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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
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
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.
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!
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.
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.
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.
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.
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!
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.
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.
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
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
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 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 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.
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
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.
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.
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.
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.
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.
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.
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
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.
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
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.
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
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!
Talk with your Doctor
To make sure you get the treatment and solutions you need to
manage your RLS symptoms and maintain your quality of life, it is vital that
you advocate for your own health through asking questions of your health care
professional and educating yourself. If
you suspect you may be suffering from RLS, use the guide below to start getting
the information and treatment you need from your health care providers.
- Keep a
Symptom Journal - The Symptoms
Journal is essentially a record of your observations regarding the nature,
severity, frequency, and duration of the symptoms you experience. You should include a daily record of all the
food, medications, and exercise you experience and note any correlations you
see between them and your symptoms. After you have 2-3 weeks of data recorded
in your Symptoms Journal, review what you have observed and, if you feel
something is out of the ordinary, call your health care provider and make an
appointment to investigate. Be sure to
take your symptoms journal with you to the appointment!
- Ask The
Right Questions - Help direct the examination with your health care
provider and also advocate for yourself by asking specific questions regarding
what they are noticing. Here are a few
questions to ask as they are performing a physical exam:
- Could any of the medications I am currently
taking cause these symptoms?
- Do you
see any evidence that these symptoms might be caused by kidney problems or
- Are my legs showing any indication of peripheral
- Do my blood test levels indicate any
abnormalities in iron, potassium, or magnesium levels?
- Could I be at risk of cadmium or thallium
Certain Tests - When you are at your appointment with your health care
provider, insist they order blood tests and imaging screens to check for more
serious conditions. Remember, the
symptoms of RLS may be indicative of a larger problem such as kidney failure,
diabetes, nutrient deficiency or peripheral neuropathy, therefore RLS should be
a diagnosis given only when every other potential cause of the symptoms has
been ruled out. Don’t be afraid to ask
for these tests to be performed!
“What’s Next?” - At the end of your appointment, be sure to ask for
information about where you go from here.
Some good questions include:
- When can I expect to hear back from the
laboratory and imaging department?
- What is your opinion at this stage?
- What can I do immediately to start relieving my
- When can I expect a final diagnosis?
- When should I follow up with your office?
For more valuable information on talking to your doctor about
RLS, check out our full length report!
Promoting nerve function and wellness is essential to
soothing and eliminating symptoms of Restless Legs Syndrome. Incorporating the
elements below into your daily lifestyle can positively influence the healing
process and help alleviate your symptoms as well as lay the foundation for
- Avoid naps during the day and try to stay
mentally alert and focused throughout your waking hours.
- Take hot baths before bedtime to soothe muscles
and improve blood flow to the legs.
- Consider altering your sleep schedule to sleep
when symptoms are less severe and stay awake and active during times when
symptoms are more severe.
adequate amounts of water to flush toxins out of your body, cleanse the blood
stream, and encourage oxygen delivery to muscles. It is recommended you drink one ounce of
water for every two pounds of your body weight.
- Include a comprehensive multivitamin in your
daily diet to ensure you are getting adequate amounts of key nutrients and
reduce the possibility of deficiency.
- Review the medications you use on a daily or
occasional basis and eliminate or substitute those that may exacerbate your RLS
symptoms. Some classifications of known RLS agitators include depression
medications, cold medications, allergy medications, and blood pressure
- Have nutrient levels in your blood checked every
three to six months to ensure you are not deficient in iron, potassium, and magnesium.
- Maintain close communication with your health
care provider or natural remedy specialist to make small adjustments or tweaks
in your treatment as needed and in a timely fashion.
For more RLS wellness tips, check out our full length report!
There are several herbal remedies that RLS patients have
found effective in easing their symptoms, all of which are classified as
anti-spasmodics. Anti-spasmodic herbs
are any plant that exhibits calming qualities similar to prescription anticonvulsants. These herbs generally encourage increase
blood flow, promote muscle relaxation and aid in restful sleep.
and Valerian Root - Chamomile and Valerian root are great examples
of anti-spasmodic herbs that are often used by RLS patients before bed to calm
their minds and limbs. There has been some evidence to suggest that Valerian
can reduce the sensitivity of some of the nerves in the limbs to reduce jerking
and twitching. Both chamomile and
valerian have mild sedative properties, and therefore should not be taken
before driving or operating heavy machinery.
may be used in two ways by RLS patients.
First, it may be ingested in tea form before bed to promote restful
sleep and relaxed muscles. You may drink
up to four cups a day if necessary. Peppermint oil may also be applied directly
to the legs while massaging them to relieve tension and cool twitches.
and Skullcap - Kelp is a form of seaweed that is rich in iodine
and other powerful nutrients which are essential for optimal nerve health. Similarly, skullcap is an herb that has been
utilized by native populations for centuries due to its healing power and is
respected by modern scientists as having anti-inflammatory properties for
For more valuable information on herbal remedies for RLS, check
out our full length report!