Restless legs syndrome

Restless legs syndrome (RLS) is a condition where you have an unpleasant feeling or sensation, usually in the calves of your legs, that creates a strong, uncontrollable urge to move your legs.

• The symptoms are usually brought on by rest and are worse in the evening or at night.
• Movement such as walking or stretching brings relief for a short time, but the symptoms usually return once you settle into a restful state.
• Both legs may be affected or one may be worse than the other.
• Sometimes other parts of your body, such as your arms or lower back, may be affected.

RLS can affect your sleep and lead to tiredness, feeling sleepy or trouble concentrating. If this happens, talk to your healthcare provider about how to manage your symptoms.

Note: Nocturnal (night-time) leg cramps are different from restless legs. A single jerky movement in the early stages of sleep is common in one third of people and is normal.

The exact cause of RLS isn’t known but it’s thought to involve your nervous system. It may be genetic (a condition that runs in families). Your risk of having RLS is 30 to 50% higher if your parents had RLS. 

Medical conditions

• lack of iron (iron deficiency)
• hypothyroidism or hyperthyroidism
• rheumatoid arthritis
• type 2 diabetes
• sleep apnoea
• chronic kidney disease
• Parkinson's disease
• varicose veins
• nerve damage (neuropathy, spinal cord disease, multiple sclerosis).

You may also get RLS during pregnancy, especially in the last trimester (final 3 months). RLS due to pregnancy often gets better on its own within a month after delivery.

Medicines

Some medicines may cause restless legs, eg, some antidepressants, sedating antihistamines and antipsychotics such as haloperidol, quetiapine or olanzapine.

A high intake of caffeine-containing drinks, such as coffee, tea and energy drinks, is also associated with RLS.

The main symptom of restless legs syndrome is that you have an urge to move the affected part of your body, usually your leg. 

This feeling can range from mild restlessness in your legs on some evenings, to a more severe problem that occurs every evening and night (and sometimes during the day) which regularly disturbs your sleep. Many people fall somewhere in between these extremes.

You may also get an uncomfortable or tingling sensation, such as 'pins and needles', prickling, pulling or crawling, in your legs.

These feelings usually begin about 15 minutes after you lie down to sleep or relax or when you haven’t moved for long periods, such as when travelling in a car or airplane.

Moving will usually make you feel better, at least for a short time. 

Many people with RLS also develop a condition called periodic limb movements of sleep (PLMS). This is where you have uncontrolled leg (and sometimes arm) twitching or jerking movements while you sleep. 

Restless legs syndrome can usually be diagnosed by your healthcare provider or neurologist (a doctor who specialises in conditions that affect the nervous system) without any special tests. However, blood tests may be needed to look for an underlying cause, such as lack of iron or a thyroid problem. Read more about the medical conditions that can be associated with RLS above. 

If you have mild symptoms of restless legs syndrome the following lifestyle changes may help improve your symptoms:

• Avoid smoking.
• Limit or avoid alcohol and caffeine.
• Get plenty of sleep because tiredness can make RLS worse. Keep your bedroom cool, quiet and comfortable, try to get into a pattern of going to bed and getting up at the same times, aiming for 7 hours sleep. Read more sleep tips.
• Exercise regularly – try gentle walking before bedtime or doing gentle leg stretches for 5 minutes before you sleep.
• Eat a healthy diet.
• Massage the affected arm or leg or have a soak in the bath.
• Try heat or ice packs on the affected leg or arm.
• Distract yourself with an activity, such as reading, so you're less aware of your symptoms.
  
  

Image credit: Heathify He Puna Waiora

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If you have a medical condition that causes restless legs syndrome or makes it worse, such as iron deficiency, treating it may improve your symptoms.

You may need to change 1 of your medicines if a side effect from the medicine is thought to be the cause of your RLS. Sometimes a few lifestyle changes may be enough to control your symptoms. See the section on self-care below.

Medicines

If your symptoms are more severe and you have badly broken sleep that’s affecting your normal daily activities, medicines may help control the urge to move and help you sleep. Different types of medicine may help, such as pramipexole, ropinirole, carbamazepine, gabapentin and pregabalin. Working closely with your healthcare provider, you may have to try a few to find the one that works best for you. They each have their own risks and benefits.

The outlook for restless legs syndrome (RLS) varies from person to person. Your symptoms might stay the same, become gradually worse, or they may improve by themselves. Some people have long periods without symptoms. If your RLS is caused by an underlying condition, it will often get better when that condition is treated.

Although there’s no cure for RLS, medicines usually help if your symptoms are interfering with your quality of life.