Restless Leg Syndrome (RLS): Causes, Triggers and Treatments

Restless Leg Syndrome (RLS) is a disorder that is widely misdiagnosed and overlooked by physicians.

Have you ever felt the irritating sensation of jumpy legs? An urge to twist and move them driven by some unknown force within your body? Then you most likely have Restless Leg Syndrome.

Restless Leg Syndrome involves symptoms such as unpleasant sensations in the legs that cause the sufferer a form of restlessness. Often these symptoms are worse in the evening or at nighttime, as the patient lies down and attempts to fall sleep. For this reason, Restless Leg Syndrome is recognized as a sleep disorder.

About 10% of the US population confronts restless legs. A clear familial link exists in patients with Restless Leg Syndrome. In fact, a family history of Restless Leg Syndrome is one of the pieces of information used to diagnose the disorder. Professionals diagnose this disorder most commonly in women and in middle-aged to elderly adults, but it can occur in a person of any gender or age, including infants and children. Interestingly, the prevalence of Restless Leg Syndrome is lower in Asian populations than it is in European or North American populations.

Causes of Restless Leg Syndrome

This disorder may be considered “primary” or “secondary.” Primary Restless Leg Syndrome is idiopathic in nature, meaning professionals cannot recognize a known cause for the disorder. A patient with secondary Restless Leg Syndrome has received a previous diagnosis of another chronic disease, such as iron deficiency. This previous disorder may have complicated or caused Restless Leg Syndrome.

The medical community suspects that a host of chronic diseases to be related to the development of secondary Restless Leg Syndrome. According to recent studies, iron deficiency and kidney disease are most prevalent in patient with Restless Leg Syndrome. While the evidence from studies on the following diseases provide less clear conclusions, an association may also exist between Restless Leg Syndrome and cardiovascular disease, arterial hypertension, diabetes, migraines, and Parkinson disease. Well-conducted studies have not proven further suspected association with chronic diseases. Other causes of secondary Restless Leg Syndrome may include specific medications (see “triggers” below) and pregnancy. While changes of experiencing Restless Leg Syndrome are higher during pregnancy, these cases typically resolve after the birth of the child.

Triggers for Restless Leg Syndrome

Some medications may trigger a flare up of Restless Leg Syndrome symptoms, including anti-nausea medications, antihistamines, some antidepressants and beta blockers. If you suspect a medication may be causing your symptoms, we strongly recommend that you discuss this with your primary care physician or specialist.

Lack of movement also triggers restlessness for patients with this disorder. This can include any period of time during which your body is not moving, such as night time/sleeping, traveling, watching television, etc. Alcohol, nicotine and caffeine can additionally provoke symptoms of Restless Leg Syndrome, as can a diet high in sugar and restrictive clothing. In a less predictive manner, body temperature does appear to trigger Restless Leg Syndrome symptoms. While restless legs are aggravated by warmth for some individuals, they are aggravated by cold in others.

Treatments for Restless Leg Syndrome

Medications. Western medical treatment for Restless Leg Syndrome typically reduces symptoms effectively. However, the cause of this disease is unknown, and thus, the treatments are aimed only at reducing symptoms. If a patient discontinues treatment, symptoms are likely to return.

While some medications can trigger Restless Leg Syndrome symptoms, others can reduce the restlessness associated with this condition. The most commonly used class of medication for Restless Leg Syndrome are dopamine agonists. These medications work similarly to the dopamine that our brains produce. Dopamine is a neurotransmitter that helps us have smooth-flowing, even movements, instead of jerky, choppy, involuntary movements. Like most drugs, this class of medications can cause unwanted effects as well, including daytime sleepiness, nausea and lightheadedness. Similarly, dopaminergic agents such as Levadopa (the drug often used in Parkinson’s Disease) can increase the level of dopamine in the brain. In select individuals, these pharmaceuticals can cause dyskenesias (involuntary movements) – the exact actions that it seeks to inhibit.

Doctors may prescribe benzodiazepines, a class of sedative medications, to patients with Restless Leg Syndrome. Rather than relieving restlessness, these drugs help patients who struggle to sleep due to restlessness. Opiates, or “pain-killers,” are prescribed to patients with Restless Leg Syndrome symptoms that reach unbearable levels of discomfort. Both benzodiazepines and opiates are highly addictive and should be prescribed and taken with caution. Anticonvulsants may relieve nerve pain and chronic pain associated with Restless Leg Syndrome, and alpha-2 agonists turn down the activity in nerves that control involuntary movement.

Alternative Treatments. Since pharmaceutical medications decrease symptoms of Restless Leg Syndrome but do not cure the disorder, doctors may recommend a myriad of other alternative treatments. Following a habitual sleep pattern prevents lack of sleep from worsening symptoms. Professionals may look at a patient’s iron, vitamin D, folic acid, magnesium or vitamin B12 levels, and make recommendations for supplementation. Just before bed, massaging or electrically-stimulating the legs or feet of an Restless Leg Syndrome patient has proven beneficial.

A patient who actively seeks to reduce his or her stress levels may see a decrease in severity or regularity of symptoms. It is important for patients with Restless Leg Syndrome to exercise moderately. Excessive exercise may aggravate symptoms, while moderate exercise proves to be greatly beneficial. Finally, your doctor may suggest acupuncture, which works quite well to alleviate Restless Leg Syndrome symptoms. For more information on how acupuncture can help, read this article by Damiana Corca, Sleep Acupuncture Specialist.

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