Restless legs syndrome

"Restless legs syndrome - Illnesses & conditions | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Brain, nerves and spinal cord Restless legs syndrome Restless legs syndrome About restless legs syndrome Symptoms of restless legs syndrome Causes of restless legs syndrome Diagnosing restless legs syndrome Treating restless legs syndrome About restless legs syndrome Restless legs syndrome, also known as Willis-Ekbom disease, is a common condition of the nervous system that causes an overwhelming, irresistible urge to move the legs. It can also cause an unpleasant crawling or creeping sensationin the feet, calves and thighs. The sensation is often worse in the eveningor at night. Occasionally, the arms are affected too. Restless legs syndrome is also associated with involuntary jerking of the legs and arms, known as periodic limb movements in sleep (PLMS). Some people havethe symptoms of restless legs syndrome occasionally, while others have them every day. The symptoms can vary from mild to severe. In severe cases, restless legs syndrome can be very distressing and disrupt a persons daily activities. What causes restless legs syndrome? In the majority of cases, theres no obvious cause ofrestless legs syndrome. This known as idiopathic or primary restless legs syndrome, and it can run in families. Some neurologists (specialists in treating conditions that affect the nervous system) believe the symptoms of restless legs syndrome may have something to do with how the body handlesa chemical called dopamine. Dopamine is involved in controlling muscle movement andmaybe responsible forthe involuntary leg movements associated withrestless legs syndrome. In some cases, restless legs syndrome is caused by an underlying health condition,such as iron deficiency anaemia or kidney failure. This is known as secondaryrestless legs syndrome. Theres also a link betweenrestless legs syndrome and pregnancy. About 1 in5 pregnant women will experience symptoms in the last three months of their pregnancy, although its not clear exactly why this is. In such cases,restless legs syndrome usually disappears after the woman has given birth. Read more about the causes of restless legs syndrome Treating restless legs syndrome Mild cases ofrestless legs syndrome that arent linked to an underlying health condition may not require any treatment, other than making a few lifestyle changes, such as: adoptinggood sleep habits for example, following a regular bedtime ritual, sleeping regular hours, and avoiding alcohol and caffeine late at night quitting smoking if yousmoke exercising regularly during the daytime If your symptomsare more severe, you may need medication to regulate the levels of dopamine and ironin your body. Ifrestless legs syndrome is caused by iron deficiency anaemia, iron supplements may be all thats needed to treat the symptoms. Read more about treating restless legs syndrome Whos affected by restless legs syndrome? As many as 1 in 10 people are affected byrestless legs syndrome at some point in their life. Women are twice as likely to developrestless legs syndrome than men. Its also more common in middle age, although the symptoms can develop at any age, including childhood. Outlook Thesymptomsofrestless legs syndrome will usually disappear if its possible to address an underlying cause. However, if the causeis unknown, the symptoms can sometimes get worse with time and severely affect the persons life. Restless legs syndrome isnt life threatening, but severe cases can severely disrupt sleep (causing insomnia )and trigger anxiety and depression . Symptoms of restless legs syndrome Restless legs syndrome typically causes an overwhelming urge to move your legs and an uncomfortable sensation in your legs. The sensation may also affect your arms, chest and face, too. It has been described as: tingling, burning, itching or throbbing a creepy-crawly feeling 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 sensationscan range from mild to unbearable, and are usually worse in the evening and during the night. They can often be relieved by moving or rubbing your legs. Some people experience symptoms occasionally,while others have them every day. You may find it difficult tosit for long periods of time for example, ona long train journey. Just over half of people withrestless legs syndrome also experience episodes of lowerback pain. Periodic limb movements in sleep (PLMS) Up to 80% of people withrestless legs syndrome also have periodic limb movements in sleep (PLMS). If you have PLMS, your leg will jerk or twitch uncontrollably,usuallyat night while youre asleep. The movements are brief and repetitive, and usually occur every 10 to 60 seconds. PLMS can be severe enough to wake up both you and your partner. The involuntary leg movementscan also occur when youre awake and resting. Causes of restless legs syndrome In many cases, the exact cause of restless legs syndrome is unknown. When no cause can be found, itsknown as idiopathic or primary restless legs syndrome. Research has identified specific genes related to restless legs syndrome, andit can run in families. In these cases, symptoms usually occur before the age of 40. Dopamine Theres evidence to suggest restless legs syndrome is related to a problem with part of the brain called the basal ganglia. The basal ganglia uses a chemical (neurotransmitter) called dopamine to help control muscle activity andmovement. Dopamine acts as a messenger between the brain and nervous system to help the brain regulate and co-ordinate movement. Ifnerve cells become damaged, the amount of dopamine in the brain is reduced, which causes muscle spasms andinvoluntary movements. Dopamine levels naturally fall towards the end of the day, which may explain why the symptoms of restless legs syndrome are often worse in the evening and during the night. Underlying health condition Restless legs syndrome can sometimes occuras a complication of another health condition, or it can be the result of another health-related factor. This is known as secondaryrestless legs syndrome. You candevelop secondaryrestless legs syndrome if you: have iron deficiency anaemia low levels of iron in the blood can lead to a fall in dopamine, triggeringrestless legs syndrome have a long-term health condition such as chronic kidney disease , diabetes , Parkinsons disease , rheumatoid arthritis , an underactive thyroid gland , or fibromyalgia are pregnant particularly from week 27until birth; in most cases the symptoms disappear within four weeks of giving birth Triggers There are a number of triggers that dont causerestless legs syndrome, but can make symptoms worse. These include medications such as: some antidepressants antipsychotics lithium used in the treatment of bipolar disorder calcium channel blockers used in the treatment of high blood pressure some antihistamines metoclopramide used to relieve nausea Other possible triggers include: excessive smoking , caffeine or alcohol being overweight or obese stress lack of exercise Diagnosing restless legs syndrome Theres no single test for diagnosing restless legs syndrome. A diagnosis will be based on your symptoms, your medical and family history, a physical examination, and your test results. Your GP should be able to diagnose restless legs syndrome, but they may refer you to a neurologist if theres any uncertainty. There are four main criteria your GP or specialist will look for to confirm a diagnosis. These are: an overwhelming urge to move your legs, usually with an uncomfortable sensation such asitching or tingling your symptoms occur or get worse when youre resting or inactive your symptoms are relieved by moving your legs or rubbing them your symptoms are worse during the evening or at night Assessing your symptoms Your GP or specialist will ask you about the pattern of your symptoms to help assess their severity. For example, they may ask you: how often you have symptoms how unpleasant you find your symptoms whether your symptoms cause significant distress whether your sleep is disrupted, making you tired during the day Keeping asleep diary may help your doctor assess your symptoms. You can use the diary to record your daily sleeping habits, such as the time you go to bed, how long it takes you to fall asleep, how often you wake during thenight, and episodes of tiredness during the day. Mild symptoms of restless legs syndrome can usually be treated by making lifestyle changes for example, establishing a regular sleeping pattern and avoiding stimulants, such as caffeine, alcohol or tobacco, in the evening. If your symptoms are more severe, you may need medication to bring them under control. Read more about treating restless leg syndrome Blood tests Your GP may refer you for blood tests to confirm or rule out possible underlying causes of restless legs syndrome.For example, you may have blood tests to rule out conditions such as anaemia , diabetes and kidney function problems. Its particularly important to find out the levels of iron in your blood because low iron levels can sometimes cause secondary restless legs syndrome. Low iron levels can be treated withiron tablets. Sleep tests If you haverestless legs syndrome and your sleep is being severely disrupted, sleep testssuch as asuggested immobilisation test may be recommended. The test involveslyingon a bed for a set period of time without moving your legs while anyinvoluntary leg movements are monitored. Occasionally, polysomnography may be recommended. This is a test that measures your breathing rate, brain waves and heartbeat throughout the course of a night. The results will confirm whether you have periodic limb movements in sleep (PLMS). Treating restless legs syndrome Mild restless legs syndrome that isnt linked to an underlying health condition can be managed with just a few lifestyle changes. If symptoms are more severe, medication may be needed. Restless legs syndrome caused by an underlying health conditioncan often be cured bytreating that condition. For example, iron deficiency anaemia can be treated by taking iron supplements. If its associated with pregnancy, itusually disappears on its own within four weeks of the birth. Lifestyle changes Anumber of lifestyle changes may be enough to ease the symptoms of restless legs syndrome, including: avoiding stimulants in the evening  such as caffeine, tobacco and alcohol not smoking  read more about quitting smoking taking regular daily exercise  but avoid exercising near bedtime practising good sleep habits  for example, going to bed and getting up at the same time every day, not napping during the day, taking time to relax before going to bed, and avoiding caffeine close to bedtime avoiding medicines that trigger the symptoms or make them worse  if you think medication is causing your symptoms, continue to take it and make an appointment to see your GP During an episode ofrestless legs syndrome, the following measures may help relieve yoursymptoms: massaging your legs taking a hot bath in the evening applying a hot or cold compress to your leg muscles doing activities that distract your mind, such as reading or watching television relaxation exercises, such as yoga ortai chi walking and stretching Asmall medical trial carried out in 2011 found a type of osteopathic exercise technique called positional release manipulation could be of benefit to people withrestless legs syndrome. It involves holding different parts of the body in positions found to reduce feelings of pain and discomfort. Medication Dopamine agonists Dopamine agonists may be recommended if youre experiencing frequent symptoms of restless legs syndrome. They work by increasing dopamine levels, which are often low. Dopamine agonists that may be recommendedinclude: ropinirole pramipexole rotigotineskin patch These medications can occasionally make you feel sleepy, so you should be cautious whendriving or using tools or machinery after taking them. Other possible side effectscan include nausea, dizziness and headaches . If you experience nausea while taking a dopamine agonist, you may be given medication to help with this (antiemitic medication). Impulse control disorder (ICD) is a less common side effect sometimes associated with dopamine agonists. People with ICD are unable to resist the urge to do something harmful to themselves or others. For example, this could be anaddiciton to alcohol , drugs, gambling, shopping, or sex(hypersexuality). However, the urges associated with ICD will subside once treatment with the dopamine agonist is stopped. Painkillers A mild opiate-based painkiller, such as codeine or tramadol, may be prescribed to relieve pain associated withrestless legs syndrome. Gabapentin and pregabalin are also sometimes prescribed to help relieve painful symptoms of restless legs syndrome. Side effects of these medicationsinclude dizziness, tiredness and headaches. Aiding sleep Ifrestless legs syndromeis disrupting your sleep, a short-term course of medication may be recommended to help you sleep. These types of medication are known as hypnotics, and include temazepam and loprazolam. Hypnotics are usually only recommended for short-term use (typically no longer than a week). You may find you still feel sleepy or hungover the morning after taking your medication. Levodopa Levodopa may be recommended if you only have occasional symptoms of restless legs syndrome. This is because if you took levodopa every day, theres a high risk it would actually make your symptoms worse. Levodopa is available in tablet or liquid form, and you should take it once you feel the symptoms ofrestless legs syndrome coming on. The medication will make you feel very sleepy (often suddenly), so you should never drive or use tools or machinery after taking levodopa. Source: NHS 24 - Opens in new browser window Last updated: 23 October 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. 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