Restless Legs Syndrome

long black legs with heelsRestless legs syndrome (RLS) is a sensory disorder causing an almost
irresistible urge to move the legs. The urge to move is usually due to
unpleasant feelings in the legs that occur when at rest. People with RLS use
words such as creeping, crawling, tingling, or burning to describe these
feelings. Moving the legs eases the feelings, but only for a while. The
unpleasant feelings may also occur in the arms.

Effects of RLS

RLS can make it hard to fall asleep and stay asleep. People with RLS often
don’t get enough sleep and may feel tired and sleepy during the day. This can
make it difficult to:

  • Concentrate, making it harder to learn and remember things
  • Work
  • Carry out other usual daily activities
  • Take part in family and social activities

Not getting enough sleep can also make you feel depressed or have mood
swings.

RLS can range from mild to severe, based on:

  • How much discomfort you have in your legs and arms
  • Whether you feel the need to move around
  • How much relief you get from moving around
  • How much sleep disturbance you have
  • How tired or sleepy you are during the day
  • How often you have symptoms
  • How severe your symptoms are on most days
  • How well you carry out daily activities
  • How angry, depressed, sad, anxious, or irritable you feel

Types of RLS

There are two types of RLS:

  • Primary RLS is the most common type of RLS. It is also
    called idiopathic RLS. “Primary” means the cause is not known. Primary RLS, once
    it starts, usually becomes a lifelong condition. Over time, symptoms tend to get
    worse and occur more often, especially if they began in childhood or early in
    adult life. In milder cases, there may be long periods of time with no symptoms,
    or symptoms may last only for a limited time.
  • Secondary RLS is RLS that is caused by another disease or
    condition or, sometimes, from taking certain medicines. Symptoms usually go away
    when the disease or condition improves, or if the medicine is stopped.

Periodic Limb Movement Disorder

Most people with RLS also have a condition called periodic limb movement
disorder (PLMD). PLMD is a condition in which a person’s legs twitch or jerk
uncontrollably about every 10 to 60 seconds. This usually happens during sleep.
These movements cause repeated awakenings that disturb or reduce sleep. PLMD
usually affects the legs but can also affect the arms.

Outlook

RLS can be unpleasant and uncomfortable. However, there are some simple
self-care approaches and lifestyle changes that can help in mild cases. RLS
symptoms often improve with medical treatment. Research is ongoing to better
understand the causes of RLS and to develop better treatments.


What Causes Restless Legs Syndrome?

Primary RLS

In most cases of restless legs syndrome (RLS), no cause can be found. When no
cause can be found, the condition is called primary RLS. It is known, however,
that primary RLS tends to run in families. People whose parents have RLS are
more likely to develop the disorder. This suggests that there may be a genetic
link that increases the chance of getting RLS.

Secondary RLS

Secondary RLS is RLS that is caused by another disease or condition, or as a
side effect of certain medications. Some of the diseases and conditions that can
cause RLS are:

  • Iron deficiency (with or without anemia)
  • Kidney failure
  • Diabetes
  • Parkinson’s disease
  • Damage to the nerves in the hands or feet (peripheral neuropathy)
    (pe-RIF-e-ral noo-ROP-a-the)
  • Rheumatoid arthritis (ROO-ma-toyd ar-THRI-tis)
  • Pregnancy

RLS is common in pregnant women. It usually occurs during the last 3 months
of pregnancy and usually improves or disappears within a few weeks after
delivery. However, some women may continue to have symptoms after giving birth
or may develop RLS again later in life.

Some of the types of medicines that can cause RLS are:

  • Antiseizure medicines
  • Antinausea medicines
  • Antidepressants
  • Some cold and allergy medicines

RLS symptoms usually go away when the medicine is stopped.

Certain substances can trigger RLS symptoms or make them worse. These
substances include:

  • Caffeine
  • Alcohol
  • Tobacco

Who Is At Risk for Restless Legs Syndrome?

Restless legs syndrome (RLS) may affect as many as 12 million people in the
United States.

Gender

RLS affects both men and women. The disorder occurs more often in women than
in men.

Age

The number of cases of RLS rises with age. Many people with RLS are diagnosed
in middle age. But in up to two out of every five cases, the symptoms of RLS
begin before age 20. People who develop RLS early in life usually have a family
history of the disorder.

Race/Ethnic Group

RLS can affect people of any race or ethnic group. The disorder is more
common in persons of northern European descent.

Pregnancy

RLS is common in pregnant women. It usually occurs during the last 3 months
of pregnancy and usually improves or disappears within a few weeks after
delivery.


What Are the Signs and Symptoms of Restless Legs Syndrome?

Restless legs syndrome (RLS) has several major signs and symptoms:

  • An almost irresistible urge to move the legs or arms when sitting or lying
    down
  • An unpleasant feeling in the legs
  • Difficulty falling asleep or staying asleep because of the unpleasant
    feelings in the legs or arms
  • Daytime sleepiness, which results from a lack of restful sleep due to the
    repeated limb movements

Urge To Move

RLS gets its name from the urge to move the legs when sitting or lying down.
This urge is due to unpleasant feelings in the legs that are relieved by
movement. Typical movements are:

  • Pacing and walking
  • Jiggling the legs
  • Stretching and flexing
  • Tossing and turning
  • Rubbing the legs

Unpleasant Feelings

The urge to move the legs usually is due to unpleasant feelings in the legs.
People with RLS describe these feelings as:

  • Creeping
  • Crawling
  • Pulling
  • Itching
  • Tingling
  • Burning
  • Aching
  • Painful
  • Hard to describe

Children may describe RLS symptoms differently than adults.

The unpleasant feelings in RLS usually occur in the lower leg (calf). But the
feelings can occur at any place between the thigh and the ankle and also in the
arm. The feelings are worse:

  • When lying down or sitting for a long period of time
  • During the evening or night, more so than during the day

The unpleasant feelings also:

  • Make it hard to fall asleep or stay asleep
  • Are not as bad or go away when you move

Duration and Severity

RLS symptoms tend to get worse over time. They may begin in childhood and
develop slowly over several years. People with early symptoms are more likely to
have other family members with RLS than people who develop RLS later in
life.

Symptoms tend to worsen faster when RLS occurs later in life. RLS that occurs
later in life is also more likely to result from an underlying condition or
illness than RLS that occurs early in life.

People with mild symptoms may only notice them when they are still or awake
for a long time, such as on a long a

Sleep Disorders

messy bed sheetsAt least 40 million Americans each year suffer from chronic, long-term sleep
disorders each year, and an additional 20 million experience occasional sleeping
problems. These disorders and the resulting sleep deprivation interfere with
work, driving, and social activities. They also account for an estimated $16
billion in medical costs each year, while the indirect costs due to lost
productivity and other factors are probably much greater. Doctors have described
more than 70 sleep disorders, most of which can be managed effectively once they
are correctly diagnosed. The most common sleep disorders include insomnia, sleep
apnea, restless legs syndrome, and narcolepsy.

Insomnia

Almost everyone occasionally suffers from short-term insomnia. This problem
can result from stress, jet lag, diet, or many other factors. Insomnia almost
always affects job performance and well-being the next day. About 60 million
Americans a year have insomnia frequently or for extended periods of time, which
leads to even more serious sleep deficits. Insomnia tends to increase with age
and affects about 40 percent of women and 30 percent of men. It is often the
major disabling symptom of an underlying medical disorder.

For short-term insomnia, doctors may prescribe sleeping pills. Most sleeping
pills stop working after several weeks of nightly use, however, and long-term
use can actually interfere with good sleep. Mild insomnia often can be prevented
or cured by practicing good sleep habits. For more serious cases of insomnia,
researchers are experimenting with light therapy and other ways to alter
circadian cycles.

Sleep Apnea

Sleep apnea is a disorder of interrupted breathing during sleep. It usually
occurs in association with fat buildup or loss of muscle tone with aging. These
changes allow the windpipe to collapse during breathing when muscles relax
during sleep. This problem, called obstructive sleep apnea, is usually
associated with loud snoring (though not everyone who snores has this disorder).
Sleep apnea also can occur if the neurons that control breathing malfunction
during sleep.

During an episode of obstructive apnea, the person’s effort to inhale air
creates suction that collapses the windpipe. This blocks the air flow for 10
seconds to a minute while the sleeping person struggles to breathe. When the
person’s blood oxygen level falls, the brain responds by awakening the person
enough to tighten the upper airway muscles and open the windpipe. The person may
snort or gasp, then resume snoring. This cycle may be repeated hundreds of times
a night. The frequent awakenings that sleep apnea patients experience leave them
continually sleepy and may lead to personality changes such as irritability or
depression. Sleep apnea also deprives the person of oxygen, which can lead to
morning headaches, a loss of interest in sex, or a decline in mental
functioning. It also is linked to high blood pressure, irregular heartbeats, and
an increased risk of heart attacks and stroke. Patients with severe, untreated
sleep apnea are two to three times more likely to have automobile accidents than
the general population. In some high-risk individuals, sleep apnea may even lead
to sudden death from respiratory arrest during sleep.

An estimated 18 million Americans have sleep apnea. However, few of them have
had the problem diagnosed. Patients with the typical features of sleep apnea,
such as loud snoring, obesity, and excessive daytime sleepiness, should be
referred to a specialized sleep center that can perform a test called
polysomnography. This test records the patient’s brain waves, heartbeat, and
breathing during an entire night. If sleep apnea is diagnosed, several
treatments are available. Mild sleep apnea frequently can be overcome through
weight loss or by preventing the person from sleeping on his or her back. Other
people may need special devices or surgery to correct the obstruction. People
with sleep apnea should never take sedatives or sleeping pills, which can
prevent them from awakening enough to breathe.

Restless Legs Syndrome

Restless legs syndrome (RLS), a familial disorder causing unpleasant
crawling, prickling, or tingling sensations in the legs and feet and an urge to
move them for relief, is emerging as one of the most common sleep disorders,
especially among older people. This disorder, which affects as many as 12
million Americans, leads to constant leg movement during the day and insomnia at
night. Severe RLS is most common in elderly people, though symptoms may develop
at any age. In some cases, it may be linked to other conditions such as anemia,
pregnancy, or diabetes.

Many RLS patients also have a disorder known as periodic limb movement
disorder
or PLMD, which causes repetitive jerking movements of the
limbs, especially the legs. These movements occur every 20 to 40 seconds and
cause repeated awakening and severely fragmented sleep. In one study, RLS and
PLMD accounted for a third of the insomnia seen in patients older than age 60.

RLS and PLMD often can be relieved by drugs that affect the neurotransmitter
dopamine, suggesting that dopamine abnormalities underlie these disorders’
symptoms. Learning how these disorders occur may lead to better therapies in the
future.

Narcolepsy

Narcolepsy affects an estimated 250,000 Americans. People with narcolepsy
have frequent “sleep attacks” at various times of the day, even if they have had
a normal amount of night-time sleep. These attacks last from several seconds to
more than 30 minutes. People with narcolepsy also may experience cataplexy (loss
of muscle control during emotional situations), hallucinations, temporary
paralysis when they awaken, and disrupted night-time sleep. These symptoms seem
to be features of REM sleep that appear during waking, which suggests that
narcolepsy is a disorder of sleep regulation. The symptoms of narcolepsy
typically appear during adolescence, though it often takes years to obtain a
correct diagnosis. The disorder (or at least a predisposition to it) is usually
hereditary, but it occasionally is linked to brain damage from a head injury or
neurological disease.

Once narcolepsy is diagnosed, stimulants, antidepressants, or other drugs can
help control the symptoms and prevent the embarrassing and dangerous effects of
falling asleep at improper times. Naps at certain times of the day also may
reduce the excessive daytime sleepiness.

In 1999, a research team working with canine models identified a gene that
causes narcolepsy – breakthrough that brings a cure for this disabling condition
within reach. The gene, hypocretin receptor 2, codes for a protein that allows
brain cells to receive instructions from other cells. The defective versions of
the gene encode proteins that cannot recognize these messages, perhaps cutting
the cells off from messages that promote wakefulness. The researchers know that
the same gene exists in humans, and they are currently searching for defective
versions in people with narcolepsy.