Restless Leg Syndrome (RLS): What You Need to Know

Many seniors suffer from restless leg syndrome (RLS), a neurological disorder that creates an urge to continuously move the legs, usually while trying to rest or sleep. The condition can impact cognitive function, interrupt sleep, and negatively affect quality of life. Estimates indicate that up to 10 percent of the population in the United States may have RLS. If you or a loved one suffer with the condition, here is what you need to know about its causes, diagnosis, and treatment.

Researchers remain unsure about the exact causes of RLS. It is believed that there may be four main causes, but more research is needed. Right now, scientists believe the main causes are:

1. An iron deficiency in the brain
2. Kidney disease, which can contribute to iron deficiency
3. A lack of dopamine in the brain (a chemical that acts as a messenger between brain cells)
4. Genetics

There are four main symptoms of RLS. The International Restless Legs Syndrome Study Group (IRLSSG) and the National Institutes of Health say the primary symptoms include:

1. An urge to move the legs because of uncomfortable sensations in the legs. Sufferers describe it as feeling like burning, creeping, crawling, aching, or tugging in the legs. For some people, the sensations begin in the legs and migrate to the feet, chest, and arms.
2. Restlessness and an urge to move the legs is relieved by moving them. Repetitive movements help the most, like pacing, rocking or shaking the legs. Stretching can also relieve some of the symptoms.
3. Symptoms get worse when the person is lying or sitting down. It can also occur when sitting for long periods of time, like in an airplane or movie theater.
4. The symptoms vary over the course of the day and night. Even if the symptoms are relieved during the day, they worsen at night. For some, there are few symptoms in the morning, but they continue to increase as the day goes on, peaking in the evening and during the night.

Specific symptoms lead to diagnosis

Diagnosing and treating RLS is essential to protecting quality of life. The disruption of sleep and the continual need to move one’s legs can interfere with the ability to engage in social activities, maintaining a regular work schedule, and attending school. It can significantly reduce energy levels and the ability to complete daily activities. The grating, relentless symptoms of RLS can also change behavior and alter mood.

Because there is no specific diagnostic laboratory or imaging test for RLS, a diagnosis can only be reached if all of the following criteria are met. According to the IRLSSG, the specific diagnostic criteria are:

1. An urge to move the legs usually, but not always, accompanied by uncomfortable and unpleasant sensations in the legs
2. The urge to move the legs/unpleasant sensations begin or worsen during periods of rest or inactivity such as lying down or sitting
3. The urge to move the legs/unpleasant sensations are partially or totally relieved by movement, such as walking or stretching, at least as long as the activity continues
4. The urge to move the legs/unpleasant sensations during rest or inactivity only occur or are worse in the evening or night than during the day
5. These symptoms cannot be explained away by the presence of other medical conditions including arthritis, vein problems, etc.

Treatments for RLS

There are several different treatment pathways for RLS. They include medications, muscle relaxants, sleep medications, and lifestyle changes.

Because a lack of iron is suspected to be a contributing cause of RLS, current treatment protocols including checking iron levels and adding supplements if they are low.

Medications to treat RLS may include drugs that increase dopamine in the brain. However, some of those drugs may have side effects that can include nausea, lightheadedness and fatigue. For some people, these dopamine enhancing drugs also have more dangerous side effects that can reduce impulse control and result in behaviors like compulsive gambling. They can also cause daytime sleepiness. Before taking any medications, discuss all the potential side effects with your physician.

Muscle relaxants and sleep medications may be prescribed if other medications and treatments aren’t working. These carry their own risks and should be taken only after discussing one’s lifestyle and occupation with the physician.

Lifestyle changes may help reduce the symptoms of RLS. Home remedies that may work include:

• Practice a consistent bedtime
• Institute a relaxing bedtime routine that includes turning off electronic devices, lowering the lights, drinking non-caffeinated tea, listening to soft music and other comforting practices
• Stretch before bed. Stretching has been shown to reduce some of the symptoms of RLS
• Soak in the tub. The warm water may reduce some of the symptoms in the legs
• Get exercise before bed, like taking a walk, to stretch the muscles in the legs
• Get regular massages to loosen the muscles

RLS is a disruptive and frustrating condition. Keeping track of the type and timing of one’s symptoms can help a doctor to diagnose the condition. That may lead to treatments that can reduce the symptoms and ensure that you can engage in the work and social activities you enjoy.

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