Restless legs syndrome

Restless legs syndrome

Restless legs syndrome, also known as Willis-Ekbom disease, is a common condition of the nervous system. It causes an overwhelming, irresistible urge to move the legs.

As many as 1 in 10 people are affected by restless legs syndrome at some point in their life.

Women are twice as likely to develop restless legs syndrome than men. It’s also more common in middle age, although the symptoms can develop at any age, including childhood.

Symptoms of restless leg syndrome

Restless legs syndrome typically causes an overwhelming urge to move your legs. It also causes an uncomfortable sensation in your legs, which can affect your arms, chest and face.

This sensation has been described as:

• tingling, burning, itching or throbbing
• a ‘creepy-crawly’ feeling
• feeling like fizzy water is inside the blood vessels in the legs
• a painful, cramping sensation in the legs, particularly in the calves

These unpleasant sensations can range from mild to unbearable. They’re usually worse in the evening and during the night. The sensation can often be relieved by moving or rubbing your legs.

Some people experience symptoms occasionally, while others have them every day. You may find it difficult to sit for long periods of time, like on a long train journey.

Periodic limb movements in sleep (PLMS)

Up to 80% of people with restless legs syndrome also have periodic limb movements in sleep (PLMS).

If you have PLMS, your leg will jerk or twitch uncontrollably, usually at night while you’re asleep. The movements are brief and repetitive, and usually occur every 10 to 60 seconds.

PLMS can be severe enough to wake up both you and your partner. The involuntary leg movements can also occur when you’re awake and resting.

Types of restless leg syndrome

There are two types of restless leg syndrome:

• primary or idiopathic restless legs syndrome
• secondary restless legs syndrome

Primary restless legs syndrome

Primary restless legs syndrome makes up the majority of restless leg syndrome cases. In these cases, there’s no obvious cause of the syndrome.

Some researchers think it may be caused by a problem with a part of the brain called the basal ganglia. This part of the brain uses a neurotransmitter (chemical) called dopamine to help control muscle activity and movement. If the cells in your basal ganglia becomes damaged, the amount of dopamine in the brain is reduced. This causes muscle spasms and involuntary movements.

Dopamine levels naturally fall towards the end of the day. This may explain why your symptoms are often worse in the evening and during the night.

Research has also identified specific genes related to restless legs syndrome. This means it can run in families. In these cases, symptoms usually occur before the age of 40.

Secondary restless legs syndrome

Secondary restless legs syndrome occurs as a complication of another health condition. It can also be the result of another health-related factor.

You can develop secondary restless legs syndrome if you have:

• iron deficiency anaemia
• chronic kidney disease
• diabetes
• Parkinson’s disease
• rheumatoid arthritis
• an underactive thyroid gland
• fibromyalgia

You can also develop secondary restless legs syndrome if you’re pregnant. It’s most common from 27 weeks onwards.

Diagnosing restless legs syndrome

There’s no single test for diagnosing restless legs syndrome.

A diagnosis will be based on your:

• symptoms
• medical history
• family history
• physical examination
• test results

Your GP should be able to diagnose restless legs syndrome.

You’ll be asked about the pattern of your symptoms to help assess their severity. You may also be referred for blood tests. These will confirm if you have primary or secondary restless leg syndrome.

If your restless legs syndrome is disrupting your sleep, you may be sent for sleep tests. These allow healthcare professionals to see exactly what happens when you’re asleep.

Treating restless legs syndrome

The treatment for restless legs syndrome can depend on:

• what type of restless legs syndrome you have
• the severity of your symptoms

There are triggers that don’t cause restless legs syndrome, but can make symptoms worse. These include medications like:

• some antidepressants
• antipsychotics
• lithium
• calcium channel blockers
• some antihistamines
• metoclopramide

Do not stop taking any medicine that’s been prescribed without checking with your GP or healthcare provider first. You could make yourself very ill.

Other possible triggers include:

• smoking
• excessive caffeine or alcohol consumption
• being overweight or obese
• stress
• lack of exercise

Treating primary restless legs syndrome

If your symptoms are mild, you may find that making a few lifestyle changes improves the syndrome.

Having good sleep hygiene can help restless leg syndrome. This means that you have healthy sleep habits, including:

• following a regular bedtime ritual and taking time to relax before bed
• sticking to the same bedtime every day
• getting up at the same time every morning
• avoiding naps during the day
• avoiding stimulants like alcohol, caffeine and drugs before bed
• avoiding exercise before bed

Other things that may help include:

• not smoking
• taking regular daily exercise

During an episode of restless legs syndrome, the following measures may help relieve your symptoms:

• massaging your legs
• taking a hot bath in the evening
• applying a hot or cold compress to your leg muscles
• doing activities that distract your mind, like reading or watching television
• relaxation exercises, like yoga or tai chi
• walking and stretching

Medication

If primary restless legs syndrome is causing more severe symptoms, there are medications that may help. Your GP may suggest trying dopamine agonists, painkillers, hypnotics or levodopa.

Treating secondary restless legs syndrome

If your symptoms are caused by an underlying health problem, medical professionals will treat that health problem first. It may be that treating that problem will resolve the syndrome.

If your secondary restless legs syndrome is caused by pregnancy, your symptoms will usually stop within four weeks of giving birth.