Restless Leg Syndrome: Causes, Symptoms & Treatment

What is Restless Leg Syndrome? 

RLS is a nervous system deficit that causes an overpowering urge to move your legs. It is commonly referred to as Willis-Ekbom disease. Doctors liken RLS to a sleeping disorder, because it usually occurs at night and tends to disrupt the sleeping patterns of the person affected. Anyone can suffer from it, but it is more common in women and middle aged people. 

Table of Contents:

Causes & Symptoms
Types
RLS & Pregnancy
Treatment

 

Causes & Symptoms of Restless Leg Syndrome

There is no root cause of RLS yet, but it may be related to your genetics. There have been many cases where the patient has a long list of family members who also suffer from RLS. Other causes may include: 

• Lifestyle: a lack of sleep or another sleeping disorder like sleep-apnea may trigger RLS symptoms or make it worse. People who consume excessive amounts of alcohol, coffee and tobacco may also suffer from RLS in the long run. 
• Medication: some medication may make your symptoms worse. This includes anti-nausea meds, antipsychotics, antidepressants and cold and allergy medication that contain antihistamines. 
• Pregnancy: some women have RLS during their pregnancy. 
• Chronic diseases; Parkinson’s disease, kidney failure or renal disease, diabetes and peripheral neuropathy can trigger RLS.

Here are a few key symptoms of RLS: 

• Painful or uncomfortable sensations in the legs making you feel that you have to move the legs to get relief
• Sometimes these sensations are described as if there are insects crawling inside the legs or as burning, creeping or tugging feelings.
• These sensations can vary from discomfort to being really painful.
• The urge to get up and move around even when you are trying to rest or to sleep.
• The feeling of discomfort increases during the evening or at night.
• The onset of the symptoms when you sit or lie down.
• Your feet or toes may even move slightly or jerk when you are sitting still or resting.
• For many people, the symptoms disappear by early morning so that you are able to catch up on some refreshing sleep. If this is the case, try to alter your daily routine so that you can sleep later in the morning.
• If you don’t get enough sleep, exhaustion can result and the quality of life can be severely affected.

The Two Types of Restless Leg Syndrome

There are two types of RLS or restless leg syndrome - namely primary RLS and secondary RLS. 

The first type – primary RLS - seems to appear without any reason and often in young people. The symptoms can be quite mild but can worsen with age. After the age of 50, such symptoms can often become more severe so that sleep is severely disrupted. This primary RLS does appear to run in families so there is a genetic connection.

The second type – secondary RLS – is usually caused by other conditions. Such conditions include:

• Being low in iron (being anemic). If the levels of iron or the anemia itself can be corrected, there is often a reduction in symptoms.
• Pregnancy. Fortunately RLS is usually a temporary symptom when linked to pregnancy (usually in the third trimester) and will disappear after the baby has been delivered.
• Kidney problems or kidney disease.
• Parkinson’s disease.
• Diabetes.
• Thyroid problems such as an overactive or underactive thyroid.
• Spinal cord tumors, peripheral nerve lesions or even spinal cord injuries.
• Sleep apnea.
• Varicose veins or problems with the nerves in either the hands or the feet.
• Alcoholism.
• Certain medications or drugs may increase or trigger RLS symptoms. These include tricyclic antidepressants, anti-nausea and anti-seizure drugs, selective serotonin reuptake inhibitors, or lithium. Changing your medication may be all that is necessary to stop the RLS symptoms.
• The use of some cold and allergy drugs can also cause RLS.
• The withdrawal of sedatives can trigger RLS.

If you are suffering from RLS, then you would be wise to get a positive diagnosis from your doctor and to discuss with him whether this could be a secondary RLS caused by one of the conditions listed above. Together you can eliminate one by one all possible conditions which could be affecting you. It could be that it is primary RLS and you have a family history with such a medical condition.

RLS can also occur in children where a diagnosis can be especially difficult because the doctor has to rely on the child’s description of what he feels and experiences. Such symptoms may well be difficult for a child to describe and so often the condition is misdiagnosed as growing pains or even attention deficit disorder.

RLS During Pregnancy

During pregnancy, the mother-to-be often suffers from various conditions that would not be a problem normally.  One such condition is RLS or restless leg syndrome which is a sleep disorder that can occur for the first time or become more severe during pregnancy. 

The causes of RLS in pregnancy can be:

• As your body grows and changes, your old sleep positions might feel less comfortable.

• The aches and pains of a normal pregnancy, such as heartburn, nausea, or hemorrhoids can tend to keep you awake at night.
• Your bladder holds less fluid as your baby grows, often necessitating getting up several times a night to urinate.
• Emotional anxiety about birth, becoming a mother, work and your changing relationship with your partner might also play a part in keeping you tossing and turning at night.

You can alleviate the problems of RLS in pregnancy by:

• Trying to do some exercise before bedtime such as a brisk walk, stretching exercises for your legs (stretch your legs, do knee bends or rotate your ankles) or even having a swim.

• Getting a massage for the affected area on the legs or persuading your partner to do one for you.
• Applying warm or cold packs to the affected area or taking warm or cool baths – depending on which one you find helpful.
• Practising relaxation techniques – such as meditation, yoga or deep breathing.
• Avoiding caffeine because this can aggravate the symptoms of RLS.
• Being active before bedtime rather than lying in bed reading or watching television.
• Checking with your doctor if you need to take additional iron. Folate deficiency, hormonal changes and circulatory changes can all be possible causes of RLS when you are pregnant.
• Sleeping on your side with a pillow between your legs.
•  Standing up frequently and walking around, especially if you are still working.
The good news is that RLS in pregnancy is usually a temporary condition – lasting up to a maximum of 6 months after your baby is born.

Treatment for RLS

This restless sleep disorder has no cure but there are ways to treat the condition and if you have it while you are pregnant, it is usually temporary.

Less severe RLS can usually be eased with good home care which we will cover later in this article.

More severe symptoms will probably need medical attention.

See your doctor for a definite diagnosis and discuss whether medication is an option while investigating any side effects especially when used long term. Such medications have actually been developed for other conditions so their use for treating the symptoms of RLS have come about almost as an after thought. While one medication may be helpful to some, it may be detrimental when used by others. In addition, these medications can lose their effect over time.

Prescription medications include:

• Hypertensive drugs for high blood pressure which can be effective in combating RLS.
• Dopaminergic agents used to treat Parkinson’s disease but which can increase the brain chemical dopamine that regulates muscle movements. 
• Benzodiazepines are sleep medications, or central nervous system depressants, but they can also suppress muscle contractions. The downside is that they can cause daytime sleepiness. 
• Non-benzodiazepine sedatives which are actually sleeping pills. 
• Opiates such as Darvon or the stronger Percodan which are pain-killers and relaxants that can suppress RLS in some sufferers but they can be addictive and should only be used in low dosages. 
• Anticonvulsants such as Gabapentin or Neurontin are used to prevent seizures. They will also reduce muscle contractions in some RLS sufferers.

As you can see, none of these pharmaceutical medications are ideal and along with caffeine and alcohol, some drugs and medications are even thought to cause the condition in the first place - including: H2-histamine blockers (such as ranitidine and cimetidine) and certain antidepressants like amitriptyline.

A more natural way of dealing with severe RLS symptoms is by using a portable, bedside TENS unit. With this, you can apply electrical stimulation to the feet and legs for 15 to 30 minutes at bedtime to reduce those night time sensations.

During the day:

• Take regular exercise to relieve the RLS symptoms.
• Wrap your legs in ace bandages or wear compression stockings.
• If you have low iron levels, take iron supplements to balance this deficiency.

At bedtime:

• Some exercise before bed or stretch the legs, do knee bends or rotate your ankles.
• Take time to relax by trying meditation, yoga or just deep breathing.
• Apply heat or cold. Suggestions include taking a bath, soaking your feet in hot or cool water, using a heating pad or hot water bottle or perhaps a cold compress.
• Lying on your side with a pillow between the knees.

Although it is often easier said than done, learning to manage the symptoms of RLS can bring relief and of course sleep.

Sources:

http://www.medicinenet.com/restless_leg_syndrome/article.htm
https://www.webmd.com/brain/restless-legs-syndrome/restless-legs-syndrome-rls#1