Restless Legs Syndrome: A Complete Guide

Introduction

Restless Legs Syndrome (RLS), also known as Willis-Ekbom Disease, is a neurological disorder characterized by an uncontrollable urge to move the legs, often accompanied by uncomfortable sensations. These symptoms typically intensify during periods of rest, especially in the evening and nighttime, leading to significant disruptions in sleep and overall quality of life. Effective management of RLS necessitates a thorough understanding of its causes, symptoms, and evidence-based medical treatments.

The Sleep Syndicate will explore the scientific research about Restless Legs Syndrome and its effects on sleep, offering a thorough understanding of its research-backed causes, symptoms, evidence-based medical treatment choices, and practical sleep habits improvement tips to incorporate into your bedtime routine.

No material on this site or in this article is intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment and before undertaking changes to health-related habits, and never disregard professional medical advice or delay in seeking it because of something you have read here.

Understanding Restless Legs Syndrome

Causes of RLS

The precise cause of RLS remains elusive; however, several factors have been associated with its development:

• Genetic Factors: A familial predisposition has been observed, suggesting a hereditary component. Studies indicate that RLS is more common in individuals with a family history of the condition. [1]
• Iron Deficiency: Low levels of iron in the brain have been linked to RLS symptoms. Iron is a cofactor in dopamine synthesis, and its deficiency may disrupt dopaminergic pathways, contributing to RLS. [2]
• Dopaminergic Dysfunction: Imbalances in dopamine, a neurotransmitter crucial for muscle movement control, may contribute to RLS. Disruptions in dopaminergic pathways can lead to the sensory and motor symptoms observed in RLS. [3]
• Chronic Diseases: Conditions such as Parkinson's disease, diabetes, and peripheral neuropathy have been associated with secondary RLS. Managing these underlying conditions may alleviate RLS symptoms. [4]
• Pregnancy: Hormonal changes during pregnancy, particularly in the third trimester, can temporarily intensify RLS symptoms. These symptoms often resolve postpartum. [5]

Symptoms of RLS

Research done by JAMA Network suggested that these are the common symptoms that occur with patients [6]:

• Unpleasant Sensations: Descriptions include tingling, crawling, itching, or aching feelings deep within the legs. These sensations are typically bilateral and occur during periods of rest or inactivity.
• Rest-Induced Symptoms: Symptoms typically emerge or worsen during periods of inactivity, such as sitting or lying down. This can lead to significant sleep disturbances and reduced quality of life.
• Urge to Move: A compelling need to move the legs to alleviate discomfort. Movement provides temporary relief, but symptoms often recur upon rest.
  
  

Medical Management of Restless Legs Syndrome

Effective management of RLS is tailored to the severity of symptoms and their impact on the individual's quality of life. A multifaceted approach, primarily guided by healthcare professionals, is recommended.

1. Pharmacological Treatments for Restless Leg Syndrome

Medications are often prescribed to manage moderate to severe RLS symptoms:

• Alpha-2-Delta Ligands: Drugs such as gabapentin enacarbil, gabapentin, and pregabalin are recommended as first-line treatments. These medications modulate calcium channels, reducing nerve excitability and alleviating symptoms.
• Dopaminergic Agents: While previously considered first-line treatments, recent guidelines advise against the routine use of dopamine agonists (e.g., pramipexole, ropinirole) due to potential adverse effects, including augmentation—a worsening of symptoms over time.
• Iron Supplementation: For patients with confirmed iron deficiency, iron supplementation (oral or intravenous) may be beneficial. Monitoring of iron levels is essential to guide therapy.
• Opioids: In cases where other treatments are ineffective, low-dose opioids may be considered. Due to the risk of dependency and other side effects, their use is typically limited to severe cases under strict medical supervision.

Research done by Wijemanne S. and Ondo W. found that these are the most common pharmacological treatments that physicians prescribe to patients suffering from RLS. [7]

2. Natural Interventions for Restless Leg Syndrome

In addition to medications, certain non-pharmacological strategies may be recommended:

• Exercise: Engaging in regular, moderate-intensity exercise may help alleviate RLS symptoms. Activities such as walking, swimming, and cycling are beneficial. It's important to avoid excessive or high-intensity workouts, especially close to bedtime, as they may exacerbate symptoms.
• Sleep Hygiene: Establishing a regular sleep schedule, creating a comfortable sleep environment, and minimizing exposure to screens before bedtime may improve sleep quality and reduce RLS symptoms. Good sleep hygiene practices are essential in managing RLS-related sleep disturbances.
• Cognitive Behavioral Therapy for Insomnia (CBT-I): CBT-I has been shown to improve sleep quality in individuals with RLS. This therapy focuses on changing negative thoughts and behaviors related to sleep.

In a systematic review done by Akbaş, P., Yaman Sözbir, Ş, they found that these non-pharmacological methods mentioned above used to cope with RLS, reduce RLS symptoms, RLS severity and mental health problems (depression, anxiety, stress, etc.), and increases quality of life and sleep quality. [8]

For a solution that leverages both Sleep Hygiene and CBT, you may want to consider a quality sleep habit program.

3. Addressing Underlying Conditions

Identifying and managing underlying conditions that contribute to RLS is crucial for symptom relief:

• Iron Deficiency: Studies have confirmed that iron supplementation can help alleviate RLS symptoms, particularly in individuals with low serum ferritin levels. Intravenous iron may be more effective than oral supplements for certain patients. [9]
• Chronic Diseases: Managing conditions such as diabetes, peripheral neuropathy, and kidney disease may alleviate secondary RLS symptoms. Proper glucose control in diabetes, for example, has been associated with reduced RLS severity. [10]
  
  

Collaborative Care and Follow-Up

Managing RLS often requires a multidisciplinary and consistent approach:

• Neurologists and Sleep Specialists: These professionals can provide specialized care, including advanced treatment options and participation in clinical trials.
• Regular Monitoring: Ongoing assessment of symptom progression and treatment efficacy is essential to adjust therapies as needed.
• Patient Education: Empowering patients with knowledge about RLS enables them to participate actively in their care and make informed decisions.
  
  

Improving your Sleep Habits

Restless Legs Syndrome is a complex neurological disorder that significantly impacts quality of life. While there is no definitive cure, a combination of pharmacological treatments, natural (non-drug) interventions, and addressing underlying conditions may effectively manage symptoms. Collaborative care involving healthcare professionals and informed patients is essential for optimal outcomes.

For individuals experiencing symptoms, consulting a healthcare provider for proper diagnosis and treatment remains the best course of action.

Several online programs offer science-backed techniques (like CBT) to improve sleep quality, which may be beneficial for those with RLS. These programs often include educational modules on sleep improvement, relaxation techniques, strategies, and many more.

The Sleep Syndicate has created an affordable 6-week program to help you improve your sleep habits. Our easy-to-follow, science-based method uses proven behavior modification strategies to help you make gradual, scientifically supported, improvements to your sleep habits.

The Sleep Syndicate’s 6 Weeks to Better Sleep program

Citations

[1] Xiong, L., Montplaisir, J., Desautels, A., Barhdadi, A., Turecki, G., Levchenko, A., Thibodeau, P., Dubé, M. P., Gaspar, C., & Rouleau, G. A. (2010). Family study of restless legs syndrome in Quebec, Canada: clinical characterization of 671 familial cases. Archives of neurology, 67(5), 617–622. https://doi.org/10.1001/archneurol.2010.67

[2] Allen, R. P., & Earley, C. J. (2007). The role of iron in restless legs syndrome. Movement disorders : official journal of the Movement Disorder Society, 22 Suppl 18, S440–S448. https://doi.org/10.1002/mds.21607

[3] Clemens, S., Rye, D. B., & Hochman, S. (2022). Restless legs syndrome: Revisiting the dopaminergic hypothesis. Pain Medicine, 23(5), 1032-1045. https://doi.org/10.1212/01.wnl.0000223316.53428.c9

[4] Trenkwalder, C., Allen, R., Högl, B., Paulus, W., & Winkelmann, J. (2016). Restless legs syndrome associated with major diseases: A systematic review and new concept. Neurology, 86(14), 1336–1343. https://doi.org/10.1212/WNL.0000000000002542

[5] Gupta, R., Dhyani, M., Kendzerska, T., Pandi-Perumal, S. R., BaHammam, A. S., Srivanitchapoom, P., Pandey, S., & Hallett, M. (2016). Restless legs syndrome and pregnancy: prevalence, possible pathophysiological mechanisms and treatment. Acta neurologica Scandinavica, 133(5), 320–329. https://doi.org/10.1111/ane.12520

[6] Muth CC. Restless Legs Syndrome. JAMA. 2017;317(7):780. doi:10.1001/jama.2016.21375

[7] Wijemanne S, Ondo WRestless Legs Syndrome: clinical features, diagnosis and a practical approach to management. Practical Neurology. 2017;17:444-452. https://pn.bmj.com/content/17/6/444.info

[8] Akbaş, P., Yaman Sözbir, Ş. Non-pharmacological methods used in coping with restless leg syndrome (RLS): A systematic review. Sleep Biol. Rhythms 19, 215–225 (2021). https://doi.org/10.1007/s41105-021-00322-z

[9] Allen, R. P., & Earley, C. J. (2007). The role of iron in restless legs syndrome. Movement disorders : official journal of the Movement Disorder Society, 22 Suppl 18, S440–S448. https://doi.org/10.1002/mds.21607

[10] Ravi Gupta, Rohit Gupta, Niraj Kumar, Vikram Singh Rawat, Jan Ulfberg, Richard Putnam Allen. Restless legs syndrome among subjects having chronic liver disease: A systematic review and meta-analysis. Sleep Medicine Reviews. Volume 58. 2021. 101463. ISSN 1087-0792. https://doi.org/10.1016/j.smrv.2021.101463. https://www.sciencedirect.com/science/article/pii/S1087079221000484