The term restless legs syndrome, or RLS, is used frequently, despite most people not understanding what the condition truly is.
Sometimes called Willis-Ekbom disease, RLS causes uncomfortable, unpleasant, or even painful sensations in the legs that lead the sufferer to need to move them. This irresistible urge to move one’s legs occurs most often at night, although many people with RLS experience symptoms at other times of day too.
How Restless Legs Syndrome Affects Sleep Quality
Restless legs syndrome is one of several conditions that impact your ability to sleep through the night. Without enough sleep, you can experience cognitive and memory problems, mood disorders, and even physical health issues.
While symptoms can worsen as you attempt to fall asleep, you may also experience discomfort, pain, and the compulsion to move your legs very strongly during periods of inactivity, such as while watching a movie or sitting on an airplane. If symptoms occur when you are awake, shifting and shaking the legs or getting up and walking can reduce the sensation. When this discomfort or pain occurs at night, it can wake you up and make going back to sleep more difficult.
About 7 to 10 percent of the United States population is believed to have RLS. While both genders can experience this condition, women are more likely to develop RLS than men. It can impact anyone at any age, but people who are middle-aged or older are more likely to struggle with RLS, as symptoms become more intense and more frequent with age.
About 80 percent of people who have RLS also have periodic limb movement of sleep (PLMS)— a condition characterized by involuntary leg or arm twitches at night. Most RLS patients benefit from prescription medications, although there are some additional treatment approaches (like a new mattress or adjustable foundation), that can also help.
The Causes & Symptoms of Restless Legs Syndrome
Restless legs syndrome is typically considered idiopathic, meaning there is no specific underlying cause.
However, research has found a potential genetic component. People with RLS are more likely to have family members with RLS, primarily when the onset of the condition occurs before 40 years old.
Some forms of iron deficiency, especially low iron levels in the brain, have also been associated with RLS. The condition may also be related to a dysfunction in an area of the brain called the basal ganglia.
A significant portion of RLS research has focused on the potential dysfunction of the basal ganglia, considering it is one of the sections of the brain that controls movement. Dopamine, a chemical associated with being in a good mood, is also important in regulating body movements by producing smooth and purposeful muscle activity. When these pathways are disrupted, the risks of shaking, muscle weakness, and involuntary movements increase.
Dopamine deficiency within the basal ganglia is also highly associated with Parkinson’s disease; therefore, those with Parkinson’s are at an increased risk of developing RLS as well.
Some additional conditions associated with a higher risk of RLS include:
- End-stage renal disease, especially during hemodialysis.
- Iron deficiency from digestive disorders.
- Certain medications, like anti-nausea medications.
- Too much caffeine.
- Nerve damage.
- Sleep apnea and sleep deprivation.
If you struggle to fall or stay asleep due to pain or discomfort in your legs, or the irresistible urge to move your legs, talk with a doctor about a possible diagnosis and subsequent medical treatment.
Your doctor will use diagnostic criteria established by the International Restless Legs Syndrome Study Group and International Classification of Sleep Disorders to determine if you have RLS and need treatment. These criteria include symptoms such as:
- An overwhelming urge or compulsion to move the legs because of abnormal, unpleasant, or uncomfortable sensations.
- The urge to move your legs gets worse during periods of rest, relaxation, or inactivity.
- You have to move your legs to alleviate the sensations for a short time.
- During the evening or at night while you sleep, the urge to move your legs increases or movement becomes involuntary.
- There are no mental or behavioral conditions that may otherwise impact your urge to move your legs or the sensations in your legs.
Depending on your answers to these questions, information about your family and medical history, changes in symptoms throughout the day, and a list of current medications, your doctor can determine whether you have restless legs syndrome and how it can best be treated.
The following sensations in the legs may trigger the urge to move your legs:
- Creeping or crawling of your skin
- Feeling electric shocks
Most people with RLS do not describe sensations as cramps or muscle spasms, indicating that there is a neurological or nerve-ending component to the condition. However, these sensations are usually not intense, so people with restless legs syndrome typically report feeling compelled to move their legs and cannot explain why.
Laboratory tests will look at your blood iron levels, hormonal levels that may be associated with pregnancy, kidney function, and other physical signs that may point toward restless legs syndrome.
Your doctor may refer you for a sleep study, also called a polysomnography, which measures your brain waves as you sleep. Sleep disorders like sleep apnea have similar effects as RLS, but different treatment plans, so it is crucial to diagnose them appropriately.
Many Restless Legs Syndrome Treatment Options
Because restless legs syndrome is an ongoing condition, medications, supplements, and lifestyle changes can manage symptoms, but they will not cure the condition.
There are several possible approaches to managing RLS. The following are some of the best treatment options for restless legs syndrome.
Lifestyle and home remedies
If you experience discomfort or pain due to RLS and moving your legs or walking for a few minutes does not help, you can try massaging your legs, soaking in a warm bath, applying cold packs to affected areas, getting regular exercise, and quitting caffeine. You should also not avoid the urge to move your legs, stretch them, or massage them when you need to while you are awake.
Few people associate symptoms of RLS with mattress or pillow issues, but changing these up can be an important part of treatment. If your mattress or pillows are old, lumpy, or out of shape, you should replace them.
When should a mattress be replaced? Mattresses typically last around 10 years, so if your mattress is older than that, it may cause disruptions in your sleep and make painful symptoms of RLS worse.
Footwraps have also been found useful in treating restless legs syndrome. A 2016 study involving 30 participants found that those using footwraps for eight weeks experienced improvement in their RLS symptoms.
Pneumatic compression using a special sock or stocking can also help. These are designed to inflate and deflate over the limbs. These were developed to treat and remove blood clots, but they also work for some people who have RLS.
Those with moderate or severe RLS symptoms may benefit from taking prescription medications that can moderate how much dopamine is available to their brains. While lifestyle remedies can ease symptoms during the day, RLS tends to be worse at night due to inactivity during sleep. Finding approaches to manage the condition while you sleep are critical to getting enough rest.
Eating a healthier diet can help keep your body in better shape overall. Taking iron supplements or eating foods high in iron can be a useful approach to treating restless legs syndrome, especially if these supplements do not interfere with any other medications you are taking. Iron supplements can also offset iron deficiency triggered by other prescription medicines.
The following common foods are high in iron:
- Dark, leafy green vegetables
- Dried fruit
- Red meat and pork
- Poultry and seafood
- Certain cereals, pastas, and bread fortified with iron
If you have a vitamin C deficiency, you may have trouble absorbing enough iron. Consider adding a vitamin C supplement to your diet or consuming these foods rich in vitamin C:
- Fresh citrus fruit like oranges, grapefruits, lemons, and limes
- Citrus fruit juices
- Other fruits like kiwis, strawberries, and melons
- Tomatoes or peppers
- Leafy greens or broccoli
Changing Your Bedding to Lessen Symptoms of Restless Legs Syndrome
Since more people understand restless legs syndrome as a medical condition that requires treatment, many accept that prescription medications may be needed to ease symptoms. If you are diagnosed with RLS and your doctor prescribes specific medicines to treat your symptoms, follow your doctor’s treatment plan first. But if you’re looking for further relief, you can supplement prescription medication with a simple change to your bedding.
One of the best remedies for RLS is to sleep with a pillow between your knees. This creates compression and gives the nerves and muscles of your legs something to react to, which can reduce sensations. Getting a firmer pillow that is not too thick can be beneficial for mild or moderate RLS symptoms.
You should also consider getting a mattress that reduces motion transfer. Memory foam mattresses can reduce how disturbed you are if your legs twitch. While the sensations may be uncomfortable, you are less likely to be shaken awake by a moving mattress.
Ultimately, a combined approach to treatment can help manage symptoms of RLS. This condition can be uncomfortable, but with medical treatment and simple lifestyle changes, you do not have to suffer from sleeplessness or exhaustion.