Restless Legs Syndrome 

Restless legs syndrome (RLS) is a treatable problem that causes sleeping difficulties for many people. About 10 percent of Americans have overpowering urges to move their legs, especially when they are resting or sleeping.

RLS is a collection of symptoms generally described as unpleasant sensations and an urge to move the lower legs. The arms and other body parts can be affected. People with the syndrome usually say the sensations are difficult to describe, but they use terms such as aching, creepy, crawly, electric, twitching, tingling, burning or prickling. The symptoms are worse when lying down or sitting and are relieved by standing up or walking around.

Sleep difficulties can have many causes, with RLS only one of them. The National Institutes of Health has drawn up a list of symptoms that describe the syndrome and can be used to diagnose RLS.

Symptoms

To have RLS, you must have the following symptoms or situations:

1. A desire or urge to move the limbs, often caused or accompanied by unpleasant sensations. You may feel pain deep inside your legs.

2. Worsening of symptoms at rest. The urge to move or unpleasant sensations begin or worsen during periods that make you drowsy, including resting, lying, sitting or otherwise being inactive. Some people have the urge to move and the unpleasant sensations after any long period of inactivity, such as during flights and while sitting in the theater.

3. Symptoms are partially or totally relieved by activity, such walking or moving around. When you move, symptoms improve immediately and relief continues for as long as you are active. The symptoms may recur as soon as you stop moving.

4. Symptoms fluctuate during the day. The peak time for symptoms is an hour around midnight, with sleep is easier in the early morning hours.

The symptoms of RLS affect people differently. They can occur only occasionally, or only in certain situations, or they can be frequent. They can range from mild to intolerable. RLS can start at any age, but most people are middle-aged or older.

Causes

Researchers don't know the cause of RLS, but they suspect a combination of factors is at work. Brain chemicals called neurotransmitters, which influence nerve cells, are probably involved. There also seems to be a genetic aspect; a person with a family history of RLS may develop the condition earlier than someone with no family history of the condition.   RLS can occur as a result of other neurological diseases, kidney dialysis, pregnancy, chronic diseases such as Parkinson's disease, iron deficiency, certain medications, alcohol and caffeine.

Treatment

If you have another condition such as a neurological disease that causes symptoms similar to RLS, this condition should be treated. Your health care provider may change medications that could cause RLS symptoms. Your provider may order a blood test to determine if you have iron deficiency.

Maintaining good sleep habits can help relieve symptoms:

• Go to sleep and wake on the same schedule each day.

• Use your bed for sleep and intimacy, not for reading or other activities.

• Before bed, avoid activities or substances such as caffeine, alcohol and nicotine that might keep you awake. A gentle walk, a warm bath or shower, or a gentle leg massage before bed may be helpful. 

A healthy lifestyle that includes a balanced diet and regular exercise can help.

Medications can be prescribed if the above measures don’t work. Ropinirole (Requip) and pramipexole (Mirapex) are both approved by the U.S. Food and Drug Administration to treat RLS. They raise the level of dopamine, a naturally occurring chemical in the brain that plays a part in controlling movement. Other drugs that also raise dopamine levels are sometimes prescribed. These include pergolide (Permax) and a combination of carbidopa and levodopa (Sinemet). These drugs are also commonly used to treat Parkinson’s disease, and they are often effective for moderate to severe symptoms of RLS.

Benzodiazepines and sleep aids can help you sleep, but they will not relieve RLS symptoms. These medications include clonazepam (Klonopin), eszopiclone (Lunesta), ramelteon (Rozerem), temazepam (Restoril, Razapam), zaleplon (Sonata) and zolpidem (Ambien). These medications can cause drowsiness during the day.    

Gabapentin, a medication used to treat epilepsy, may be used to treat RLS symptoms.     

Opiates, also called narcotic medications, can relieve mild to severe symptoms of RLS. They are sometimes prescribed for use before bed. Examples of these mediations are codeine; medications that combine oxycodone and acetaminophen (Percocet, Roxicet); and medications that combine hydrocodone and acetaminophen (Vicodin, Duocet). These can cause daytime drowsiness and constipation.

Some medications that treat other conditions can make RLS symptoms worse. These include antidepressants, some antihistamines and lithium. If you take these medications and have RLS, don’t stop taking them. Medications that treat RLS can be prescribed to help control RLS symptoms.

You may have to try several different medications to find something that adequately treats your symptoms. Over time, you may find that a medication stops working or does not work as well. If this happens, your health care provider can prescribe a different medication.

The RLS Foundation, at http://www.rls.org, has dozens of support groups around the country that can help people with severe RLS cope with the condition.