According to the National Institute of Neurological Disorders and Stroke (NINDS), restless legs syndrome (RLS) is a disorder characterized by throbbing, pulling, creeping or other unpleasant sensations in the legs and an uncontrollable, and sometimes overwhelming, urge to move them. The good news is that venous insufficiency is a known and treatable cause of RLS. Before initiating a trial of RLS medications, get screened for venous disease.
Symptoms occur primarily at night when a person is relaxing or at rest and can increase in severity during the night. The most distinctive or unusual aspect of the condition is that lying down and trying to relax increases symptoms while moving the lower extremities relieves the discomfort. Symptoms include:
- Throbbing, pulling, creeping or other unpleasant sensations in the legs
- An uncontrollable, and sometime overwhelming urge to move them
- Discomfort that occurs primarily at night when you are relaxing or at rest
- If lying down and trying to relax increases your symptoms
- If moving your legs relieves the discomfort
Another classic feature of RLS is a distinct symptom-free period in the early morning. Common triggers of RLS include periods of inactivity such as long car trips, sitting in a movie theater, long-distance flights, immobilization in a cast or relaxation. Because individuals are forced to move their legs for relief, RLS is classified as a movement disorder.
What Causes RLS?
As mentioned above, venous insufficiency may cause symptoms of restless legs, and since it is treatable, this should be considered immediately. In most cases, the cause of RLS is unknown. However, it may have a genetic component; RLS is often found in families where the onset of symptoms is before age 40. Specific gene variants have been associated with RLS. Possible causes researched include low levels of brain iron or dysfunction of the basal ganglia dopamine pathways. The latter is supported by the fact that those affected with Parkinson’s disease often have RLS.
Up to 10 percent of the U.S. population is affected. RLS is a serious condition that causes sleep deprivation with resultant exhaustion and daytime fatigue. Difficulties with work, personal relationships and activities of daily living are frequently reported, as memory is impaired and individuals are unable to concentrate. It can make traveling difficult and even cause depression.
Additional Risk Factors
Additional risk factors for RLS include:
- Chronic disease such as kidney failure, diabetes and peripheral neuropathy.
- Medications including antinausea drugs (prochlorperazine or metoclopramide), antipsychotic drugs (haloperidol or phenothiazine derivatives), antidepressants that increase serotonin, and some cold and allergy medications that contain sedating antihistamines.
- Pregnancy, especially in the last trimester that often resolves within four weeks of delivery. RLS is approximately twice as common in women.
- Alcohol and sleep deprivation
- Venous Insufficiency – People who have both RLS and an associated medical condition tend to develop more severe symptoms rapidly.
Should you suffer from RLS and venous insufficiency, treating the underlying vein problem can give you relief. Other potential remedies include the following:
Lifestyle changes include decreased use of caffeine, alcohol and tobacco; supplements to correct deficiencies in iron, folate and magnesium; changing or maintaining a regular sleep pattern; a program of moderate exercise; and massaging the legs, taking a hot bath, or using a heating pad or ice pack.
A trial of iron supplements is recommended only for individuals with low iron levels. Although many people find some relief with such measures, rarely do these efforts completely eliminate symptoms.
Medications are usually helpful, but no single medication effectively manages RLS for all individuals. Trials of different drugs may be necessary. In addition, medications taken regularly may lose their effect over time, making it necessary to change medications periodically.