What Is Restless Legs Syndrome?
Restless legs syndrome (RLS) is a disorder that
causes a strong urge to move your legs. This urge to move often occurs with
strange and unpleasant feelings in your legs. Moving your legs relieves the
urge and the unpleasant feelings.
People who have RLS describe the unpleasant feelings
as creeping, crawling, pulling, itching, tingling, burning, aching, or electric
shocks. Sometimes, the feelings also occur in the arms.
The urge to move and unpleasant feelings occur when
you’re resting and inactive. They tend to be worse in the evening and at
night and are temporarily relieved in the morning.
Overview
RLS can make it hard to fall asleep and stay asleep.
It may make you feel tired and sleepy during the day. This can make it hard to
learn, work, and do your normal routine. Not getting enough sleep also can
cause depression, mood swings, or other health problems.
RLS can range from mild to severe based on:
- The strength of your symptoms and how often they
occur
- How easily moving around relieves your symptoms
- How much your symptoms disturb your sleep
One type of RLS usually starts early in life
(before age 45) and tends to run in families. It may even start in childhood.
Once this type of RLS starts, it usually lasts for the rest of your life. Over
time, symptoms slowly get worse and occur more often. If you have a mild case,
you may have long periods with no symptoms.
Another type of RLS usually starts later in life
(after age 45). It generally doesn’t run in families. This type tends to
have a more abrupt onset. The symptoms usually don’t get worse with age.
Some diseases, conditions, and medicines also may
trigger RLS. For example, it has been associated with kidney failure, Parkinson
disease, diabetes, rheumatoid arthritis, pregnancy, and iron deficiency. When a
disease, condition, or medicine causes RLS, the symptoms usually start
suddenly.
Medical conditions or medicines often cause or
worsen the type of RLS that starts later in life.
Outlook
RLS symptoms often get worse over time. However,
some people’s symptoms go away for weeks to months.
If a condition or medicine triggers RLS, it may go
away if the trigger is relieved or stopped. For example, RLS that occurs due to
pregnancy tends to go away after giving birth. Kidney transplants (but not
dialysis) relieve RLS linked to kidney failure.
Treatments for RLS include lifestyle changes and
medicines. Some simple lifestyle changes often help relieve mild cases of RLS.
Medicines usually can relieve or prevent the symptoms of more severe RLS.
Research is ongoing to better understand the causes of RLS and to find better
treatments.
What Causes Restless Legs Syndrome?
Faulty Use or Lack of Iron
Research suggests that restless legs syndrome (RLS)
is mainly due to the faulty use or lack of iron in the brain. The brain uses
iron to make the chemical dopamine and to control other brain activities.
Dopamine works in the parts of the brain that control movement.
A number of conditions can affect how much iron is
in the brain or how it’s used. These conditions include kidney failure,
Parkinson disease, diabetes, rheumatoid arthritis, pregnancy, and iron
deficiency. All of these conditions increase the risk of having RLS.
People whose family members have RLS also are more
likely to develop the disorder. This suggests that genetics may contribute to
the faulty use or lack of iron in the brain that triggers RLS.
Nerve Damage
Nerve damage in the legs or feet and sometimes in
the arms or hands may cause or worsen RLS. Several conditions can cause such
nerve damage, including diabetes.
Medicines and Substances
Certain medicines may trigger RLS. These include
some:
- Antinausea medicines (used to treat upset
stomach)
- Antidepressants (used to treat depression)
- Antipsychotics (used to treat certain mental
health disorders)
- Cold and allergy medicines that contain
antihistamines
- Calcium channel blockers (used to treat heart
problems and
high
blood pressure)
RLS symptoms usually get better or may even go away
if the medicine is stopped.
Certain substances, such as alcohol and tobacco,
also can trigger or worsen RLS symptoms. Symptoms may get better or go away if
the substances are stopped.
Who Is At Risk for Restless Legs Syndrome?
Restless legs syndrome (RLS) may affect as many as
12 million people in the United States. More than half of the people who have
RLS have family members with the condition.
RLS can affect people of any race or ethnic group,
but the disorder is more common in people of Northern European descent. RLS
affects both genders, but women are more likely to have it than men.
The number of cases of RLS rises with age. Many
people who have RLS are diagnosed in middle age. However, in about 40 percent
of RLS cases, symptoms start before age 20. People who develop RLS early
in life usually have a family history of it.
People who have certain diseases or conditions or
who take certain medicines are more likely to develop RLS. (For more
information, see “What Causes Restless Legs
Syndrome?”)
For example, RLS is common in pregnant women. It
usually occurs during the last 3 months of pregnancy. The disorder usually
improves or goes away after giving birth. Some women may continue to have
symptoms after giving birth. Other women may develop RLS again later in life.
What Are the Signs and Symptoms of Restless Legs
Syndrome?
The four key signs of restless legs syndrome (RLS)
are:
- A strong urge to move your legs. This urge often,
but not always, occurs with unpleasant feelings in your legs. When the disorder
is severe, you also may have the urge to move your arms.
- Symptoms that start or get worse when
you’re inactive. The urge to move increases when you’re sitting
still or lying down and resting.
- Relief from moving. Movement, especially walking,
helps relieve the unpleasant feelings.
- Symptoms that start or get worse in the evening
or at night.
You must have all four of these signs to be
diagnosed with RLS.
The Urge To Move
RLS gets its name from the urge to move the legs
when sitting or lying down. This movement relieves the unpleasant feelings that
RLS sometimes causes. Typical movements are:
- Pacing and walking
- Jiggling the legs
- Stretching and flexing
- Tossing and turning
- Rubbing the legs
Unpleasant Feelings
People who have RLS describe the unpleasant feelings
in their limbs as creeping, crawling, pulling, itching, tingling, burning,
aching, or electric shocks. More severe RLS symptoms may cause painful
feelings. However, the pain usually is more of an ache than a sharp, stabbing
pain.
Children may describe RLS symptoms differently than
adults. Sometimes children with RLS are misdiagnosed as having ADHD.
The unpleasant feelings from RLS often occur in the
lower legs (calves). But the feelings can occur at any place in the legs or
feet. They also can occur in the arms.
The feelings seem to come from deep within the
limbs, rather than from the surface. You usually will have the feelings in both
legs. However, the feelings can occur in one leg, move from one leg to the
other, or affect one leg more than the other.
People who have mild symptoms may only notice them
when they’re still or awake for a long time, such as on a long airplane
trip or when watching TV. If they fall asleep quickly, they may not have
symptoms when lying down at night.
The unpleasant feelings from RLS aren’t the
same as the leg cramps many people get at night. Leg cramps often are limited
to certain muscle groups in the leg, which you can feel tightening. Leg cramps
cause more severe pain and require stretching the affected muscle for relief.
Sometimes arthritis or
peripheral
arterial disease (PAD) can cause pain or discomfort in the legs. Moving the
limbs usually worsens the discomfort instead of relieving it.
Periodic Limb Movement in Sleep
Most people who have RLS also have a condition
called periodic limb movement in sleep (PLMS). PLMS causes your legs or arms to
twitch or jerk about every 10 to 60 seconds during sleep. These
movements cause you to wake up often and get less sleep.
PLMS usually affects the legs, but it also can
affect the arms. Not everyone who has PLMS also has RLS.
Related Sleep Problems
The symptoms of RLS can make it hard to fall or
stay asleep. If RLS disturbs your sleep, you may feel very tired during the
day.
Lack of sleep may make it hard for you to
concentrate at school or work. Not enough sleep also can cause depression, mood
swings, or other health problems such as diabetes or
high
blood pressure.
How Is Restless Legs Syndrome Diagnosed?
Your doctor will diagnose restless legs syndrome
(RLS) based on your symptoms, your medical and family histories, and the
results from a physical exam and tests.
Your doctor will use this information to rule out
other conditions that have symptoms similar to those of RLS.
Specialists Involved
Your primary care doctor usually can diagnose and
treat RLS. However, he or she also may suggest that you see a sleep specialist
or neurologist.
Symptoms
You must have the
four key signs of RLS to be diagnosed
with the condition.
Your doctor also will want to know how your symptoms
are affecting your sleep and how alert you are during the day.
To help your doctor, you may want to keep a sleep
diary. Use the diary to keep a daily record of how easy it is to fall and stay
asleep, how much sleep you get at night, and how alert you feel during the day.
For a sample sleep diary, see the National Heart,
Lung, and Blood Institute’s
“Your
Guide to Healthy Sleep.”
Medical and Family Histories
Your doctor may ask whether you have any of the
diseases or conditions that can trigger RLS. These include kidney failure,
Parkinson disease, diabetes, rheumatoid arthritis, pregnancy, and iron
deficiency.
Your doctor also may want to know what medicines
you take. Some medicines can trigger or worsen RLS.
Because the most common type of RLS tends to run in
families, your doctor may ask whether any of your relatives have the disorder.
Physical Exam
Your doctor will do a physical exam to check for
underlying conditions that may trigger RLS. He or she also will check for other
conditions that have symptoms similar to those of RLS.
Tests
Currently, no test can diagnose RLS. Still, your
doctor will likely order blood tests to measure your iron levels. He or she
also may order muscle or nerve tests. These tests can show whether you have a
condition that may worsen RLS or that has symptoms similar to those of RLS.
Rarely,
sleep
studies are used to diagnose RLS. A sleep study measures how much and how
well you sleep. Although RLS can cause a lack of sleep, this sign isn’t
specific enough to diagnose RLS.
Researchers continue to study new tests to diagnose
RLS.
Drug Therapy Trial
If your doctor thinks you have RLS, he or she may
prescribe certain medicines to relieve your symptoms. These medicines, which
are used to treat people who have Parkinson disease, also can relieve RLS
symptoms. If the medicines relieve your symptoms, your doctor can confirm that
you have RLS.
How Is Restless Legs Syndrome Treated?
Restless legs syndrome (RLS) has no cure. If a
condition or medicine triggers RLS, it may go away or get better if the trigger
is relieved or stopped.
RLS can be treated. The goals of treatment are to:
- Prevent or relieve symptoms
- Increase the amount and improve the quality of
your sleep
- Treat or correct any underlying condition that
may trigger or worsen RLS
Mild cases of RLS often are treated with lifestyle
changes and sometimes with periodic use of medicines. More severe RLS usually
is treated with daily medicines.
Lifestyle Changes
Lifestyle changes can prevent or relieve the
symptoms of RLS. For mild RLS, lifestyle changes may be the only treatment
needed.
Preventing Symptoms
Many common substances, such as alcohol and tobacco,
can trigger RLS symptoms. Avoiding these substances can limit or prevent
symptoms.
Some prescription and over-the-counter medicines can
cause or worsen RLS symptoms. Tell your doctor about all of the medicines
you’re taking. He or she can tell you whether you should stop or change
certain medicines.
Adopting good sleep habits can help you fall asleep
and stay asleep—a problem for many people who have RLS. Good sleep habits
include:
- Keeping the area where you sleep cool, quiet,
comfortable, and as dark as possible.
- Making your bedroom sleep-friendly. Remove things
that can interfere with sleep, such as a TV, computer, or phone.
- Going to bed and waking up at the same time every
day. Some people who have RLS find it helpful to go to bed later in the evening
and get up later in the morning.
- Avoiding staying in bed awake for any long period
in the evening or during the night.
Doing a challenging activity before bedtime, such as
solving a crossword puzzle, may ease your RLS symptoms. This distraction may
make it easier for you to fall asleep. Focusing on your breathing and using
other relaxation techniques also may help you fall asleep.
Regular, moderate physical activity also may help
limit or prevent RLS symptoms. Often, people who have RLS find that if they
increase their activity during the day, they have fewer symptoms.
Relieving Symptoms
Certain activities can relieve RLS symptoms. These
include:
- Walking or stretching
- Taking a hot or cold bath
- Massaging the affected limb(s)
- Using heat or ice packs on the affected limb(s)
- Doing mentally challenging tasks
Choose an aisle seat at the movies or on airplanes
and trains so you can move around, if necessary.
Medicines
You may need medicines to treat RLS if lifestyle
changes can’t control symptoms. Many medicines can relieve or prevent RLS
symptoms, including many new medicines.
No single medicine works for all people who have
RLS. It may take several changes in medicines and dosages to find the best
approach. Sometimes, a medicine will work for a while and then stop working.
Some of the effective medicines used to treat RLS
also are used to treat Parkinson disease. These medicines make dopamine or act
like it in the parts of the brain that control movement. (Dopamine is a
chemical that helps you move properly.)
If medicines for Parkinson disease don’t
prevent or relieve your symptoms, your doctor may prescribe other medicines.
You may have to take more than one medicine to treat your RLS.
Always talk with your doctor before taking any
medicines. He or she can tell you the side effects of each RLS medicine. Side
effects may include nausea, headache, and daytime sleepiness.
In some cases, RLS medicines may worsen problems
controlling excessive gambling, shopping, or sexual activity. Sometimes,
continued use of RLS medicines may make your RLS symptoms worse.
Contact your doctor if you have any of these
problems. He or she can adjust your medicines to prevent these side effects.
Living With Restless Legs Syndrome
Restless legs syndrome (RLS) is often a lifelong
condition. Symptoms may come and go often or go away for long periods. Symptoms
often get worse over time.
If a condition or medicine triggers RLS, the
disorder may go away if the trigger is relieved or stopped. For example, RLS
that occurs due to pregnancy tends to go away after giving birth.
Although RLS has no cure, treatments can relieve or
prevent RLS symptoms. Mild cases of RLS often are treated with lifestyle
changes and sometimes with periodic use of medicines. More severe RLS usually
is treated with daily medicines. (For more information, see
“How Is Restless Legs Syndrome
Treated?”)
Ongoing Medical Care
If you have RLS, see your doctor regularly so he or
she can watch for changes in your symptoms. This will show whether your
treatment is working and whether it will continue to work over time.
Call your doctor if you notice your treatment is no
longer working or if you have new symptoms.
Other Considerations
Try to plan long car trips and other long periods of
inactivity at the times of day when your symptoms are least severe. Give
yourself time to stretch or take walking breaks.
Choose an aisle seat at the movies or on airplanes
and trains so you can move around if needed.
Consider finding a work setting where you can stand
or walk around.
Support Groups
Many people who have RLS find it helpful to join a
support group, such as those that the
RLS Foundation offers.
Key Points
- Restless legs syndrome (RLS) is a disorder that
causes a strong urge to move your legs. This urge often occurs with strange and
unpleasant feelings in your legs. Moving your legs relieves the urge and the
unpleasant feelings.
- People who have RLS describe the unpleasant
feelings as creeping, crawling, pulling, itching, tingling, burning, aching, or
electric shocks.
- The urge to move and unpleasant feelings occur
when you’re resting and inactive. They tend to be worse in the evening
and at night and are temporarily relieved in the morning.
- RLS can make it hard to fall asleep and stay
asleep. It may make you feel tired and sleepy during the day. This can make it
hard to learn, work, and do your normal routine. Not getting enough sleep also
can cause depression, mood swings, and other health problems.
- One type of RLS usually starts early in life
(before age 45) and tends to run in families. Once this type of RLS starts, it
usually lasts for the rest of your life. Over time, symptoms slowly get worse
and occur more often.
- Another type of RLS usually starts later in life
(after age 45). It generally doesn’t run in families. This type tends to
have a more abrupt onset. The symptoms usually don’t get worse with age.
- Some diseases, conditions, and medicines also
may trigger RLS. For example, it has been associated with kidney failure,
Parkinson disease, diabetes, rheumatoid arthritis, pregnancy, and iron
deficiency. When a disease, condition, or medicine triggers RLS, symptoms
usually start suddenly. The disorder may go away if the trigger is relieved or
stopped.
- Research suggests that RLS is mainly due to the
faulty use or lack of iron in the brain. Nerve damage in the limbs and some
medicines and substances also may cause RLS.
- The number of cases of RLS rises with age. Many
people who have RLS are diagnosed in middle age. However, in about 40 percent
of RLS cases, symptoms start before age 20. People who develop RLS early
in life usually have a family history of it.
- The four key signs of RLS are an urge to move
your legs (unpleasant feelings in the legs often occur with this urge),
symptoms that start or get worse when you’re inactive, relief from
moving, and symptoms that get worse in the evening or at night.
- Your doctor will diagnose RLS based on your
symptoms, your medical and family histories, and the results from a physical
exam and tests. Your primary care doctor usually can diagnose and treat RLS.
However, he or she also may suggest that you see a sleep specialist or
neurologist.
- Treatments for RLS include lifestyle changes and
medicines. Mild cases of RLS often are treated with lifestyle changes and
sometimes with periodic use of medicines. More severe RLS usually is treated
with daily medicines. Lifestyle changes include avoiding certain substances and
adopting good sleep habits.
- If you have RLS, see your doctor regularly so he
or she can watch for changes in your symptoms. Call you doctor if you notice
your treatment is no longer working or if you have new symptoms.
- Try to plan long car trips and other long periods
of inactivity at the times of day when your symptoms are least severe. Give
yourself time to stretch or take walking breaks. Choose an aisle seat at the
movies or on airplanes and trains so you can move around if needed. You might
want to consider finding a work setting where you can stand or walk around.
Links to Other Information About Restless Legs
Syndrome
NHLBI Resources
Non-NHLBI Resources
Clinical Trials
|