Restless Legs Syndrome: (Not So) Happy Feet
Medically reviewed on Mar 30, 2017 by C. Fookes, BPharm.
When Your Legs Just Want To Keep On Walking
Restless legs syndrome (RLS) is a nerve disorder characterized by throbbing, pulling, creeping or other unpleasant sensations in the legs and an uncontrollable, usually overwhelming, urge to move them.
Symptoms usually start in the evening just as you sit down to relax, and may progressively worsen throughout the night. Both legs are usually affected although one may be worse than the other. In more severe cases, the arms and lower trunk may also be affected. RLS affects more than twice as many women as men.
Your Genes Play A Role
Although researchers have found a genetic basis to RLS - meaning if one of your family members has it then you are at higher risk - they still don't know what really causes it.
A lack of dopamine (a type of chemical transmitter in the body) or low iron is thought to play a role, and the syndrome is also strongly associated with depression and anxiety disorders. RLS may be the only complaint a person has or it may seem to follow on from another disorder. But research is ongoing to determine the exact cause of this troublesome problem.
Double-Trouble With Jerking Limb Movements During Sleep
Have you ever watched a dog's legs twitch and spasm in their sleep as if they were running?
Well, humans occasionally do this as well, and it's known as Periodic Limb Movement of Sleep (PLMS). In fact, 4 out of 5 people with RLS have PLMS, as well. These movements can be so violent that they often jerk the person awake, making for an exhausting night and very little sleep!
No Specific Tests. Just Your Own Story
There is no specific exam or lab test a doctor can do to determine if you have RLS. Your description of what happens to your body when you try to relax is usually sufficient.Tell your doctor if you have:
- An overwhelming urge to move your limbs, accompanied by an uncomfortable or tingling sensation
- Funny sensations in your legs triggered by rest, relaxation or sleep and relieved with movement
- Symptoms that are worse at night and better in the morning.
Searching For An Exacerbating Cause
Since RLS can occur because of another condition, your doctor may still run a few tests. RLS is more common in people:
Share Your Experiences. Learn From Others
The Restless Legs Syndrome Foundation offers support for people with RLS and helps to connect you with others. Consider joining the Drugs.com Restless Legs Support group to ask questions, keep up-to-date with new, and voice concerns, too.
Adopting certain behaviors that improve sleep, and doing brief exercises with a few gentle leg stretches before bedtime can also help.
Distracting activities such as reading a book may help reduce the awareness of the discomfort.
Medicines Usually Reserved For People with Severe Symptoms
Rest assured there are certain medicines you can try if your symptoms are severe or distressing and your daytime function is affected by poor sleep quality. RLS can be severe in up to 20% of sufferers.
RLS medicines are usually taken 1 to 3 hours before bedtime and may only need to be taken intermittently in people with symptoms that come and go.
Ropinirole Stimulates Dopamine Receptors
Ropinirole (Requip) is a dopamine agonist and was the first medication approved for moderate-to-severe RLS by the FDA in 2005. Ropinirole fools dopamine receptors into thinking that there is extra dopamine available, and consequently helps relieve symptoms of RLS.
Ropinirole is also used to treat people who suffer from Parkinson's disease; but don't worry, scientists have found no link whatsoever between RLS and an increased risk of developing Parkinson's disease. Ropinirole should not be stopped suddenly. As with any new medicine, discuss the risks and benefits with your doctor.
Pramipexole and Rotigotine: Alternatives
Pramipexole (Mirapex) acts in a similar way to ropinirole. Like any drug, it has side effects, and some people taking pramipexole experience hallucinations and sleep disturbances at night. Rotigotine (Neupro) is also similar, and many people have reported success with this patch, although daytime sleepiness is common.
Be aware that impulse control issues are possible with any medicine that increases dopamine or stimulates dopamine receptors. People with a history of addictive or compulsive behaviors should use these medicines cautiously.
Topping Up Low Dopamine
Carbidopa/Levodopa (Sinemet, Parcopa) is another medicine that is used in the treatment of both RLS and Parkinson's disease. Levodopa is converted in the brain into dopamine, and stimulates dopamine receptors directly. Levodopa is usually given with another drug, carbidopa, which stops the breakdown of levodopa before it reaches the brain.
Levodopa/carbidopa is not typically a first-line treatment for RLS, but may be reserved for when other treatments fail.
Just like ropinirole, levodopa should not be stopped suddenly if it has been taken regularly for a long period of time, although the immediate-release form can be used intermittently with your doctor's direction.
Augmentation: Getting Worse Instead Of Better
Bizarrely, the medicines used to treat RLS can sometimes make it worse. This phenomenon is called "Augmentation", and refers to the worsening of RLS over time.
Augmentation symptoms tend to occur earlier in the day than reported before treatment started and may involve the trunk and arms. Symptoms usually start within the first 3 to 4 weeks of treatment. Reducing the dose, stopping the medication for a short-time, or switching to a different drug may help. Taking tablets intermittently, instead of daily, may also lessen the risk of augmentation.
Other Suitable Options
Gabapentin enacarbil (Horizant) is an extended-release drug that may be useful for RLS if pain is also a significant symptom. Other options in the same class include pregabalin (Lyrica) and immediate-release gabapentin. Low-dose opioids (narcotic pain relievers) may be used temporarily, particularly if augmentation occurs; however, these medicines are not recommended long-term as their addiction potential is high. Iron supplements may also be beneficial for people with low iron levels. Using iron supplementation in people with normal iron levels is not recommended. Other drugs such as clonazepam and clonidine have also been tried with mixed success.
Magnesium: Worth A Try?
Ask your doctor first. Magnesium is a mineral needed by every organ in our body. It also activates enzymes, contributes to energy production, and helps regulate levels of calcium, copper, zinc, potassium, and vitamin D. Magnesium is found in foods such as whole grains, nuts, and green leafy vegetables. Some people have found magnesium supplements beneficial in RLS, a finding that was also reported by a small, open-label study. However, larger and more well-controlled studies with magnesium in RLS are needed, and some experts refute the benefit of magnesium.
RLS In Pregnancy
Medications are usually only given during pregnancy if the benefits outweigh the risks. On a positive note, RLS that occurs during pregnancy usually goes away once your baby is born.
Doctors should check your folate and iron levels to determine if you have a deficiency that can be easily (and safely) corrected. Gentle leg stretches before bed, walking, or a bedtime distraction (such as reading a book) may help when symptoms occur. Eating a healthy diet is also beneficial not only for RLS symptoms but for you and your baby!
Finished: Restless Legs Syndrome: (Not So) Happy Feet
- Tarsey D, et al. Treatment of restless legs syndrome/Willis-Ekbom disease in adults. Up To Date. http://www.uptodate.com/contents/treatment-of-restless-legs-syndrome-willis-ekbom-disease-in-adults#H1935612
- Restless Legs Syndrome Foundation. http://www.rls.org/about-rls
- American Academy of Sleep Medicine. Restless Legs Syndrome - Overview and Facts. http://www.sleepeducation.com/essentials-in-sleep/restless-legs-syndrome
- Restless Legs Syndrome. Harvard Health Publications. https://www.drugs.com/health-guide/restless-legs-syndrome.html