Patient education: Restless legs syndrome (The Basics)

What is restless legs syndrome? — Restless legs syndrome, or "RLS," is a condition that causes strange sensations in your legs. If you have RLS, you probably have the urge to move your legs at night. This can make it hard to get comfortable and fall asleep.

In some cases, RLS happens on its own and seems to run in families. In other cases, the condition seems to be linked to other medical problems. For instance, a condition called "iron deficiency anemia," in which there is too little iron in the blood, seems to increase the risk of RLS. Other conditions that increase the risk of RLS include kidney disease, diabetes, and multiple sclerosis. Pregnancy seems to increase a person's risk of developing RLS, too.

What are the symptoms of RLS? — People who have RLS get an uncomfortable urge to move their legs when they are at rest. They describe the feeling as crawling, creeping, pulling, or itching. And they say the feeling is deep in the legs – not on the skin – usually below the knees. These symptoms usually get worse as the day moves on, and they are worst at night. The symptoms can be especially bad when trying to stay still to read a book, watch television, or fall asleep. But people can make the feeling go away temporarily if they walk around or move their legs. Some people with RLS find that their legs move on their own while they are asleep.

In short, the symptoms:

●Happen when you are at rest

●Go away if you move your legs on purpose

●Are worst at night

●Sometimes include the legs moving on their own during sleep

Together, the symptoms of RLS can make it hard to get a good night's sleep. People with the condition often feel tired during the day.

Is there a test for RLS? — No, there is no test. Your doctor or nurse should be able to tell if you have RLS by asking about your symptoms and doing an exam. They might also do blood tests to see whether you have enough iron in your blood.

Is there anything I can do on my own to feel better? — Yes. There are some things you can do that might help (table 1).

For example, you can:

●Practice good "sleep hygiene" – This means following certain habits to improve your sleep. For example, avoid caffeine and alcohol, especially near bedtime. It also helps to avoid looking at screens before bed.

●Do activities that keep your mind alert during the day, such as crossword puzzles

●Stay physically active – Any activities that involve moving your body are good for you. Even gentle forms of exercise, like walking or yoga, can help.

●Massage your legs – You can also have someone massage them, if possible. Some people also feel better if they use "pneumatic compression devices." These are special sleeves that fill with air and squeeze your legs.

●Apply heat to your legs – You can do this by using a heating pad or taking a warm bath.

●Avoid taking medicines that can make RLS worse – These include antihistamines like diphenhydramine (sample brand name: Benadryl) and some medicines used to treat depression. If you take any medicines regularly, talk to your doctor before stopping. They might recommend trying a different medicine instead.

Should I see a doctor or nurse? — See your doctor or nurse if your condition bothers you, or if it keeps you from getting a good night's sleep.

Some people with RLS have another condition that affects their sleep, such as sleep apnea. People with sleep apnea stop breathing for short periods while they are asleep. If your doctor thinks you might have this or another condition, they can order tests. They can also recommend treatment if needed.

How is RLS treated? — Some people with RLS do not need medicine for it because they have mild symptoms that don't bother them very often. If treatment is needed, there are a number of medicines doctors can suggest. Examples include:

●Iron supplements

●Gabapentin enacarbil (brand name: Horizant)

●Gabapentin (brand name: Neurontin)

●Pregabalin (brand name: Lyrica)

●Pramipexole (brand name: Mirapex)

●Ropinirole (brand name: Requip)

●Rotigotine (brand name: Neupro)

●Carbidopa-levodopa (brand name: Sinemet)

In people with RLS who also have a severe form of kidney disease called kidney failure, the RLS might improve with a treatment called hemodialysis (also known as just dialysis).

What if I am pregnant? — If you are pregnant, you can take iron supplements and try the other tips that do not involve taking prescription medicines. Most of the medicines used to treat RLS are not proven to be safe to take during pregnancy. If your symptoms are bad, there are some medicines that might be OK to take. But keep in mind that the condition usually goes away or gets much better after you give birth.

More on this topic

Patient education: Anemia caused by low iron (The Basics)
Patient education: Insomnia (The Basics)
Patient education: Daytime sleepiness (The Basics)
Patient education: What is a sleep study? (The Basics)

Patient education: Insomnia (Beyond the Basics)
Patient education: Anemia caused by low iron in adults (Beyond the Basics)