Restless legs syndrome

Restless legs syndrome (RLS), also known as Willis-Ekbom disease, is a common condition of the nervous system. It gives you an overwhelming, irresistible urge to move your legs.

As many as 1 in 10 people are affected by restless legs syndrome at some point in their life.

Women are twice as likely as men to develop it. It's also more common in middle age, though the symptoms can start at any age, including childhood.

Restless legs syndrome usually brings an overwhelming urge to move your legs. There's also an uncomfortable sensation in the legs, and this can reach your arms, chest and face too.

People have described the sensation in different ways:

• tingling, burning, itching or throbbing
• a "creepy-crawly" feeling
• a feeling like fizzy water is inside the blood vessels in the legs
• a painful, cramping sensation in the legs, particularly in the calves

These unpleasant sensations can be mild or severe. They're usually worse in the evening and during the night, and moving or rubbing your legs often relieves them.

Some people have symptoms only now and then, while others have them every day. You may find it hard to sit for long periods, such as on a long train journey.

Up to 80% of people with restless legs syndrome also have periodic limb movements in sleep (PLMS).

If you have PLMS, your leg jerks or twitches without you being able to control it, usually at night while you're asleep. The movements are brief and they repeat, usually every 10 to 60 seconds.

PLMS can be bad enough to wake both you and your partner. The involuntary leg movements can also happen when you're awake and resting.

Restless legs syndrome comes in 2 types:

• primary or idiopathic restless legs syndrome
• secondary restless legs syndrome

Primary restless legs syndrome is the more common type of restless legs syndrome. Doctors call it "primary" when there's no obvious cause.

It may be caused by a problem with a part of the brain called the basal ganglia. This part of the brain uses a neurotransmitter called dopamine (a chemical) to help control muscle activity and movement. If the cells in your basal ganglia get damaged, the amount of dopamine in the brain is reduced. This causes muscle spasms and involuntary movements.

Dopamine levels naturally fall towards the end of the day. This may explain why your symptoms are often worse in the evening and during the night.

Specific genes may also be related to restless legs syndrome, which means it can run in families. In these cases, symptoms usually start before the age of 40.

Secondary restless legs syndrome happens as a complication of another health condition. You can develop it if you have:

• iron deficiency anaemia
• chronic kidney disease
• diabetes
• Parkinson's disease
• rheumatoid arthritis
• an underactive thyroid gland
• fibromyalgia

Some women develop secondary restless legs syndrome during pregnancy. It's most common from 27 weeks onwards, and it usually stops within 4 weeks of giving birth.

There's no single test for diagnosing restless legs syndrome. Your doctor will base the diagnosis on your:

• symptoms
• medical history
• family history
• physical examination
• test results

A doctor should be able to diagnose restless legs syndrome without much difficulty.

You'll be asked about the pattern of your symptoms, which helps the doctor judge how severe they are. You may also be sent for blood tests, and these will confirm whether you have primary or secondary restless legs syndrome.

If the condition is disrupting your sleep, you may be sent for sleep tests. These let healthcare professionals see exactly what happens while you're asleep.

The treatment for restless legs syndrome can depend on:

• what type of restless legs syndrome you have
• the severity of your symptoms

Some things don't cause restless legs syndrome but can make the symptoms worse. These include medicines like:

• some antidepressants
• antipsychotics
• lithium
• calcium channel blockers
• some antihistamines
• metoclopramide

Don't stop taking any medicine you've been prescribed without checking with your doctor first. Stopping suddenly can make you unwell.

Other possible triggers of restless legs syndrome include:

• smoking
• excessive caffeine or alcohol consumption
• being overweight or obese
• stress
• lack of exercise

If your symptoms are mild, a few lifestyle changes may be enough to ease restless legs syndrome. Good sleep hygiene can help, and that simply means keeping healthy sleep habits.

• exercise regularly
• follow a regular bedtime routine
• take time to relax before bed
• stick to the same bed time every day
• get up at the same time every morning
• have a warm bath in the evening

• do not smoke
• do not nap during the day
• do not drink or use stimulants like alcohol, caffeine and drugs before bed
• do not exercise before bed

When you have an episode of restless legs syndrome, these measures may help relieve your symptoms:

• massaging your legs
• applying a hot or cold compress to your leg muscles
• doing things that distract your mind, like reading or watching television
• relaxation exercises, like yoga or tai chi
• walking and stretching

If primary restless legs syndrome is causing more severe symptoms, there are medicines that may help. Your doctor may suggest trying:

• iron supplements, particularly if you have low levels of iron or a protein called ferritin
• neuropathic agents, medicines like gabapentin or pregabalin
• painkillers, like codeine or tramadol
• hypnotics, like clonazepam

If other medicines have not worked, your doctor may offer you dopamine agonists. These can cause complications like impulse control disorders and augmentation, which makes restless legs syndrome worse.

If an underlying health problem is causing your symptoms, doctors will treat that problem first. Treating it may clear up the syndrome.

Restless legs syndrome is not life threatening. In severe cases, though, it can disrupt your sleep and lead to insomnia, and it can trigger anxiety and depression.