Comorbidities And Quality Of Life
The clinical impact of RLS is not only related to the fatigue induced by sleep disruption and subjectively perceived by the patient, but it is possibly also linked to a more extended systemic disruption. It has been shown that RLS is associated with different pathologies, not only neurological diseases and other sleep disorders, but also cardiovascular disease, hypertension and diabetes .
The Sleep Heart Health Study showed that the odds ratio for cardiovascular disease was increased in the RLS population to 2.07. An association has been shown between RLS and hypertension, and a mediator might be PLMS, which usually induce sleep instability and an increase in heart rate and blood pressure, especially when PLMS are associated with electroencephalogram arousals. The increase in blood pressure and heart rate leads to a higher sympathetic drive and this consequently, as observed in non-dipping patients , raises the risk of developing cardiovascular disease .
In addition, inflammation is considered another possible mechanism leading to a higher risk for hypertension and cardiovascular disease, because increased C-reactive protein levels have been shown in RLS patients with PLMS. A correlation between C-reactive protein levels and PLMS frequency has been found .
What Causes Restless Leg Syndrome
More often than not, the cause of RLS is a mystery. There may be a genetic predisposition and an environmental trigger.
More than 40 percent of people with RLS have some family history of the condition. In fact, there are five gene variants associated with RLS. When it runs in the family, symptoms usually start before age 40.
There may be a connection between RLS and low levels of iron in the brain, even when blood tests show that your iron level is normal.
RLS may be linked to a disruption in the dopamine pathways in the brain. Parkinsons disease is also related to dopamine. That may explain why many people with Parkinsons also have RLS. Some of the same medications are used to treat both conditions. Research on these and other theories is ongoing.
Its possible that certain substances like caffeine or alcohol can trigger or intensify symptoms. Other potential causes include medications to treat:
Primary RLS isnt related to an underlying condition. But RLS can actually be an offshoot of another health problem, like neuropathy, diabetes, or kidney failure. When thats the case, treating the main condition may resolve RLS issues.
There are certain things that may put you in a higher risk category for RLS. But its uncertain if any of these factors actually cause RLS.
Some of them are:
Having RLS can affect your overall health and quality of life. If you have RLS and chronic sleep deprivation, you may be a higher risk of:
- heart disease
Diet Recommendations For People With Restless Leg Syndrome
There arent any specific dietary guidelines for people with RLS. But its a good idea to review your diet to make sure youre getting enough essential vitamins and nutrients. Try to cut high-calorie processed foods with little or no nutritional value.
Some people with symptoms of RLS are deficient in particular vitamins and minerals. If thats the case, you can make some changes to your diet or take dietary supplements. It all depends on what your test results show.
If youre deficient in iron, try adding more of these iron-rich foods to your diet:
- dark green leafy vegetables
Those strange sensations in your legs can be uncomfortable or painful. And those symptoms can make it almost impossible to fall asleep and stay asleep.
Sleep deprivation and fatigue are dangerous to your health and well-being.
In addition to working with your doctor to find relief, there are a few things you can do to improve your chances of restful sleep:
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What Causes Restless Legs Syndrome
In most cases, the cause of RLS is unknown . However, RLS has a genetic component and can be found in families where the onset of symptoms is before age 40. Specific gene variants have been associated with RLS. Evidence indicates that low levels of iron in the brain also may be responsible for RLS.
Considerable evidence also suggests that RLS is related to a dysfunction in one of the sections of the brain that control movement that use the brain chemical dopamine. Dopamine is needed to produce smooth, purposeful muscle activity and movement. Disruption of these pathways frequently results in involuntary movements. Individuals with Parkinsons disease, another disorder of the basal ganglias dopamine pathways, have increased chance of developing RLS.
RLS also appears to be related to or accompany the following factors or underlying conditions:
- end-stage renal disease and hemodialysis
- iron deficiency
- certain medications that may aggravate RLS symptoms, such as antinausea drugs , antipsychotic drugs , antidepressants that increase serotonin , and some cold and allergy medications that contain older antihistamines
- use of alcohol, nicotine, and caffeine
- pregnancy, especially in the last trimester in most cases, symptoms usually disappear within 4 weeks after delivery
- neuropathy .
Sleep deprivation and other sleep conditions like sleep apnea also may aggravate or trigger symptoms in some people. Reducing or completely eliminating these factors may relieve symptoms.
What Is Restless Legs Syndrome
Restless legs syndrome , also called Willis-Ekbom Disease, causes unpleasant or uncomfortable sensations in the legs and an irresistible urge to move them. Symptoms commonly occur in the late afternoon or evening hours, and are often most severe at night when a person is resting, such as sitting or lying in bed. They also may occur when someone is inactive and sitting for extended periods . Since symptoms can increase in severity during the night, it could become difficult to fall asleep or return to sleep after waking up. Moving the legs or walking typically relieves the discomfort but the sensations often recur once the movement stops. RLS is classified as a sleep disorder since the symptoms are triggered by resting and attempting to sleep, and as a movement disorder, since people are forced to move their legs in order to relieve symptoms. It is, however, best characterized as a neurological sensory disorder with symptoms that are produced from within the brain itself.
RLS is one of several disorders that can cause exhaustion and daytime sleepiness, which can strongly affect mood, concentration, job and school performance, and personal relationships. Many people with RLS report they are often unable to concentrate, have impaired memory, or fail to accomplish daily tasks. Untreated moderate to severe RLS can lead to about a 20 percent decrease in work productivity and can contribute to depression and anxiety. It also can make traveling difficult.
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Restless Legs Syndrome Prognosis
Restless legs syndrome is a lifelong condition that might get worse with age. But some people go into remission and donât have symptoms for days to years.
Keep your doctor updated on how youâre doing. If you start to feel worse, they might suggest different lifestyle changes or medications.
It can help to talk to other people who know what youâre going through, whether itâs a family member who has RLS or a support group.
Lifestyle Management And Home Remedies
If the symptoms of restless legs syndrome are mild, lifestyle changes may be the only treatment needed. In these cases, there are plenty of natural treatments and home remedies that can be tried.
Adopting good sleep practices can help a person with restless legs syndrome get enough sleep. Not getting enough sleep can be one of the most disruptive consequences of RLS. Good sleep habits can include:
- Going to bed and waking up at regular times, even on the weekends or days off
- Not napping during the day
- Making sure the bedroom is dark, cool, quiet and comfortable
- Taking electronic equipment, such as TV and phone, out of the bedroom
Changes to diet may also help with reducing symptoms of restless legs syndrome:
- Avoid stimulants, like caffeine, nicotine and alcohol, particularly before bed
- Drink plenty of water to prevent dehydration
Certain activities can ease restless legs syndrome symptoms, such as:
- Regular, moderate exercise
- Avoid being confined in places, for example, choose an aisle seat at the movies or on a plane
- Massaging the legs
- Taking a warm bath
- RLS-UK suggests hot-cold therapy, a shower of alternating hot and cold water
- Simple leg stretches or getting up and walking a little as often as possible may help in confined spaces like a plane, as well as in daily life when e.g. working a desk job sitting all day
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Children And Elderly People
Considering that no objective tests or clinical biomarkers are needed for the diagnosis of RLS, according to the RLS diagnostic criteria , it is apparent that the identification of the disease can be far more difficult in particular age groups, such as children and elderly people.
In pediatric patients, the importance of symptom description in the childâs own words is crucial and, when decision for treatment has to be taken, the clinical course criteria cannot be applied. Children frequently describe their urge to move the legs by means of expressions such as âwant to moveâ, âneed to moveâ or âgot to kickâ. Therefore, the concept of urge needs an interpretation correlated to the patientâs ability to express him/herself .
The presence of PLMS and family history of RLS and periodic leg movement disorder can be supportive criteria, although an overnight polysomnogram is not always available for pediatric patients. It must be noted, however, that in some children PLMS may appear before subjective symptoms and they are found in 63%â74% of children with RLS .
As in adults, sleep disruption provoked by RLS affects mood, cognition and function, but in children behavioral problems as well as educational impairment are more prominent as compared to the problems commonly described in adult patients .
Treatment of RLS in children requires special attention, because most drugs used for adults are not approved for children or the experience is limited.
Who Gets Restless Legs Syndrome
About 10% of people have restless legs syndrome, also called RLS. About 2% to 3% of them have moderate to severe symptoms that affect their quality of life. Also:
- Slightly more women than men get it.
- Most people with severe RLS are middle-aged or older.
- Only 2% of children get RLS.
- People with RLS in their family usually get it at a younger age.
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Where Can I Get More Information
For more information on neurological disorders or research programs funded by the National Institute of Neurological Disorders and Stroke, contact the Institute’s Brain Resources and Information Network at:
Office of Communications and Public LiaisonNational Institute of Neurological Disorders and StrokeNational Institutes of HealthBethesda, MD 20892
NINDS health-related material is provided for information purposes only and does not necessarily represent endorsement by or an official position of the National Institute of Neurological Disorders and Stroke or any other Federal agency. Advice on the treatment or care of an individual patient should be obtained through consultation with a physician who has examined that patient or is familiar with that patient’s medical history.
Can Restless Legs Syndrome Develop Into Something More Serious
Most people with restless legs syndrome have the idiopathic form, meaning theres no known cause. For them, there is no risk of RLS developing into something more serious, like Parkinsons disease.
Restless legs syndrome can get worse in people with other medical conditions if they dont get those conditions treated.
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Primary Or Idiopathic Rls
Idiopathic means that the cause is unknown.
It is the most common type and has the following characteristics:
- It usually begins before the age of 40.
- It can start as early as childhood.
- It may have a genetic cause.
- Once primary RLS starts, it tends to be lifelong.
Symptoms may be sporadic, or gradually worsen and become more prevalent over time.
In mild cases, the person may have no symptoms for a long time.
Clinical Features And Diagnosis Of Rls
RLS is a sensorimotor disorder characterized by typical symptoms with a peculiar circadian way of presentation. The patients complain of a strong, irresistible urge to move the legs, often accompanied by uncomfortable sensations deeply in the legs. The urge typically begins or worsens during periods of inactivity and are relieved by movement, such as walking or stretching. Symptoms occur in the evening or at night and can progressively worsen across the night, but tend to resolve spontaneously by early hours of the morning .
Patients may have difficulty describing their symptoms, often using various terms such as ârestlessâ, âtwitchyâ, âneed to stretchâ, âurge to moveâ, âtensionâ, âitchingâ, âburningâ and âlegs want to move on their ownâ. The RLS sensations are often described as painful, but isolated pain with an urge to move is uncommon and should raise the suspicion that the patient may not have RLS .
RLS symptoms usually are located distal to the knee in the calf region, but the symptoms can also affect other body parts, such as the thigh and the arms. Most patients describe that they perceive the discomfort deep inside the leg and less commonly superficially. The symptoms generally involve the limbs bilaterally, but they can also alternate on the two sides or more rarely be strictly unilateral .
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What Is Restless Leg Syndrome
Restless leg syndrome is when you feel very unpleasant “creepy-crawly” sensations in your legs while you’re sitting or lying still, especially at bedtime.
People can experience restless leg syndrome in different ways. Although it affects mostly the legs, RLS can also affect your arms. Most people will develop RLS in their calves. It’s not related to emotional or psychological stress or disorders.
Restless Legs Syndrome Diagnosis
Thereâs no medical test for RLS. Your doctor might want to talk to your sleep partner about what theyâve noticed.
The five basic criteria for a diagnosis of RLS are:
- An overwhelming urge to move your legs, especially along with uncomfortable or unusual feelings
- An urge that starts or gets worse while youâre at rest
- An urge that goes away, either partly or totally, when you move
- An urge that starts or gets worse in the evening
- Another condition, such as leg cramps, arthritis, or muscle pains, isnât causing it
Your doctor may use lab tests to rule out other conditions. A neurological exam can check for nerve damage or blood vessel problems. A sleep study called polysomnography can tell them if you have other sleep disorders that might cause RLS.
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Treatment And Medication Options For Restless Legs Syndrome
- Iron A trial of iron supplements is often recommended as a first treatment if your blood test indicates low or low-normal ferritin, a protein in the body that binds to iron.
- Anti-seizure drugs These can be effective in decreasing sensory disturbances such as creeping and crawling as well as nerve pain. The U.S. Food and Drug Administration has approved gabapentin enacarbil for the treatment of moderate to severe RLS.
- Dopaminergic agents These have been shown to reduce symptoms of RLS when taken at nighttime. The FDA has approved , pramipexole, and rotigotine to treat moderate to severe RLS.
- Opioid drugs Methadone, codeine, hydrocodone, or oxycodone are sometimes prescribed to treat individuals with more severe symptoms of RLS who do not respond well to other medications.
- Benzodiazepines Medications such as clonazepam and lorazepam are sometimes prescribed to treat anxiety, muscle spasms, and insomnia.
- Hot baths
- Lifestyle changes, including implementing a regular exercise program, maintaining regular sleep patterns, and limiting use of tobacco, alcohol, and caffeine
Being active throughout the day helps alleviate symptoms for some. This gives your muscles the chance to exert the energy that they would otherwise exert at night.
Some people find that good sleep habits can also help with symptoms of RLS.
These habits can include:
What Other Treatments Are Available
Addiction isnt a negative habit, but a medically-recognized disease that requires adequate treatment. Our rehab centers understand that just as with other diseases, there is no one treatment fits all methodeffective healing methods have to be specific to each individual.
Thats why research in the past decades has been dedicated to finding methods that work for anyone who enters addiction treatment services. Men and women have different needs, people seeking treatment for multiple abuse disorders have differing needs, people with mental health issues and abuse disorders have different needs than people without mental health issues. No matter what needs you bring to treatment, you can have them addressed, and comprehensive healing is necessary for a successful recovery.
Whatever rehab center you choose, make sure it offers treatment methods that work to give you the best overall chance of meeting your goals. Some of our evidence-based methods include:
- Gender-specific treatment
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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 sensation in the feet, calves and thighs. The sensation is often worse in the evening or 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 .
Some people have the 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 person’s daily activities.
What Is The Prognosis For People With Restless Legs Syndrome
RLS is generally a lifelong condition for which there is no cure. However, current therapies can control the disorder, minimize symptoms, and increase periods of restful sleep. Symptoms may gradually worsen with age, although the decline may be somewhat faster for individuals who also suffer from an associated medical condition. A diagnosis of RLS does not indicate the onset of another neurological disease, such as Parkinsons disease. In addition, some individuals have remissionsperiods in which symptoms decrease or disappear for days, weeks, months, or yearsalthough symptoms often eventually reappear. If RLS symptoms are mild, do not produce significant daytime discomfort, or do not affect an individuals ability to fall asleep, the condition does not have to be treated.
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