What is restless legs syndrome?
Restless legs syndrome (RLS) is a condition that causes a strong urge or any abnormal sensation to move your legs that delays the onset of sleep. The urge usually comes with an uncomfortable feeling in the legs. It is worse when you sit or lie still, and it is usually worse in the evening and at night. Moving your legs or walking brings relief, but only while you keep moving.
RLS is common, and it can affect sleep, mood, and energy during the day. It is a real medical condition, and it can be treated.
RLS often runs in families. It can also be linked to:
- Low ferritin levels
- Chronic anemia
- Kidney disease
- Pregnancy
- Nerve damage in the feet and legs (neuropathy)
- Some medicines, such as certain allergy medicines, antidepressants, and anti-nausea medicines
Common symptoms
- An urge to move your legs, often with feelings described as crawling, pulling, itching, aching, or “electric”
- Symptoms that start or get worse when you rest, such as sitting in a car, a movie, or bed
- Relief when you move, stretch, or walk
- Symptoms that are worse in the evening and at night
- Trouble falling asleep or staying asleep, and feeling tired during the day
RLS or periodic limb movement disorder (PLMD)?
Periodic limb movement disorder (PLMD) causes repeated jerking or kicking movements of the legs during sleep, often every 20 to 40 seconds. The big toe, ankle, knee, or hip may bend. PLMD can break up your sleep and leave you tired during the day.
People often confuse RLS with PLMD. RLS happens while you are awake and resting, and it delays the onset of sleep. PLMD occurs after you fall asleep. Usually only your bed partner is aware of the movements, unless a movement causes an arousal and wakes you up. Once you are awake, the RLS can start again.
Many people with RLS also have these leg movements during sleep. A sleep study can measure them.
How we make the diagnosis
RLS is diagnosed mainly by talking with you about your symptoms. There is no single test that proves it. At your visit, we will:
- Ask about your symptoms, when they happen, and what helps
- Ask about your sleep and how you feel during the day
- Review your medicines and health conditions
- Examine your legs, nerves, and movements
Ferritin testing
We check your ferritin with a blood test. Ferritin is the protein that stores iron, and its level shows your body’s long-term iron stores, most of which are kept in the liver. Your serum iron can be normal while your ferritin is low. RLS is linked to how iron is taken into and handled by the brain, not just to low iron in the blood. For people with RLS, we aim for ferritin levels higher than what many labs list as normal, so a result that looks “normal” on a lab report may still be too low for you.
Treatment options
Treatment depends on how often your symptoms happen and how much they affect your life.
Daily habits
- Keep a regular sleep schedule
- Cut back on caffeine and alcohol, especially later in the day
- Try gentle exercise, stretching, leg massage, or a warm bath in the evening
- Keep your mind busy during times you must sit still, such as with a puzzle or book
Iron
When your ferritin is low, raising it can ease RLS. Some people take iron pills. Iron pills may not raise ferritin enough for everyone.
When ferritin is low and pills are not enough or not a good fit, IV iron may help. IV iron is given through a vein, usually in one or a few visits. It can be given at the infusion center in our building, so you do not have to go far.
Medicines
Medications can help, and everyone responds to them differently. Make sure you bring a typed list of medications used to treat RLS that failed or caused side effects. Use BPMedTracker to track your medications and print a list.
A risk with dopamine agonists: augmentation
Augmentation occurs with dopamine agonists, such as pramipexole, ropinirole, and rotigotine. These medicines often work well at first. But over time, they can cause augmentation. This means RLS gets worse because of the medicine. Symptoms may start earlier in the day, feel stronger, or spread to the arms.
If your symptoms occur earlier and earlier in the day, see a movement disorder specialist immediately. They can progress to starting in the morning because of the dopamine agonist.
If you take one of these medicines and your symptoms are getting worse, do not raise the dose on your own. Tell us. We can adjust your treatment safely, which may include checking your ferritin and slowly changing medicines.
Other medicines are available for severe RLS that does not respond to these treatments.
Better sleep
Good sleep is a key goal of RLS treatment. If you still sleep poorly after your RLS improves, we may look for other sleep problems, such as sleep apnea.
When to see a specialist
Consider seeing a movement disorder specialist if you or a loved one has:
- An urge to move the legs that makes it hard to fall asleep or stay asleep
- RLS that got worse during treatment with a dopamine agonist
- Symptoms that start earlier and earlier in the day, or spread to the arms, while taking a dopamine agonist (see a specialist immediately)
- Low ferritin, or RLS that has not improved with treatment
Call 940-828-MOVE (6683) to schedule a visit.