Restless Legs Syndrome (RLS)

What is restless legs syndrome (RLS)?

Restless legs syndrome (RLS) is a cause of insomnia (trouble sleeping) for many people. RLS sufferers have aching, twitching, tingling, burning, or prickling sensations in their lower leg muscles when they lie in bed or sometimes when they are sitting. The discomfort may be relieved only by getting up and standing or walking.

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.

What are the symptoms?

Symptoms may include:

• aching, twitching, tingling, burning, prickling in the lower legs when you are lying down or sitting
• relief from the symptoms when you stand up or walk around.

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 or 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?

Your healthcare provider can prescribe medicine to relieve the symptoms and allow you to sleep. Pramipexole and ropinirole are recommended as the first drugs to try. These drugs act like levodopa (Sinemet), which is another drug that sometimes helps. Low-dose narcotic medicines or benzodiazepines (such as Valium) may also help.

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. If the nondrug treatments described below work well enough, then not taking a drug for RLS is generally wise.

How can I take care of myself?

• Follow your healthcare provider's advice for relief of your RLS symptoms.
• Stretch or massage the leg muscles before going to sleep.
• Practice relaxation methods.
• Wear long socks to bed.
• Use a covered hot water bottle or cold most cloths on painful areas before you go to sleep.
• Take a warm bath before bedtime.
• Avoid or cut back on caffeine (coffee, tea, cocoa, cola).
• Avoid or cut back on alcohol.
• Improve your general health: Eat a healthy diet. Exercise regularly.

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