8 Key Things to Know About Restless Legs Syndrome

Restless legs syndrome (RLS), also known as Willis–Ekboms disease, is a common sleep disorder that affects around 5% of the general population and as many as 10% of people over 65 years old. There is also a link to pregnancy: about 1 in 5 pregnant women will experience symptoms. Here are eight key things you should know if you suspect that you or someone you know may have RLS.

The exact symptoms vary widely

What it feels like to have RLS varies greatly – from a slight sense of discomfort to feelings of pain that give you an urge or a need to move your body, most often your legs. Episodes also vary in frequency. In severe cases of RLS, symptoms occur more than twice a week and seriously disrupt both your sleep and daily life, causing restless days and often sleepless nights.

 It doesn’t only affect the legs

The term restless legs syndrome is somewhat misleading because RLS doesn’t only affect your legs. This is a key reason there is an ongoing effort to change the name of the condition from restless legs syndrome to Willis–Ekboms disease, named after two early scientists who studied the condition. As well as feeling discomfort in the legs (but rarely in the feet), some patients experience the same type of discomfort in their arms and chest. 

If you kick in your sleep – it doesn’t always mean you have restless legs syndrome

Twitching or moving your arms or legs in your sleep is called periodic limb movement disorder (PLMD). Although the vast majority of people with restless legs syndrome, have PLMD, the reverse isn’t true – many people who twitch or jerk their legs while sleeping don’t have restless legs syndrome. One key difference is that restless legs syndrome results in voluntary movement whereas PLMD is involuntary.

Several other issues can cause night-time leg movements

For those with periodic limb movement disorder (PLMD), night-time limb movements can be caused by secondary factors such as medications, or other underlying medical problems, such as Parkinson’s disease. But PLMD is also a syndrome in its own right, known as primary periodic limb movement disorder. The exact cause of primary PLMD is unknown, although it has been linked to nerve abnormalities and is more common in middle-aged and older people. PLMD can also cause poor quality sleep and daytime drowsiness.

Other sleeping disorders that result in jerky leg movements include sleep-related leg cramps, which are similar to muscle cramps experienced during the day. Another is condition is called sleep-related rhythmic movement disorder, which is mainly seen in children under five and normally involves movements such as the body rocking, but it can also include leg banging. Leg movements are also associated with benign sleep myoclonus of infancy (BSMI), a movement disorder that starts in young babies and includes repetitive jerks of the limbs.

RLS is caused by broken dopamine signals but there also seems to be a strong relationship between iron deficiency and restless legs

Images using special radioactive chemicals show that patients with severe RLS have reduced function of the dopamine receptors and transporters in their brains. Dr. Christopher Earley at the John Hopkins School of Medicine has used the analogy of a person watching TV to describe what may be happening in patients with RLS: when you can’t hear something clearly on TV, you turn up the volume; similarly, if a cell can’t “hear” the dopamine message from another cell, it tells it to turn up the dopamine. At the same time, iron deficiency has been found to be the strongest environmental risk factor associated with RLS. Exactly how iron and dopamine interact is still unclear, but it has been shown that similar changes in dopamine activity are true of animals with low iron levels. New research also suggests that other chemicals, including glutamate, may also play a major role in RLS.

Giving yourself the full spa treatment helps alleviate symptoms

As many people with restless legs syndrome already know, you can get some relief by treating yourself to a “spa-type” treatment. This includes hot baths, massaging and rubbing your legs, and applying hot or cold packs. 

Lifestyle factors can make symptoms worse… or better

People with RLS who don’t know what’s stopping them from sleeping often try to self-medicate with alcohol. But this has been shown to make the symptoms of RLS worse. Cutting back on alcohol and abstaining from caffeine have both been shown to help reduce the severity of RLS symptoms.

Other beneficial lifestyle changes include daily meditation and exercise. Studies show that even moderate exercise can lessen the severity of symptoms for people with RLS. Many sufferers say that activities that distract you or take your mind off symptoms, such as needlework can also be helpful.

There isn’t a cure. But important discoveries are paving the way

Right now, there is no known cure for restless legs syndrome, and no treatment options exist that work for everyone with RLS. Key medical treatment methods include medicines that target dopamine production, opiates (which have been used as a treatment for the condition since 1685), iron, certain types of sleeping pills (mainly benzodiazepines receptor agonists), and drugs that stabilize the electrical activity of nerve cells. However, new research is opening up new possible treatment alternatives. Research published in 2018 shows that targeting the way messages are sent between nerve cells may become one promising new path to finding treatments that could help prevent or alleviate the symptoms of RLS.