Restless legs syndrome is a disorder of the nervous system. Patients with RLS have uncomfortable feelings in their legs; patients say it feels like something is crawling under their skin. Other feelings might include pain, itching, and pins and needles.
These feelings only occur when patients are resting, mostly in the evenings and during sleep. These unpleasant feelings go away when people move their legs. Patients with RLS have a strong urge to keep moving their legs. Patients say they cannot resist the urge to keep moving their legs. When sleeping, leg twitching is common.
About one in 10 people have RLS. It affects people of all ages, but most patients tend to be middle aged. RLS usually worsens with age. More women than men have RLS. Many pregnant women experience RLS, but it usually goes away after the baby is born. Most people with RLS have serious sleep problems. RLS patients are then tired the next day and have problems paying attention to what they are doing. Many patients say they don’t have the energy to do the things they like to do.
What Causes RLS?
RLS can be caused by genes, which is why it tends to run in families. This is called primary RLS. Often RLS is related to another medical issue. This is called secondary RLS. Some conditions causing RLS include kidney disease, low iron levels, anemia, high blood pressure, heart disease and diabetes.
Your doctor may order lab tests to determine if you have low iron or abnormal blood levels. Your doctor might want you to stay overnight in a sleep lab too. This is to see if there are other things causing your sleeping problems. Several medications also cause secondary RLS. Medications taken for depression, colds, allergies and nausea usually worsen symptoms. RLS is also linked to lack of exercise, caffeine, smoking, alcohol and anxiety.
Getting Diagnosed with Restless Leg Syndrome
People are diagnosed with restless leg syndrome if they answer yes to the following four questions: Do you have the urge to move your legs because of unpleasant feelings in them? Does the urge to move increase if you are resting or sitting down? Do the unpleasant feelings decrease or go away when you move your legs? Are the unpleasant feelings and the urge to move worse in the evenings and night?
Coping with Restless Leg Syndrome
The Restless Legs Syndrome Foundation recommends these steps for living and coping with restless legs syndrome:
Talk to others about RLS. Don’t hide your condition. Explain your symptoms to others. It helps them be more understanding.
Don’t resist the urge to move, but try to find an activity that gets your mind off RLS.
Wrapping your legs is a common coping method when sleeping with others.
Keep a sleep diary, and share it with your doctor. It helps your doctor understand the sleeping problems you experience.
If possible, raise your desktop so you can work and read standing up.
Begin and end each day with stretching.
Consider joining a support group.
When possible, take the stairs. Park your car some distance to increase walking.
Taking hot or cold showers may reduce your symptoms. Rubbing cream or gel on your legs before going to bed may reduce symptoms.
Applying pressure also helps.
When traveling, take morning flights. Explain to flight attendants that you need to move around so your legs don’t bother you.
Can Medication Help?
There is no cure for RLS, but three medications exist to treat it. These medications help ease the unpleasant feelings. If RLS is causing severe pain, your doctor may prescribe pain relievers. Sleeping pills may reduce sleeping problems. Some medicines that are used to treat convulsions or Parkinson’s disease also reduce the unpleasant feelings. No single treatment works for everyone. Your doctor may have you take several medications to find which one works best for you.
What Else Can I Do?
There are several things you can do to reduce your symptoms. For many patients, certain things make RLS worse. These are called triggers. You should keep a diary, and write down what you were doing before your symptoms got worse. If you find a particular activity worsens your symptoms, avoid this trigger if possible.
Regular or moderate exercise is recommended each day. Thirty to 60 minutes are recommended. Exercise must involve using your legs, such as walking or running. Try combining your exercise with an activity that you like, such as exercising and watching TV. Avoid extreme exercise; it may worsen your symptoms. And don’t exercise before you go to bed.
You should change your diet by eliminating or reducing caffeine and alcohol. If you smoke, consider quitting or cutting back on the number of cigarettes you smoke. Limiting the amount of refined sugar consumed during the day may ease your symptoms at night.
Improving your sleep habits is very important. People sleep better in a cool and dark room. Go to bed the same time each night, and get up at the same time each morning.
Where Can I Get More Information?
The Restless Legs Syndrome Foundation provides more information, including where to find a support group. Support group members help each other understand RLS and discuss ways to cope.
Note: This article was originally published March 18, 2013 on PharmacyTimes.com.
From Web Md
There are no cures for primary restless legs syndrome, or RLS, although various treatments often can help relieve symptoms. Treatment for secondary restless legs syndrome (RLS caused by another medical problem) involves treating the underlying cause.
The First Step in Treating Restless Legs Syndrome
The first line of defense against restless legs syndrome is to avoid substances or foods that may be causing or worsening the problem. Stay away from alcohol, caffeine, and nicotine. This may partly relieve your symptoms. In addition, review all medications you are taking with your doctor to determine if any of these drugs could be causing the problem.
Any underlying medical conditions, such as anemia, diabetes, nutritional deficiencies, kidney disease, thyroid disease, varicose veins, or Parkinson’s disease, should be treated. Dietary supplements to correct vitamin or mineral deficiency may be recommended. For some people, these treatments are all that is needed to relieve RLS symptoms.
You may also benefit from physical therapy and self-care treatments, such as stretching, taking hot or cold baths, whirlpool baths, applying hot or cold packs to the affected area, limb massage, or vibratory or electrical stimulation of the feet and toes before bedtime. Exercise and relaxation techniques also may be helpful.
Medications for Restless Legs Syndrome
Daily medication is usually recommended only for people who have symptoms of restless legs syndrome at least three nights a week, or as determined by your doctor. Keep in mind that drugs used to treat primary RLS do not cure the condition, but only relieve symptoms. People whose RLS symptoms occur sporadically may be prescribed medication to take only when they have symptoms.
The following medications are the most widely prescribed to treat RLS. They may be given alone or, in certain cases, in combination. Your doctor will prescribe the best treatment plan for you.
- Dopamine agonists: These are most often the first medicines used to treat RLS. These drugs, including Mirapex (pramipexole), Neupro (rotigotine), and Requip (ropinirole), act like the neurotransmitter dopamine in the brain. Side effects include daytime sleepiness, nausea, and lightheadedness.
- Dopaminergic agents: These drugs, including Sinemet — a combination of levodopa and carbidopa — increase the level of dopamine in the brain and may improve leg sensations in RLS. However, they may cause a worsening of symptoms for some people after daily use. Side effects can also include nausea, vomiting, hallucinations, and involuntary movements (dyskinesias).
- Benzodiazepines: Benzodiazepines, such as Restoril (temazepam), Xanax (alprazolam), and Klonopin (clonazepam), are sedatives. They do not so much relieve symptoms as help you sleep through the symptoms.
- Opiates: These drugs are most often used to treat pain, but they can also relieve RLS symptoms. Because opiates are very addictive, they are usually used only when other drugs don’t work. Vicodin (hydrocodone) is one example.
- Anticonvulsants: These agents, such as Neurontin (gabapentin) and Horizant (gabapentin enacarbil), may help relieve the symptoms of RLS as well as any chronic pain or nerve pain.
- Alpha2 agonists: These agents stimulate alpha2 receptors in the brain stem. This activates nerve cells (neurons) that “turn down” the part of the nervous system that controls muscle involuntary movements and sensations. The drug Catapres (clonidine) is an example.