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 Restless legs syndrome

First Published March 2007

What is Restless Legs Syndrome?

Restless Legs Syndrome (RLS) is a common, but often overlooked disorder that affects movement and sleep.

Symptoms

  • The main symptom of RLS is a compelling urge to move the legs, usually accompanied by uncomfortable sensations often described as creeping-crawling, tingling or prickling.

  • When sufferers sit or lie down, they can get an aching, creeping or prickly feeling in their legs. Other descriptions have included “fidgety, jumpy or twitchy legs”, “like an electric current”, “soda bubbling in the veins” and “itching bones”.

  • The symptoms generally occur at rest, such as when sitting, lying or sleeping, and are only temporarily relieved by movement. Symptoms normally begin, or become worse, in the evening and at night.

  • RLS often results in sleep disturbance and insomnia. Nearly nine out of 10 people with RLS have sleep problems and people with moderate to severe RLS may sleep on average less than five hours per night.

  • About 80% of people with RLS also suffer from involuntary leg jerks known as periodic limb movements in sleep (PLMS) which can occur throughout the night.

Restless Leg Syndrome - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet ReferencesRLS is not a new disease

In 1685, King Charles II’s renowned doctor, Dr Thomas Willis, wrote about RLS as “leapings and contractures” of the tendons – adding that sufferers could no more sleep than if they were being tortured.

In 1945, Swedish neurologist Karl-Axel Ekbom described the condition, calling it restless legs. It was later called Ekbom’s syndrome after the author of this key paper. One of the patients who Ekbom described was a soldier who kicked so violently in his sleep that other soldiers in the same tent had to put up planks to protect themselves.

Who gets RLS?

The number of people suffering from RLS severe enough to make them likely to seek medical advice is around 3% of the adult population. The majority of sufferers are women and the prevalence of the condition increases with age.

Causes

Although the exact cause of RLS is unknown, growing numbers of studies show that people with RLS have a problem related to dopamine. Dopamine is a chemical in the brain which, amongst other things, affects movement.

Dopamine levels naturally go down in the evening, which may help to explain why RLS symptoms are worse in the evening and at night. Another cause of RLS is a lack of iron, which is essential to make dopamine.

There are two types of RLS

  • Primary RLS

This occurs naturally and can begin at any age. It can start in early adult life as a mild problem, but may slowly progress to daily symptoms with badly disturbed sleep, usually after the age of 50.
There is a strong hereditary element to primary RLS. One study found that when RLS occurred before the age of 45, it was found in half of their immediate family. If the condition came on after 45, only 10% of close relatives were affected.

 

  • Secondary RLS

This occurs as a complication of another condition, for example:

  • iron-deficiency anaemia

  • kidney failure

  • pregnancy

  • chronic alcoholism

Diagnosis of RLS

If you think you might have RLS, ask yourself do you have any or all of the following symptoms:
 

U (Urge to move) Do you have, or have you ever had, an urge to move the legs, usually accompanied by, or caused by, uncomfortable or unpleasant sensations in the legs?
R (Rest brings it on) Do these sensation begin or worsen during periods of rest or inactivity, such as lying down or sitting?
G (“Get up and go” helps) Are these sensations partially or totally relieved by movement, such as walking or stretching, for at least as long as the activity continues?
E (Evenings are worse) Are these sensations worse during the evening or night than they are during the day, or only occur during the evening or night?


If you answered yes to all or some of these questions visit your GP who should be able to give you a diagnosis.

Sleep advice

Symptoms of RLS may be eased by following simple sleep advice aimed at promoting sleep at night and wakefulness during the day.

  • Don’t delay going to bed – get to bed at a reasonable time

  • Get a comfortable bed and ensure the bedroom is dark and quiet

  • Establish a routine – go to bed and get up at the same times each day, including weekends

  • Avoid naps, especially in the early evening. At most, take a brief nap of less than 10 minutes in the early afternoon

  • Take some exercise during the day to improve alertness, but not just before bedtime

  • Don’t eat late in the evening or have caffeinated drinks

  • Try to relax before going to bed, e.g. by taking a warm bath or having a hot milky drink

The sensations caused by RLS can sometimes be eased by stimulating the affected areas. A change in temperature (e.g. by taking a warm or a cool bath), rubbing affected limbs, walking, stretching or using transcutaneous electrical nerve stimulation (TENS) can relieve symptoms in some patients.

Medication

There are now licensed medicines for the treatment of primary RLS. Your doctor can advise you on managing RLS and whether treatment is appropriate.

 


 


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