General Description

What is Restless Legs Syndrome?

Restless Legs Syndrome, also known as RLS, is a condition characterized by feelings of discomfort and irritation in the legs while sitting or lying down that are relieved by standing or walking.  Contrary to the apparent physical nature of the condition, the National Institutes of Health categorize the disorder as a neurological condition.  The specific cause of RLS is unknown.

While the symptoms may appear relatively harmless, Restless Legs Syndrome is a serious and frustrating condition that has the ability to disrupt quality of life for individuals who suffer from it.  In many instances, these feelings are so disrupting that they can affect an individual’s ability to sleep, leading to chronic and severe exhaustion. 

It is unknown exactly how many people suffer from RLS today, as the National Institutes of Health note that the condition is widely under reported and even more widely under diagnosed or misdiagnosed.  Often, symptoms will be attributed to other more understood conditions such as insomnia, stress, aging, arthritis, or an anxiety disorder. The NIH notes that the common figure used by the medical community is around 12 million Americans.

It is important to note that over 80% of individuals diagnosed with RLS also develop over time another condition called Periodic Limb Movement Disorder (PLMD).  Patients who suffer from PLMD experience involuntary leg convulsions, jerks, and twitches that occur one to several times a minute while sleeping. PLMD, like RLS, can lead to disrupted sleep and complications related to exhaustion.  Similarly, the exact physiological mechanisms that cause PLMD are poorly understood by the medical community. Interestingly, the majority of patients who are initially diagnosed with PLMD do not develop RLS. 

Symptoms

Even though Restless Legs Syndrome is classified as a neurological disorder, its symptoms are predominately physical in nature and can compromise an individual’s quality of life.  The characteristic terms used by patients to describe the uncomfortable sensations in the legs include “creeping,” “itching,” “tugging,” “burning,” “gnawing,” “aching,” “pulling,” or “creepy-crawly.”

An informational bulletin released by the Restless Legs Syndrome Foundation stated that the condition has four main symptoms:

• “Excruciating” but not necessarily painful sensations in the legs that cause an overwhelming desire to move
• Sensations that only appear or worsen when at rest, especially while lying down
• Sensations that become more unbearable at night
• Sensations that are relieved, if only temporarily or partially, by moving the legs or standing

Additional symptoms include the involuntary jerking of legs or arms during sleep and kicking during sleep.  In addition to sleeping, many patients report that their symptoms will appear during periods of prolonged sitting such as during car trips.

The symptoms of RLS can vary in severity from patient to patient and also from day to day.  Some patients experience a consistent level of discomfort while others report that some days are worse than others.  Studies have shown that RLS tends to be a progressive condition, with individuals noting an increase in severity, duration, and tenacity of their symptoms over several months or years.  

In addition to the basic symptoms of restless legs, RLS causes several severe secondary symptoms that occur as a result of RLS symptoms, not the condition itself.  The most profound of these secondary symptoms is the inability to sleep. Many RLS patients report that they are unable to sleep through the night due to their symptoms waking them up or preventing their falling asleep. The constant disruption of sleep caused by RLS often leads to chronic exhaustion, insomnia, and excessive daytime sleepiness.

For more valuable information on the symptoms of RLS, check out our full length report!

Causes

In spite of the explosion of scientific interest in Restless Legs Syndrome over the past twenty years, one exact cause of the condition has yet to be pinpointed.  Instead, a range of potential causes has been identified by doctors, natural remedy specialists, and even patients themselves.

• Genetics - Many researchers believe that a genetic element plays a significant role in the development of the condition.  According to the National Institutes of Health, “a family history of the condition is seen in approximately 50 percent of such cases, suggesting a genetic form of the disorder.”  In 2009, The Mayo Clinic reported that researchers had identified sites on several chromosomes that showed promise as a potential location for RLS related genes.

• Pregnancy - Another commonly cited cause of RLS in women is pregnancy.  The condition most commonly develops in women during their third trimester, and according to the NIH most women report a disappearance of symptoms within 4 weeks after birth. Researchers estimate that up to 25% of women will experience RLS during their pregnancy.

• Iron Deficiency - Researchers have pointed to mild iron deficiency or anemia as a potential cause of Restless Legs Syndrome in some patients.  Both the National Institutes of Health and the Mayo Clinic have reported a correlation between the two conditions, a link that is supported by the fact that many RLS patients claim an improvement in their symptoms when their iron deficiencies have been corrected.

• Chronic Diseases - A variety of chronic diseases has been associated with the development of RLS, including diabetes, Parkinson’s Disease, alcoholism and rheumatoid arthritis. Researchers have noted that the treatment of these conditions often leads to a reversal in RLS symptoms as well. There is some evidence to suggest kidney failure and peripheral neuropathy might also lead to RLS.

• Cadmium and Thallium Poisoning - Some natural remedy specialists have pointed to heavy metals like cadmium and thallium as a cause of RLS.  Cadmium is a highly toxic metal that is used in some daily household items, like rechargeable nickel batteries and even certain foods.  Arguably the most common form of cadmium poisoning comes from cigarette smoking.  Studies have suggested that one tobacco cigarette contains up to 2 micrograms of cadmium, up to 10% of which is inhaled as the cigarette is smoked.  Another suggested cause of RLS is thallium poisoning.  Thallium is another highly toxic metal that is used in wide range of household items, such as rat and ant poison.  It is even used in some traditional treatment methods for conditions like ringworm, skin infections, and even coronary artery disease. 

For more valuable information on the causes of RLS, check out our full length report!

Traditional Treatments

There are several classes of prescription drugs which can help relieve the symptoms of RLS.  It should be noted that while these drugs can soothe symptoms and allow for some much needed undisturbed sleep, many patients find that in the long term the amount of side effects associated with these drugs are not a viable solution for their everyday symptom regulation.   

• Dopaminergic Agents - The only prescription drug currently sanctioned by the FDA for treatment of RLS is a dopaminergic called ropinirole. Dopaminergic agents are a class of prescription drugs that all affect the levels of dopamine in the brain and blood stream. Common dopaminergic brand names include Requip and Mirapex, both of which are used most often to treat Parkinson’s patients. It is reported that the body becomes used to the treatment after long term use and that RLS symptoms can start to manifest earlier and earlier in the day as a result. Side effects of dopaminergic agents include nausea, fatigue, and dizziness.

• Opioids - Opioids, best known under the brand names Vicodin and Roxicodone, are a class of narcotic medications that have been shown to be effective in treating RLS at any severity level.  While extremely effective in promoting relaxation and reducing sensations of restlessness and pain not just in the legs but throughout the body, opioids are extremely addictive and can fundamentally change an individual’s brain chemistry over time. For this reason, opioids are often a last choice for treating RLS and are only employed when no other therapy is working. Short term side effects of opioids include nausea, vomiting, constipation, dry mouth and drowsiness. Long term side effects include dependency, hallucinations, and respiratory depression.

• Benzodiazepines - Benzodiazepines are a class of prescription medication that promote sleep.  Common brand names include Klonopin, Lunesta, and Ambien.  Benzodiazepines depress the central nervous system by affecting various neurotransmitters in the brain and induce undisturbed sleep.  They do not reduce the sensations of RLS, including the kicking and twitching, but override an individual’s awareness of the symptoms with sleep.  They can be habit forming. Side effects of benzodiazepines include daytime drowsiness, depression, decreased libido, and memory formation.

• Anticonvulsants - Anticonvulsants are a broad classification of prescription therapy, most of which, like dopaminergic agents, affect the messages between the brain and the central nervous system. Most commonly used to treat epilepsy, drugs like Neurontin effect the brain’s interpretation of nerve signals from the legs for twitches, jerks, and other sensations, resulting in a soothing of symptoms. Side effects of anticonvulsants include dizziness, sleeplessness, and fatigue.

For more valuable information on traditional treatments for RLS, check out our full length report!

Misdiagnosis of Symptoms

One of the most challenging elements of Restless Legs Syndrome is that its symptoms are often misdiagnosed as indicative of another condition.  And while Restless Legs Syndrome has enjoyed increased attention over the past ten years, many in the medical community are still ignorant about the condition and its symptoms, contributing to a high rate of misdiagnosis. Another element that contributes to the misdiagnosis of RLS is the difficulty some patients have articulating the sensations they are feeling in their legs

If you receive a diagnosis of one of the conditions below, but suspect you might suffer from Restless Legs Syndrome, we advise you to seek out a second opinion or contact a medical professional who has experience dealing with RLS.

• Depression - Depression is an emotional state characterized by persistent and pervasive low mood. It may be triggered by a traumatic event, such as death, loss, or pregnancy, or a chemical imbalance in the brain. Symptoms of depression include feelings of sadness, anger, guilt, or anxiety, abnormal irritability, carbohydrate cravings, lack of interest in daily activities or work, lowered libido, and persistent mental and physical fatigue. Patients who suffer from depression alone typically don’t report uncomfortable leg sensations as one of their symptoms. If you suffer from Restless Legs Syndrome but are diagnosed with depression, you will note that while your mood may lift you will still experience uncomfortable leg sensations that disrupt sleep patterns.

• Insomnia - Insomnia is a condition that occurs when an individual has trouble going to sleep or sleeping through the night. Some Symptoms of insomnia include problems falling asleep, waking up too early, waking often throughout the night, light or un-refreshing sleep. Many RLS patients experience insomnia as their condition continues to be untreated. If you suffer from Restless Legs Syndrome but are diagnosed with insomnia, you will note that with mild to moderate treatments (such as warm baths, reduced caffeine, and mild sleep aides) you may feel more rested but the unpleasant leg sensations will continue.  However, if you are prescribed a strong muscle relaxant or sleep aide, you may notice a relief of leg sensations. Note: long term use of prescription muscle relaxants or sleep aides can lead to dependency, abuse, reduced physical function, or death.  

• Stress - Stress is a mental and physiological state that occurs in reaction to a wide range of events.  Some common life events that are known to cause stress include pregnancy, surgery, loss of a job, financial uncertainty, divorce, death of a loved one, or an overbooked schedule.  Stress exists on a spectrum, from mild stress to severe stress, and depending on its severity, stress can manifest in a variety of physical and emotional ways. Symptoms of stress vary from person to person. Some common symptoms of stress can include irritability, fatigue, chronic headaches, alcohol or drug abuse, overeating or not eating at all. Stress and anxiety have been reported as a symptom of Restless Legs Syndrome due to the inability to sleep and the uncomfortable sensations.  If you have Restless Legs Syndrome and are diagnosed with stress, you will note that stress relieving techniques may alleviate mental discomfort but not provide relief for physical discomfort.

• Potassium Deficiency - Potassium deficiency occurs when an individual does not have enough of the nutrient potassium in their body. Symptoms of potassium deficiency include muscle cramps, muscle fatigue, weakness, irritability, dry skin, irregular heartbeat, fatigue, depression, insomnia, nausea, low blood pressure, constipation, headaches, and thirst. Potassium deficiency and Restless Legs Syndrome share many of the same symptoms and can appear almost identical to medical professionals, however are not related. In order to ensure the proper diagnosis, both a blood test and a urine test may be performed to analyze the amount of potassium an individual has in their system and determine if they are deficient. If the tests return negative for deficiency, then a diagnosis of Restless Legs Syndrome should be entertained.

• Peripheral Neuropathy - Peripheral Neuropathy is a disruption of proper nerve functioning, typically in the hands and feet, as the result of damage to the spinal cord or actual nerves. Symptoms of Peripheral Neuropathy include tingling in the fingers and toes that gradually spread up into the arms and legs, burning or sharp stabbing pain at nerve endings, sensitivity to touch, muscle weakness, and reduced coordination.  Peripheral Neuropathy has been considered as a possible cause of Restless Legs Syndrome. It is essentially progressive nerve damage, meaning an imaging test or nerve biopsy can be performed to analyze the state of the nerves and determine if the restless sensation an individual feels in their legs is the result of Restless Legs Syndrome or Peripheral Neuropathy. 

For more valuable information on potential misdiagnosis of RLS, check out our full length report!

Changes to Make

There are a variety of lifestyle and dietary changes an individual can make to help manage and reduce their RLS symptoms. These adjustments can work in concert with other treatments, including prescription medications, herbal remedies, and vitamin regimens. 

• Enhanced External Couterpulsation - Enhanced External Couterpulsation (EECP) is an alternative treatment that works to stimulate blood flow throughout the body. EECP utilizes hydraulic cuffs around the calves and thighs to force blood from the lower half of the body to the upper half.  The compression of the cuffs is timed with the contractions of the heart muscle to provide maximum blood flow throughout the body with the least amount of work from the cardiovascular system. One study treated severe RLS patients with EECP for one month; at the end of the 35 EECP treatment sessions, study participants noted significant improvements of their symptoms which lasted between three months and a year.

• Photonic Stimulation - In 2000, the FDA approved the PHOTONIC stimulator, a device which directs a beam of photons onto major nerves and acupuncture points on the body to promote healing and proper function.  Self-reported patient-based evidence suggests that using this device can lead to a permanent reduction in the severity and frequency of RLS symptoms.

• Massage - A simple yet effective alternative therapy for mild to moderate RLS is massage. Medical professionals speculate that massage is effective because it stimulates the release of endorphins, while some natural practitioners suggest that deep tissue massage can break up toxin build up in the legs which may cause RLS.  Massage can be effective either when self-performed or when provided by a professional massage therapist.

• Reduced Stimulant Intake - One of the key dietary changes recommended for RLS patients is the reduction or cessation of caffeine or tobacco use.  These items have stimulating properties that can agitate muscles and affect quality of sleep.  Alcohol also should be eliminated, as it has works initially as a stimulant and can disrupt proper sleep patterns. 

• Maintain a Healthy Weight – Maintaining a healthy BMI (Body Mass Index) can help reduce RLS symptoms as excess fat can strain muscles and exacerbate RLS. To read more about BMI and how to calculate it, click here

• Consistent Sleep Schedule - Maintaining a consistent sleep schedule has also been shown to be effective in managing RLS symptoms.  Going to bed at the same time every night and waking up at the same time every day can help your body rest more deeply and rise more refreshed. Many patients also note it reduces the disruption they experience from their symptoms.

• Take Regular Exercise - Exercise seems to play a substantial role in managing symptoms of RLS.  Moderate activities, such as walking, swimming, or using cardiovascular equipment at an intermediate pace can increase blood flow to the legs, move calcium deposits, and stretch muscles.  It should be noted that vigorous exercise, especially too close to bedtime, is not recommended as it can actually increase the severity of symptoms. 

For more valuable information on lifestyle changes you can make for RLS, check out our full length report!

Vitamins & Supplements

Due to the fact that several causes of RLS are due to nutrient imbalances in the body (i.e. anemia), many mainstream health care providers and natural remedy specialists encourage the use of vitamins and supplements to reduce symptoms of the condition.  In most cases, rectifying nutrient imbalances will severely reduce or completely eliminate symptoms of the condition.

• Iron - Iron deficiency or anemia is thought to be a common cause of RLS, and patients often report that their symptoms decreased in severity after they started taking an iron supplement.  Arthur S. Walters, MD suggests RLS patients try taking 300 mg tablets three times daily to rectify any deficiency. 

• Folic Acid - Patients who experience RLS as a result of their pregnancy have found that taking folic acid, also known as vitamin B9, helps reduce their RLS symptoms.  One prevailing medical theory suggests that the effectiveness of this treatment is due to the fact that many women become B9 deficient during pregnancy. Most people can rectify any B9 deficiency through taking a comprehensive multivitamin to get the recommended 400 micrograms daily. 

• Magnesium - Many patients note a remarkable improvement of their symptoms after starting a magnesium supplement. Ideally, magnesium works to relax muscles and open blood vessels so calcium can be properly absorbed and not allowed to build up.  Luckily, magnesium deficiency can be quickly and effectively rectified by taking between 200 and 600 mg of magnesium supplement daily.

• Potassium - A host of RLS patients have reported their symptoms decreased as soon as they incorporated bananas, a high potassium food, into their diet.  Like magnesium, potassium works to reduce the muscle cramps which are at the root of some people’s RLS.

For more valuable information on the vitamin therapy for RLS, check out our full length report!

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