12 Facts About Restless Legs Syndrome
Nighttime leg problems
Restless legs syndrome (RLS) is a real medical condition—but its funny name and strange-sounding symptoms have stirred up controversy. Some people question everything from the criteria used to diagnose it to the medications used to treat it.
Still, studies have found that about 7% of the population suffers from symptoms such as creepy-crawly feelings in their legs that interrupt sleep. Here are 12 facts you should know about RLS.
RLS legs don't move involuntarily
RLS is characterized by sensations often described as itching, tingling, pulling, crawling, or cramping. These can cause a strong urge to get up and walk around, but people are always in control of their movements, says Michele Tagliati, MD, director of the Movement Disorders Program at Cedars-Sinai Medical Center, in Los Angeles.
"The feeling drives them nuts, so they have to get out of bed or out of their chair and walk around," Dr. Tagliati says.
People with involuntary leg movements may have another condition called
periodic limb movement disorder. Many people with RLS also have this disorder.
RLS is more common during pregnancy
For reasons that aren't completely understood, pregnant women sometimes experience RLS symptoms that go away after they give birth. One possible explanation, Dr. Tagliati says, is that pregnancy is often associated with iron deficiency, and low iron levels are a contributing factor in some RLS cases.
A 2010 study found that women who suffer from RLS during one pregnancy are at a
higher risk of having symptoms during future pregnancies, or of developing a chronic form of RLS later on.
Supplements can help
Medications aren't the only treatment for restless legs. "Every time someone comes into my clinic complaining of something that may sound like restless legs, we check their iron," says Dr. Tagliati, who has received speaking fees from a company that makes RLS drugs. "If they're low, we treat it with supplementation."
Restoring iron levels in the body also can help restore dopamine in the brain, experts believe, which may help reduce RLS symptoms.
Folate and magnesium supplements may also relieve RLS symptoms.
Drug companies didn't create RLS
When medication was first approved for RLS, in 2005 and 2006, drug companies began to run ads on television.
Comedians mocked the disorder, and studies and news coverage were criticized by some doctors who called into question statistics used by one drug company to overstate RLS's prevalence.
The bottom line is that RLS has been around longer than the drugs to treat it, Dr. Tagliati says. "Those ads were able to help some people realize that they are not crazy, that they actually have a treatable condition."
Medication can have strange side effects
RLS drugs such as Requip (ropinirole) and Mirapex (pramipexole) target dopamine receptors in the brain, which are linked to risk and reward. These medications can aggravate gambling or compulsive sex addictions in some people, Dr. Tagliati says.
Dr. Tagliati says this is more common in people who already had some impulsivity. "You have to already have that urge that's been suppressed," he says. "What these medications do is cause your inhibitory breaks to start failing."
The risk of developing this side effect may be more common in those taking larger doses for Parkinson's disease, rather than the lower RLS doses.
Risk increases with age
RLS can strike at any age, but it is more common in people 65 and older.
Symptoms typically get worse as you get older; many people with the condition will suffer from daily symptoms and significant sleep interruptions after age 50.
Exercise can curb symptoms
Many people find that regular exercise helps keep RLS under control, or that the condition acts up more on days when they haven't moved around much.
Gentle stretching and massage may also help, either before bed or when symptoms start. Too much or too intense exercise, however, can make RLS worse.
RLS is not trivial
People who don't have RLS have a hard time understanding what it feels like—and how much the sensations can disrupt daily (and nightly) life. RLS can cause serious sleep deprivation, which in turn may cause other health problems.
Studies have also linked RLS to
RLS isn't hard to diagnose
There isn't a blood test for RLS, but that doesn't fuzzy science is used to diagnose it.
There are four necessary criteria for people to be diagnosed with RLS: an urge to move their legs, usually because of uncomfortable tingling or crawling sensations; the urge must begin or get worse during periods of rest or inactivity; the sensations are partially or totally relieved by movement; and the sensations and the urge to move are worse in the evening or at night.
Using these criteria, it can be a straightforward diagnosis if your doctor is familiar with the condition. Your doctor may, however, order blood and other tests to look for underlying causes of RLS, such as iron deficiency.
RLS may be genetic
In 2007, researchers in Europe and at Emory University, in Atlanta, discovered a gene variant that doubled a person's risk of developing RLS. In 2011, an international team of scientists discovered two genetic regions that seem to play a role as well.
That RLS often runs in families and appears to be most prevalent among people of Western European descent has long hinted at a genetic component of the condition.
Symptoms occur at night
RLS follows a circadian rhythm, getting worse at night as the body and brain begin to relax and prepare for sleep.
Doctors believe this is due to dopamine that follows the body's natural sleep-wake cycle, as well as fewer mental distractions at night.
Some RLS patients try to schedule meetings (or naps) during the early part of the day because sitting for long periods of time is difficult later in the day. Others say that keeping busy with mentally stimulating activities at night helps relieve their symptoms.
RLS isn't a sign of Parkinson's disease
Because the drugs used to treat RLS often are used for Parkinson's disease, it's easy for people to assume that the two disorders are somehow related, Dr. Tagliati says.
"I don't think I've ever seen any of my RLS patients develop Parkinson's, and we know that's not how Parkinson's starts," he says.
A 2011 Norwegian study found that people with early Parkinson's disease were
no more likely to have RLS symptoms than people without Parkinson's disease.