Overview
Have you ever spent the entire night tossing and turning - not because of bad dreams, but due to the feeling of ants crawling up your legs? If this is the case, you may be suffering from a disease of the nervous system known as restless legs syndrome (RLS), or Willis-Ekbom disease.
It is frequently characterised as an overwhelming desire to move your legs, particularly at night.1 RLS affects 5 to 15% of the general population, interfering with sleep and negatively affecting general well-being. Often, people who suffer from RLS may also be diagnosed with mental health difficulties.2,3
This article will examine the relationship between RLS and mental health, in addition to commonly used management techniques. If RLS is affecting your day-to-day routine, contact your healthcare provider.
Understanding restless legs syndrome (RLS)
Restless legs syndrome is a disease characterised by an insatiable urge to move the legs. RLS involves problems with both sensation and movement, making it a sensory-motor disorder. Many individuals suffering from RLS find that movement provides momentary relief.
RLS symptoms are commonly characterised as:
- Aching
- Throbbing
- Pulling
- Crawling
Even though the precise cause of RLS is still unknown, numerous factors are thought to play a part in the disease. RLS is speculated to be associated with an imbalance in dopamine, a neurotransmitter involved in regulating muscular movements.
RLS is more common in people assigned female at birth (AFAB) than male at birth (AMAB) and can affect people of any age.4 Other proposed theories for the cause of RLS include:
- Low levels of iron
- A family history of RLS
- Pregnancy
- Chronic diseases such as Parkinson's disease, kidney failure, diabetes, or peripheral neuropathy1
What are the consequences of restless legs syndrome on mental health?
Restless legs syndrome is more than just uncomfortable legs. You may feel irritated and exhausted from sleep deprivation resulting from a persistent impulse to move at night.
A lack of sleep negatively influences your mental health and, when this is combined with stress due to the inability to relax, these effects can become detrimental.
Restless legs syndrome and sleep deprivation
The uncomfortable sensations associated with RLS can occur during rest or inactivity. These sensations – such as crawling, pulling, aching, or tingling – can become more intense, making it difficult to find a comfortable position to fall asleep. You might feel an increased urge to move your legs as you try to fall asleep.
Stretching, massaging your legs, or getting up and moving about may ease the symptoms but disrupted sleep can leave you exhausted and unrested in the morning. A lack of sleep can have several harmful effects on your mental well-being, including:
- Daytime fatigue and sleepiness
- Difficulty concentrating and memory problems
- Increased irritability and mood swings5,6
This sets off a domino effect and creates a vicious cycle severely influencing overall mental health. You may find that your brain is not able to work at its peak due to sleep deprivation. This may make it hard for you to concentrate, stay focused, and retain information. It’s as if your mind is always running on low power and making it strenuous for you to remain focused and logical. The exhaustion makes way for frustration as you are not able to focus on the task at hand.
Restless leg syndrome and mood disorders
If you are exhausted all the time, you might have feelings of hopelessness, depression, or exhibit signs of anxiety. Scientific evidence reports a direct link between RLS and depression. It is interesting to note that the likelihood of depression in people with RLS is 2 to 4 times greater than in individuals without RLS.7
According to another study, RLS and depression move together. The more often you experience RLS symptoms, your depression increases in the same frequency.8 When a comparison was made of RLS patients with healthy individuals, the risk of experiencing major depression, panic disorder, or generalised anxiety disorder within a year was higher in people with RLS.9
Individuals with RLS are also frequently affected by other mental health issues, such as dysthymia. Imagine trying to sleep at night with the constant temptation to shake your legs, then add to it a sense of hopelessness, depression, or unexpected panic attacks.
Managing restless legs syndrome and mental health
RLS and mental health issues like depression, anxiety, and mood disorders are treatable and managing RLS may aid symptoms associated with these conditions. In case your RLS is severe, you should consider consulting a physician specialising in RLS. They can assist you in:
- Identifying and avoiding the triggers: This includes substances like alcohol, coffee, and some medications
- Keeping an eye on iron levels: RLS can become worse due to low iron. Your doctor may prescribe you some supplements to overcome this deficiency
- Improving your sleeping habits: Take help from your doctor to devise a sleep plan, or, if required, you can ask your doctor to refer you to a sleep physician
Additionally, your doctor may prescribe medications when your RLS is severe. Such as:
- Drugs that increase the level of dopamine, for example, pramipexole, ropinirole or rotigotine
- Muscle relaxants like benzodiazepines and sleeping aids
- Narcotics to aid in relaxation by combating pain and strange sensations
- Anticonvulsants to reduce abnormal sensations, for example, gabapentin or pregabalin
If the treatment of RLS does not offer you any respite from mood swings or depression, it is an indication that you need separate medical attention for mental health issues. You can seek help from a mental health specialist who can treat you with either medication, therapy, or a combination of both.
There are three primary approaches to easing symptoms of depression:
- Healthy lifestyle: A healthy diet, social engagement, and regular exercise are all essential for mental well-being
- Therapy: Speaking with a therapist, social worker, psychiatrist, or psychologist can be beneficial as sharing your story can be incredibly relieving
- Medication: Antidepressants have a lot of potential, but they function best when used in conjunction with counselling and a balanced lifestyle.
The cycle of restless legs syndrome and mental health
RLS has a reciprocal relationship with mental health. Significant mental health problems may arise as a result of RLS symptoms, which may then make RLS symptoms worse.
Stress and symptom severity
RLS symptoms might intensify as a result of stress and worry caused by tense muscles and an increased sensitivity to pain. Stress levels might rise in response to symptoms worsening, starting a vicious cycle.
If you experience stress at work, you may find that your RLS symptoms increase in the evening, leading to poor sleep and increased stress the following day.
Sleep deprivation and mood disorders
Mood disorders, including anxiety and depression, can arise from chronic sleep deprivation caused by RLS. These mental health conditions have the potential to exacerbate RLS symptoms and lower the quality of sleep.
A person with RLS who experiences depression as a result of sleep loss could find it more difficult to fall asleep, leading to a vicious cycle of sleep deprivation and worsened mood.
Negative thought patterns
Frequent RLS victims may develop negative psychological patterns, such as feeling powerless and hopeless. RLS symptoms may worsen as a result of these thoughts, which can also increase stress and anxiety.
Avoidance and social isolation
The symptoms of RLS can influence social activities, leading to social isolation and avoidance behaviours. The symptoms of RLS may intensify as a result of this isolation, which may further exacerbate anxiety and despair.
Side effects of anti-depression medication
Although many antidepressants help treat depression, some can worsen RLS. There are two basic methods by which this can occur:
- Neurotransmitters, mainly serotonin, are increased by most antidepressants. Unfortunately, RLS symptoms are triggered by this increase10
- Histamine receptors are disrupted by some antidepressants, worsening RLS
Thus, the cycle continues of sleep deprivation and mood issues.
Summary
Restless legs syndrome does not only wreak havoc on a peaceful night's sleep but has a detrimental effect on an individual's quality of life. Sleep deprivation due to RLS can significantly influence a person’s mood, making them irritable and hindering day-to-day tasks. However, RLS and mental health can be managed with the help of specialised doctors by making lifestyle changes, taking supplements and prescribed medications, and, if required, engaging in therapy.
References
- Becker PM. The biopsychosocial effects of restless legs syndrome (RLS). Neuropsychiatr Dis Treat. 2006 Dec;2(4):505–12. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2671952/
- Fulda S, Beitinger ME, Reppermund S, Winkelmann J, Wetter TC. Short-term attention and verbal fluency is decreased in restless legs syndrome patients. Mov Disord Off J Mov Disord Soc. 2010 Nov 15;25(15):2641–8. Available from: https://pubmed.ncbi.nlm.nih.gov/20836134/
- Pearson VE, Allen RP, Dean T, Gamaldo CE, Lesage SR, Earley CJ. Cognitive deficits associated with restless legs syndrome (RLS). Sleep Med. 2006 Jan 1;7(1):25–30. Available from: https://pubmed.ncbi.nlm.nih.gov/16198145/
- Makrani AH, Afshari M, Kheradmand M, Foroughi Z, Ghajar M, Farshidi F, et al. Prevalence of restless legs syndrome in pregnant women: a meta-analysis. Sleep Biol Rhythms. 2018 Jan 1;16(1):3–10. Available from: https://link.springer.com/article/10.1007/s41105-017-0126-6
- Simon GE, VonKorff M. Prevalence, burden, and treatment of insomnia in primary care. Am J Psychiatry. 1997 Oct;154(10):1417–23. Available from: https://pubmed.ncbi.nlm.nih.gov/9326825/
- NIH. National Institutes of Health State of the Science Conference Statement: Manifestations and Management of Chronic Insomnia in Adults. June 13–15, 2005. Sleep. 2005 Sep 1;28(9):1049–57. Available from: https://pubmed.ncbi.nlm.nih.gov/16268373/
- Hornyak M. Depressive Disorders in Restless Legs Syndrome. CNS Drugs. 2010 Feb 1;24(2):89–98. Available from: https://pubmed.ncbi.nlm.nih.gov/20088617/
- Winkelman JW, Finn L, Young T. Prevalence and correlates of restless legs syndrome symptoms in the Wisconsin Sleep Cohort. Sleep Med. 2006 Oct;7(7):545–52. Available from: https://pubmed.ncbi.nlm.nih.gov/16740407/
- Winkelmann J, Prager M, Lieb R, Pfister H, Spiegel B, Wittchen HU, et al. “Anxietas tibiarum”. Depression and anxiety disorders in patients with restless legs syndrome. J Neurol. 2005 Jan;252(1):67–71. Available from: https://pubmed.ncbi.nlm.nih.gov/15654556/
- Page RL, Ruscin JM, Bainbridge JL, Brieke AA. Restless legs syndrome induced by escitalopram: case report and review of the literature. Pharmacotherapy. 2008 Feb;28(2):271–80. Available from: https://pubmed.ncbi.nlm.nih.gov/18225972/