Restless Legs Syndrome And Quality Of Life

Restless legs syndrome, as the name suggests, is a condition where the person constantly moves their legs in order to relieve pain or irritation from their limbs. Read on to understand how this condition affects the quality of life of the person experiencing it.

Introduction 

Restless legs syndrome (RLS) involves the irresistible urge to move the legs due to an uncomfortable feeling in the legs. It is also known as Willis-Ekbom disease. It affects a considerable proportion of the population.¹

Symptoms

The affected people usually fail to pinpoint the sensation in their legs that causes discomfort but vaguely describe it as aching, itching, pulling, tickling, buzzing, or a trembling feeling. It is usually confined to the legs but may occasionally affect the arms as well. The restlessness most commonly starts in the evening when one starts to relax, such as while sitting or lying down and continues in the night often disturbing sleep.²

Causes 

The causes of this condition are not completely understood. However, some features have been identified:

• It is widely reported in research studies that changes in the dopamine level, a neurotransmitter, can contribute to the condition. As dopamine levels go down, the brain uses abnormal levels of iron causing iron deficiency
• This condition can worsen in pregnancy as the oestrogen levels increase
• It can occur as a result of alcohol withdrawal or opioid withdrawal
• Genetic predisposition- most cases are inherited from the parents as an autosomal dominant trait
• It can develop as a side effect of medications – restless legs syndrome develops as a side effect of certain medications and their constituents such as antidepressants, antihistamines, antiemetics, caffeine and antipsychotics^1,2

Risk factors for RLS

Some people with certain risk factors and conditions are more prone to develop restless legs syndrome than others. Some of the risk factors include:

• Low iron levels
• Chronic kidney disease
•  Parkinson’s disease
• Diabetes Mellitus
• Rheumatoid arthritis
• Anaemia
• Pregnancy¹

Classification 

Restless legs syndrome can be categorised into two types:²

Primary restless legs syndrome – there are unknown causes for this type, therefore, it is termed idiopathic. This type of restless leg syndrome generally develops before the age of 45. It progresses gradually and gets worse with age. There is a family history of the condition, indicating the significant role played by genetics.³

Secondary restless legs syndrome – develops later in life being diagnosed after 45 years of age, it is the result of other medical conditions such as chronic kidney disease, neurological disorders, iron deficiency, and the medications used for the management of these conditions.³

Diagnosis 

There are no specific tests that help confirm the diagnosis of restless legs syndrome. Diagnosis can be made by ruling out other diseases and by assessing symptoms according to certain criteria such as: 

• Increased urge to move the legs associated with or caused by uncomfortable sensations deep in the legs
• Increased pain, irritation and urge to move the legs during the night, while resting or during inactivity such as lying or sitting (Or symptoms only happen in the evening or at night)
• Partial or complete relief of symptoms by walking and stretching³

Treatment of RLS

With treatment, it is important to make sure that there is no underlying disease. If present, it must be treated first. In the absence of any underlying disease, RLS can be treated to an extent, with the help of medications, and a few modifications to the affected person's lifestyle. Pharmacological treatment is generally reserved for people with severe, continuous RLS and not initiated for those with sporadic or mild symptoms especially as most of the medications have side effects.^2,3 

Some of the medications include:

• Iron supplements
• Anti-seizure medications like gabapentinoids
• Dopamine agonists – substances that activate dopamine receptors
• Medications that promote the formation of dopamine^2,3 

 The lifestyle changes include:

• Smoking cessation and reduced alcohol consumption
• Sleep hygiene – improving the sleeping routine including avoiding screentime before bed and regulating or completely avoiding caffeine before bedtime
• Attend to nutrition
• Taking or increasing regular exercise^1,2

Impact of restless legs syndrome on the quality of life 

Restless legs syndrome can have a severe impact on a person’s quality of life. It can affect them physically, and mentally, and also their capacity to carry out their day-to-day activities. The constant involuntary urge to move the legs, especially at night, may affect the person's sleep pattern and quality considerably. This will result in a disrupted sleep routine and in time can lead to insomnia.^1,2,6,7

Adequate quality sleep is essential for a human being to function properly and indeed for survival. It is when the body and mind reset and get the rest required after being put to work the whole day. When a person does not get sufficient sleep their body slowly starts to become impaired. This results in fatigue and increased daytime sleepiness making the person drowsy and irritable.⁴

Once the body and mind become impaired it starts to affect the individual’s daily activities, decreasing functional efficiency and productivity. 

Due to lack of sleep and proper rest, the person becomes tired and easily irritated which can cause social isolation and stress. Gradually this may evolve into anxiety and depression interfering with the person’s mental health and social life.^4,5,7

Assessment of the quality of life in people with RLS 

The quality of life of people with restless legs syndrome can be assessed with the help of a number of tools. The assessment tools that best serve the purpose are questionnaires and clinical interviews. Two types of questionnaires are used to assess the quality of life of a patient. They are called RLS-QoL and SF-36.^6,7

RLSQoL – is a questionnaire with a set of 18 questions related specifically to restless legs syndrome and helps with the assessment of its impact on the person’s quality of life.⁶

SF-36 – is another questionnaire comprising 36 questions aimed at getting a general measure of the individual’s quality of life. It is not specific to RLS but covers 8 domains of health including:

• physical health
• mental health
• social relationships
• vitality
• and overall well-being

Coping strategies for patients

Dealing with restless legs syndrome can be very tiresome, as it does not have any definitive cure, and can take a toll on the personal and social lives of the individuals affected by it. Therefore, finding coping mechanisms that make it easier to deal with the condition is very important. 

Affected individuals can aid relaxation by creating a supportive sleep environment, and by reducing stress through practising meditation, yoga, massage, and relaxation exercises.^2,3 

It is difficult for sufferers to handle the situation alone; therefore, it is important to create a proper support system. It is helpful if family and friends are all educated about the condition, enabling them to better understand what the person is going through and to help provide appropriate mental and physical support.²

Creating support groups with fellow sufferers can also relieve stress by providing a sense of community and encouraging a sense of togetherness and mutual supportiveness among the patients.

Summary

Restless legs syndrome, also referred to as Willis-Ekbom disease is a condition in which the affected person has a constant urge to move their legs to relieve the discomfort, irritation or pain. 

If it appears before the age of 45, and the cause is unknown it is referred to as primary restless legs syndrome. If its cause is secondary to an underlying condition, it is called secondary restless legs syndrome - this happens more commonly in people over 45. There is no absolute causative mechanism understood for this condition, but there are multiple factors, that contribute to the disease. 

People affected by the condition often experience pain, itching, trembling, pulsating or throbbing in their legs, which is relieved partially or completely by moving the legs. The symptoms appear in the evening or night when the body is resting. Therefore, they disrupt sleep and can ultimately cause severe sleep disorders. The quality of life of the individual can be severely adversely affected.

Restless legs syndrome can be controlled with the help of medications, and lifestyle changes to an extent. Further studies are under progress to understand the aetiology of the condition (the way by which it is caused), and to provide an absolute treatment for the affected individuals.