uk/conditions/restless-legs-syndrome/causes/

-https://www.healthline.com/health/restless-leg-syndrome