What Is Restless Leg Syndrome?

Restless legs syndrome (RLS) is a condition that results in an urge to move the legs due to uncomfortable sensations.

Individuals with a family history of RLS, chronic disease, iron deficiency and those taking certain medications are more prone to the condition. It can be treated with medications and lifestyle adjustments. If RLS is affecting your daily life, it is recommended to consult a healthcare provider. 

Overview

Restless Leg Syndrome (RLS), also known as Willis-Ekbom disease, is a neurological disorder characterised by an uncontrollable urge to move the legs, usually accompanied by uncomfortable sensations.¹ These sensations are often described as creeping, crawling, tingling or throbbing and typically worsen during periods of inactivity; particularly in the evening or at night. RLS affects both men and women and can occur at any age, though it tends to be more common in middle-aged and older adults.

Causes of restless leg syndrome

In most cases, there is no obvious cause for restless legs syndrome. However, it is believed to be related to a combination of genetic, environmental and lifestyle factors. Some possible contributing factors include: 

1. Genetics: RLS appears to have a strong genetic component, with up to 50% of individuals with RLS having a family history of the disorder²
2. Dopamine: Some neurologists (experts who treat disorders that affect the nervous system) believe that symptoms of restless legs syndrome may be related to how the body uses a chemical called dopamine.³ Since dopamine is reponsible in controlling muscle movements, therefore, it may be linked for the involuntary leg movements associated with restless legs syndrome
3. Iron deficiency: In some cases, restless legs syndrome is caused by an underlying disorder such as iron deficiency anaemia.⁴ This is called secondary restless leg syndrome. Low levels of iron in the brain may contribute to the RLS
4. Pregnancy: There is also an association between restless leg syndrome and pregnancy.⁵ Around 20% of pregnant women will experience symptoms during the final trimester of pregnancy, but the underlying cause is unknown. However, this condition is typically transient and tends to resolve on its own after delivery
5. Chronic disease: Certain chronic health conditions, for example, kidney failure, diabetes and peripheral neuropathy can increase the risk of developing RLS⁶ 

Signs and symptoms of restless leg syndrome

The primary symptom indicating RLS is a strong urge to move the legs.⁷ You may also experience an unpleasant tingling or crawling sensation in your feet, calves or thighs. Symptoms frequently intensify during the evening and nighttime. Sometimes the arms are also affected. Restless legs syndrome is also associated with involuntary cramping of the legs and arms known as periodic limb movements (PLM). RLS can occur intermittently in some individuals, while in others, they may be present on a daily basis. Symptoms can range from mild to severe. RLS can cause significant distress and disruption to daily activities in severe cases.

Periodic limb movements 

Periodic limb movements (PLM) can occur with other sleep disorders but are present in over 80% of individuals with restless legs syndrome.⁸ If you have PLM, your legs will cramp uncontrollably, usually, at night while you sleep. Movements are short and repetitive and usually, it occurs every 20-40 seconds. PLM can be severe enough to disturb your sleep as well as your partner’s. Involuntary leg movements can also occur while awake and at rest. 

Management and treatment for restless leg syndrome

Treating the underlying health condtion that causes RLS can often result in a cure for the condition.⁷ For example, iron deficiency anemia can be treated by taking iron supplements. If associated with pregnancy, it usually resolves spontaneously within 4 weeks after delivery. 

For mild cases of RLS that are not associated with an underlying health condition, making a few lifestyle changes may be sufficient and treatment may not be necessary. 

These include:⁹

• Lifestyle changes (e.g. maintaining a regular bedtime ritual, getting regular sleep, avoiding alcohol and caffeine late at night)
• Quit smoking if you smoke
• Exercise regularly during the day
• If symptoms are more severe, medications may be needed to regulate dopamine and iron levels in the body 

Diagnosis of restless leg syndrome

There is no single test to diagnose restless legs syndrome. Diagnosis is based on symptoms, medical and family history, physical examination, and laboratory results.⁶ Your GP is capable of diagnosing restless leg syndrome, but if you are uncertain, they may refer you to a neurologist.

There are four main criteria that a GP or specialist looks for to confirm a diagnosis:⁶

• An overwhelming urge to move your feet, usually accompanied by discomforts such as itching or tingling
• Symptoms that develop or worsen with rest or inactivity
• Symptoms are relieved by moving or stretching the leg
• Symptoms tend to get worse during the evening and at night 

FAQs

Can restless leg syndrome be prevented

While there is no known cure for RLS, there are several steps that can be taken in order to prevent RLS and reduce its symptoms:⁷ 

1. Lifestyle changes would incorporate maintaining a healthy lifestyle by eating a balanced diet, getting regular exercise (even daily walks would help) and reducing stress could potentially help to prevent RLS symptoms from manifesting
2. Avoiding triggers: this involves identifying and avoiding triggers that can worsen RLS symptoms such as high caffeine intake, alcohol consumption and smoking
3. Certain medications such as dopamine agonists can be prescribed by a healthcare provider to help manage RLS symptoms
4. Some cases of RLS are associated with iron deficiency, thus, taking iron supplements can help with reducing RLS symptoms
5. Gentle stretching exercises like stretching and massage can help to relieve RLS symptoms

It is crucial to note that the effectiveness of these strategies can vary depending on the individual and the severity of their RLS symptoms. In addition, it is always best to consult with your healthcare provider to get the best course of action for RLS management. 

How common is restless leg syndrome

Restless leg syndrome is a common condition that can affect you at any point in your life. However, a woman is twice as likely as a man to develop restless legs syndrome.⁵ It can occur at any age, including childhood, but is more common in middle age. 

Who are at risk of restless leg syndrome

RLS occurs in a variety of conditions, including iron deficiency, diabetes, renal failure and pregnancy. Lifestyle factors such as lack of physical activity, obesity, smoking, alcohol consumption and coffee consumption have also been hypothesized to influence the risk or severity of RLS. 

When should I see a doctor

It is recommended to see a doctor when you are experiencing the following: 

1. Sleep disruption
2. Uncontrollable urges
3. Pain or discomfort
4. Difficulty with managing symptoms

Summary

Restless leg syndrome causes an irresistible urge to move the legs accompanied by uncomfortable sensations. However, lifestyle changes, medication and other treatments are available to help manage the symptoms. If RLS is causing distress or interfering with the quality of life, it is worth discussing it with a doctor.