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Brandon Peters, M.D.

30 Days to Better Sleep: Quiet Your Restless Legs

By January 24, 2013

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Resting at night depends on getting to sleep easily and staying asleep. Aside from insomnia, one of the sleep disorders that can make it difficult to fall asleep is restless legs syndrome (RLS). What is this condition and what are the major causes of RLS? Frequent bouts of restlessness in your legs may require treatment, so what are the options? Learning if you have RLS and finding an effective therapy will certainly help you to sleep better.

Restless legs syndrome, or RLS, is a commonly experienced but infrequently discussed condition. It may affect up to 20% of adults. It typically involves an uncomfortable or disagreeable feeling in the legs that occurs at night while sitting or lying, with an urge to move that is relieved by movement. The feeling may be described as a restlessness, an electrical sensation, like bugs are crawling under the skin, or even as a deep ache. It often affects the legs, but may affect the arms or any part of the body. Though it frequently occurs at night or in the evening, it may occur during the day, especially during prolonged sitting like on a flight or long car ride. As the name "restless legs syndrome" does not always characterize the symptoms completely, it has been more recently referred to as Willis-Ekbom disease, acknowledging the original doctors who described it.

No matter what you call it, RLS can really impact your ability to sleep. If you feel like bugs are crawling under your skin, and you have to constantly shift your legs so that you do not have the sensation, you can imagine that this might make it tough to relax and sleep. Many people who suffer from the condition have to get up and walk around to make the symptoms subside. This will delay sleep onset, and may contribute to feelings of insomnia. In order to understand how to relieve this, it is important to consider the major causes.

Restless legs syndrome may be primary or idiopathic. This means that it is not due to another known medical cause or that the underlying cause is simply unknown. For the vast majority of people, this is the best description of why RLS is occurring. There are, however, some recognized causes of RLS that can be reversed. The known causes of RLS include:

Aside from these major causes, there are other conditions that seem to be associated with RLS. Obesity is by far the most common. Others include hypothyroidism, high blood pressure, and heart disease. Problems with the nervous system can contribute such as peripheral neuropathy, lumbosacral radiculopathy, or spinal stenosis. Diet can also contribute, including vitamin deficiencies, excessive caffeine intake, and low blood sugar (typically among diabetics on medications).

How do you know if you have RLS? The diagnosis is based only on symptoms. There is no testing required. Movement of the legs during sleep can be captured with a sleep study. These periodic limb movements of sleep (PLMS) are often associated with RLS. These are not, however, diagnostic of RLS. Restless legs syndrome is about the sensation, not the movement. Someone can have PLMS without having any symptoms of RLS, and thus would not be diagnosed with RLS. This is because PLMS may result from other conditions as well, including sleep apnea. If you do not have symptoms of RLS, even with PLMS on a sleep study, you do not need evaluation or treatment of RLS. It is sufficient for a sleep doctor to determine if you have RLS based solely on a proper history.

Once it is determined that you have RLS, it is often useful to check an iron level in the blood called ferritin. If this is low, oral iron supplementation may be recommended. If there is another contributing cause, this should be treated as appropriate. Residual symptoms can be treated with multiple effective medications.

If you have restless or uncomfortable feelings that disrupt your ability to fall asleep at night, you should see a sleep specialist. After a careful interview, you can discuss whether treatments for RLS may help quiet your restless legs and help you to sleep better.

Check out the entire series, "How to Sleep Better in 30 Days."

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