What is Restless Legs Syndrome?

When you try to relax in the evening or sleep at night, do you ever have unpleasant, restless feelings in your legs that can be relieved by walking or movement?

Restless Legs Syndrome (or RLS), also known as Willis-Ekbom disease, is a neurological disorder characterised by an irresistible urge to move your legs to stop uncomfortable sensations.

The sensations have been described as an itching, tickling, fizzing or creepy crawly feeling in the muscles, like "an itch you can't scratch" or an unpleasant "tickle that won't stop." These feelings are temporarily relieved by movement.

RLS usually affects the legs, but can also affect other parts of the body. Symptoms often begin as you’re falling asleep, leaving you no choice but to get out of bed to stretch, sometimes multiple times. RLS can therefore lead to sleepless nights and daytime fatigue. Some people living with RLS also report discomfort or pain during the day, especially when they are relaxed.

Many people living with the symptoms of RLS also experience involuntary jerking of their limbs during sleep which can wake them up and cause fatigue, referred to as Periodic Limb Movement Disorder (PLMD).

This is similar to the sudden jerking movements that you might get as you’re falling asleep, that can wake you up from light sleep, called hypnic jerks. The difference is that with Periodic Limb Movement Disorder the movements occur repeatedly throughout the night, and can wake you up multiple times.

Who is most at risk of developing Restless Legs Syndrome?

The charity, RLS-UK, estimates that Restless Legs Syndrome affects up to 10% of people in the UK. The prevalence is hard to measure since some people have only mild and infrequent symptoms while for others it can cause major disruption to sleep, and quality of life.

RLS can start at any age and affects men and women, young and old, although it is most commonly seen in women over the age of 40, or during pregnancy. Women are twice as likely to report RLS as men. In childhood, RLS can lead to problems and symptoms which are similar to ADHD.

What causes Restless Legs Syndrome?

Primary or idiopathic Restless Legs Syndrome has no known cause and usually begins slowly, before 40–45 years of age. It is often genetically linked, and runs in families. Primary RLS can come and go, sometimes for months on end, and may get progressively worse if untreated.

Secondary RLS often has a sudden onset and is usually associated with another medical condition or the use of certain drugs. RLS affects one in five pregnant women, most often in the third trimester, but usually resolves after birth.

While the causes of RLS are not always clear, the symptoms may have something to do with a circadian dip in iron and dopamine levels at night. Iron deficiency anaemia is often associated with RLS and if this is the case iron supplementation may help to reduce the symptoms. If you develop new and persistent symptoms, your GP will usually test for anaemia, kidney problems, diabetes, thyroid problems, nerve disorders and magnesium, B12 and folate deficiency.

Some medications, such as certain antidepressants, antacids, and the antihistamines in cold and allergy remedies, can make the symptoms worse.

Periodic Limb Movements are more common in older age. They are more common in shift workers or in people with abnormal sleep patterns. They can be triggered by snoring, drinking excessive amounts of coffee, severe stress or if the use of sleeping tablets is suddenly withdrawn.

How can you treat Restless Legs Syndrome, or Periodic Limb Movement Disorder?

Although there isn’t a definitive cure for RLS, there is a lot that can be done to manage it using lifestyle changes, and/or medication.

In terms of lifestyle, much of the advice is about the positive sleep habits which are common to everyone. For example,

• Protecting at least 7 hours for sleep each night
• Waking up at the same time every day
• Not eating late at night
• Limiting alcohol and caffeine intake
• Not smoking
• Protecting time to wind down and relax, both before bed and during the day
• Regular exercise, including regular stretching and walking in the evening

Compression may make things worse, so try to avoid crossing your legs during the day. Some people find it helpful to sleep with a pillow between their legs to avoid compressing the nerves.

Dehydration can make things worse, so stay well hydrated, especially in hot weather.

A healthy, natural diet will help to ensure you’re getting all the nutrients you need. A lack of iron, magnesium, vitamin B, folic acid or calcium could worsen symptoms. It’s always a good idea to discuss it with your doctor before taking supplements.

Relief in the immediate term may come from stretching your legs (for example by doing squats, or going for a walk), having a massage, using hot or cold packs, taking a warm bath (not too hot), or practicing relaxation techniques.

If lifestyle changes are not effective, speak to your doctor about alternative ways to manage the condition. It may be that you can change trigger medications which aggravate the symptoms. Anti-nausea drugs and sedating antihistamines can block the brain’s dopamine receptors, which can worsen the symptoms. Antidepressants that increase serotonin, antacids and antipsychotic medications can also aggravate the condition.

Sometimes RLS is treated with drugs which influence dopamine signalling in the brain, such as levodopa, or anticonvulsants or opioids. You might be referred to a neurologist or sleep specialist. It is recommended that children with Restless Legs are treated by a neurologist.

Periodic Limb Movements are often treated with very similar drugs and lifestyle interventions which is why they are grouped them together.

How can I find out more about Restless Legs Syndrome?

Restless Legs Syndrome and Periodic Limb Movement Disorder can have a very serious impact on sleep, energy, mood and overall wellbeing. If you’re having problems with restless legs or limbs at night, contact your GP in the first instance. There is also a lot of useful information on the RLS-UK website , a registered charity which provides education and support for people living with Restless Legs Syndrome and Periodic Limb Movement Disorder.