Restless Legs Syndrome: An Overview
If you’re overcome by the painful urge to constantly move your legs, or by unconscious kicking and jerking that’s keeping you awake at night, you’re not alone. Restless legs syndrome (RLS) affects up to 7-10% of adults in the US population, with approximately 2% of RLS patients being children. However, this rate may be even higher, as scientists speculate that RLS is often misdiagnosed as insomnia, depression, or other neurological disorders.
Patients with RLS suffer from an overwhelming impulse to move their legs, which is often followed by uncomfortable sensations similar to tremors or needles. These symptoms can range in severity from irksome to painful, and become worst at night or when entering a relaxed state. These painful sensations make it difficult for RLS patients to fall and stay asleep, resulting in chronic sleep deprivation and its related consequences.
Here’s a look at RLS symptoms, diagnosis, and treatment.
What Is Restless Legs Syndrome?
RLS is a sleep-related neurologic sensorimotor disorder, or movement disorder, which causes patients to feel an irresistible urge to move their legs during periods of inactivity or rest. These impulses are often coupled with discomforting sensations, which can be temporarily relieved through motion or applied pressure. RLS symptoms worsen in the evening, when the patient is entering a period of rest. Naturally, the discomfort impedes the patient’s ability to fall asleep, and interrupts sleep when it is finally reached. This sleep deprivation results in chronic daytime fatigue and irritability, the consequences of which wreak havoc on the patient’s waking life on both personal and professional levels.
The main symptom characterizing RLS is the overwhelming impulse to move the legs, triggered when the patient is at rest. In fact, trying to relax—or lying down, specifically—is what appears to activate this impulse. The sensations accompanying this urge varie according to the personal experience of the patient, but has been described as feeling like: tremors, spasms, throbbing, creeping, crawling, pulling, tugging, or itching. This may affect one or both sides of the body. Movement or pressure should temporarily relieve these symptoms. Due to this, RLS patients can be found in constant motion: bouncing the legs, pacing the floor, and jerking while asleep.
The unpleasant urges peak at night, when the patient is falling asleep. They can also be triggered during extended periods of inactivity, such as when sitting through a flight, a movie, or a car ride. Patients also experience involuntary leg spasms, and are often awakened during the night from unconscious leg jerking. These symptoms usually wane in the early morning, allowing a small window where the patient can rest without disturbance. In turn, RLS symptoms encompass those of sleep deprivation: fatigue, irritability, inability to concentrate, and the damage associated with impaired mental performance.
While some patients may only experience symptoms once a week with mild consequences, patients with severe RLS may experience symptoms more than twice a week with dramatic interruption of sleep and damage to their waking life. Moreover, some patients may even experience a brief remission early on, but the symptoms generally worsen depending on the health of the patient. Patients who suffer from RLS in conjunction with an associated medical condition may deteriorate relatively quickly, while others in good health may take years before the symptoms become a regular problem. These symptoms intensify as you age.
RLS Risk Factors
The exact cause of RLS is not yet known. Studies have found a strong genetic link, where over 70% of children with RLS had at least one parent who also suffered from the condition. This is most often the case when there is a family history of symptom development before the age of 40, with specific gene variants found to be associated with the condition. Other studies suggest that RLS may be related to iron deficiencies in the brain.
There is also evidence indicating that the dysfunction responsible for RLS may be similar to that of Parkinson’s disease: a disorder of the basal ganglia circuits, which release the dopamine needed for smooth muscle movement. Interference with these dopamine pathways are known to cause involuntary muscle spasms, such as twitching or jerking. Patients with Parkinson’s disease are often also diagnosed with RLS.
There are also a few medical conditions commonly associated with RLS, mainly chronic diseases like diabetes or kidney failure. Specific medications may also exacerbate symptoms for some patients, such as: certain antidepressants, anti-nausea medication, antipsychotic drugs, and some antihistamines. Women in the last trimester of pregnancy also report RLS symptoms, though these tend to resolve shortly after giving birth.
There is no specialized test for diagnosing RLS. Your doctor will assess the description of your symptoms, focusing on: the frequency and severity of the symptoms, when your symptoms are activated, whether motion or pressure relieves the sensations, if the symptoms subside in the early morning, and the affect these symptoms have on your quality of sleep.
Your doctor may also request a family history to determine if there is a genetic factor at play, and may perform sleep testing such as a polysomnography to observe your sleep patterns.
Since the cause remains unknown, there is no treatment that can cure primary RLS. However, secondary RLS caused by an underlying medication condition should resolve once the primary disease is treated.
Dopamine treatments have proven successful in relieving the symptoms of RLS, again indicating a disorder in the brain’s dopamine pathways. Dopamine agonists activate these dopamine receptors in the brain, and are usually the first medication prescribed to treat RLS patients. Likewise, dopaminergic drugs increase the dopamine levels in the brain, and are effective but not recommended for daily use.
Other medications may be prescribed to help you cope with the symptoms of RLS, such as sedatives to aid in sleep and painkillers to alleviate unpleasant sensations.
RLS Relief with Dr. Shukla
For restless legs syndrome relief and a return to restful sleep, schedule a consultation with esteemed sleep specialist Dr. Mayank Shukla today. For more questions about sleep health and hygiene, contact the caring staff at the Asthma Allergy Sleep Center of New York.