Restless Legs Syndrome What is restless legs syndrome?



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Restless Legs Syndrome

What is restless legs syndrome?


Restless legs syndrome (RLS) is a cause of insomnia (trouble sleeping) for many people. Restless legs syndrome is aching, twitching, tingling, burning, or prickling feelings in the lower leg muscles when you lie in bed. You have a strong urge to move your legs. This may also happen when you are sitting. Moving your legs or getting up and standing or walking may make your legs feel better, but not for long. True restless legs syndrome is different from night-time leg cramps or occasional sudden jerks of leg muscles at night.

How does it occur?


The exact cause of RLS is not known. It tends to run in families. It is more common after middle age and occurs more often in women than in men. Many people with RLS can remember having what they called growing pains in their legs during childhood. It may be that a nerve malfunction is involved. RLS has also been linked with alcohol dependence, smoking, too much caffeine (usually from drinking coffee), rheumatoid arthritis, anemia, and diabetes. Use of some medicines may make symptoms worse. The problem may get worse when you are not active for a long period of time. For example, it might get worse when you have been lying in bed, sitting in a theater, working at a desk, or riding in a car for a long time.

What are the symptoms?


Symptoms include:

  • strong urges to move your legs

  • aching, twitching, tingling, burning, prickling in the lower legs when you are lying down or sitting

  • relief from the symptoms when you move, especially if you get up and walk.

The symptoms start or get worse in the evening or at night.

Leg cramps and occasional, sudden jerking of legs or arms are not symptoms of restless legs syndrome. A day of heavy exercise can lead to a tight cramp in your calf (sometimes called a charley horse). Stretching and jiggling the calf muscle helps the cramp ease off and usually you can go back to sleep without having a relapse. Many people also have an occasional night jerk where their arm, leg, or half their body twitches once as they are falling asleep. This may wake you up, but it is not serious. Almost always you can go back to sleep without a second occurrence.

During sleep it is not unusual to have uncontrolled movements of your arms or legs. This is called periodic limb movements of sleep, or PLMS. Usually, you are not aware of these movements and you sleep through them. By themselves, they usually are not bothersome to the sleeper, although they may disturb a bed partner. People can have RLS or PLMS or both. Treatment of PLMS alone usually is not needed.

How is it diagnosed?


The diagnosis of RLS is based on your medical history. Your healthcare provider will examine you and may order blood tests or other tests to check for an underlying medical problem, such as anemia, rheumatoid arthritis, or diabetes.

How is it treated?


Studies have found that over half of the people who have RLS describe their problems as mild or minor. If your symptoms are mild, you may not need medical treatment. Here are some things you can do that may help relieve your symptoms:

  • Stretch or massage the leg muscles before going to sleep.

  • Practice relaxation methods.

  • Wear long socks to bed. Sometimes elastic compression socks up over the calf are helpful. Ask your provider about these socks.

  • Use a covered hot water bottle or cold moist cloths on painful areas before you go to sleep.

  • Take a warm bath before bedtime.

If these steps do not help, your healthcare provider may prescribe medicine to relieve the symptoms and help you sleep better. Quite a few medicines have been tried as treatments. Some are helpful but none are a cure. Drugs that may be recommended are:

  • levodopa, a drug normally used for Parkinson's disease

  • pramipexole and ropinirole

  • low-dose narcotic medicines or benzodiazepines (such as Valium

Getting more iron if you are iron deficient sometimes helps ease the symptoms.

If you have RLS every day and the usual treatments don't help, the RLS is called refractory. Medicines that may be prescribed in this case include gabapentin and cabergoline. These are much more expensive medicines.


How can I take care of myself?


Follow your healthcare provider's advice for relief of your RLS symptoms. You may need to:

  • Avoid or cut back on caffeine (coffee, tea, cocoa, cola).

  • Avoid or cut back on alcohol.

  • Improve your general health by eating a healthy diet and exercising regularly.

For many people who have RLS, it is a great relief just to learn that there are other RLS sufferers like themselves and that they are not alone. Also, it is good news to hear that RLS does not keep getting worse or become disabling. It does not lead to other diseases. If nondrug treatments work well enough, then not taking a drug for RLS is generally wise.

For more information about restless legs syndrome, visit the Restless Legs Syndrome Foundation Web site: http://www.rls.org/.




Patient handouts provided by Merck Medicus. Copyright © 2012-2013 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc.

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