Do You Have Restless Leg Syndrome?
Just like sleep apnea, Restless Leg Syndrome (RLS) is a medical sleep disorder that can go unrecognized or misdiagnosed. In fact, many patients are not diagnosed until 10-20 years after symptom onset. Yet its prevalence is not insignificant - RLS is thought to affect between 5-15% of the general population (13% of adult population).
What is RLS and what are the signs and symptoms to look out for?
Restless legs syndrome (RLS) is a sleep disorder that causes an intense, often irresistible urge to move the legs and people report a tingling, itching or burning feeling in their legs, which may be accompanied by leg pain and cramps. These sensations are brought on by resting such as lying down in bed, or sitting for prolonged periods and they are only relieved only by walking or other movement of the legs. RLS typically occurs in the evening, making it difficult to fall asleep and stay asleep. People with RLS may also suffer from significant daytime fatigue or sleepiness, as well as irritability and cognition issues as a result of their disturbed night time sleep. Those with restless legs syndrome are more likely to have depression or anxiety.
How RLS develops is a bit of a mystery but neurologists believe it’s related to a dysfunction in the way the brain uses the neurotransmitter dopamine, a chemical used by brain cells to communicate and produce smooth, purposeful muscle activity and movement.
Iron deficiency (specifically ferritin levels in the brain) may also be an implicated cause and many conditions like diabetes, rheumatoid arthritis, kidney failure, Parkinson's disease and obesity are associated with RLS. Poor circulation of the legs such as with varicose veins can cause restless leg syndrome and there may also be a genetic link. Alcohol, caffeine, nicotine and certain medications have also been linked to RLS (such as allergy and antihistamine medications, many antidepressants, over-the-counter sleep aids and nearly all centrally active dopamine-receptor antagonists, including anti-nausea medications).
Women are twice as likely to develop it, especially during pregnancy, where 25-40% of pregnant women show symptoms of this disorder. Genetics plays a role as well - more than 50% of those who have RLS have a pattern of it in their family.
Diagnosing RLS
You can be diagnosed for RLS by your primary healthcare practitioner. They will first ask you the following questions:
Do you have difficulty falling asleep because of an urge to move your legs?
Do you feel an itching or crawly sensation in your legs when you lie down to go to sleep?
Do your legs seem to feel better when you walk, stretch or make other movements in the evening or at night?
If you answered yes to any of these questions, you may have restless legs syndrome.
Your doctor will also take a medical and family history, and they may order blood tests, including measuring ferritin and an iron panel. You may also be asked to complete a sleep diary, tracking your sleep for up to 2 weeks. An overnight sleep study is not usually required to diagnose this condition, although your doctor may want to rule out other sleep disorders that may be concurrently present with RLS, including sleep apnea and other medical sleep disorders that may be disrupting your sleep.
Treatment Options
Restless leg syndrome is not considered curable but it is treatable.
Lifestyle and behavioural interventions are recommended as the first line of RLS management.
These include:
leg exercises and stretching muscles
moderate exercise and weight loss
reducing nicotine, alcohol and caffeine intake
acupuncture and massage
having a bath
using weighted blankets
experimenting with heat or cold (so like ice packs and hot compresses)
anxiety reduction techniques, such as deep breathing or yoga
positive sleep hygiene practices (eg. consistent bed and wake times, managing light exposure, etc)
Medication and/or supplementation may be appropriate in some cases and might include:
iron supplements
intravenous ferric carboxymaltose
low dose opioids (*with caution)
gabapentin enacarbil, pregabalin
*long term use of dopamine agonists, such as pramipexole and ropinirole is no longer recommended due to risks of worsening symptoms over time
A new nerve stimulation therapy (bilateral high frequency peroneal nerve stimulation) has been showing promising results for some people and may also be recommended.
If you’re not sure whether you have restless leg syndrome, speak to your healthcare provider. While there are a range of treatments to manage the condition, early intervention is the best way to prevent other sleep issues, like insomnia, from developing and becoming a more long-term problem.
