Clearing's Chronic Pain Blog
Restless Leg Syndrome: Causes and Treatments
It strikes in the evening when you need to unwind. It’s like soda bubbles in your shins or electric worms crawling through your calves. It burns, and itches; it startles you awake and makes you pace. If it sounds like a real nightmare, that’s because it is.
Some people call it Willis-Ekbom disease, but the condition is more commonly known as Restless Leg Syndrome (RLS). It has long mystified the medical community, and it’s still not widely recognized today.
So we’re about to better explore the mysteries of RLS, including:
- What is Restless Leg Syndrome?
- How do I know whether I have Restless Leg Syndrome?
- What are the causes of Restless Leg Syndrome?
- At-home strategies for Restless Leg Syndrome
- Clinical care for Restless Leg Syndrome
What is Restless Leg Syndrome?
RLS is notoriously difficult to describe in words — people with it often say it’s like an unstoppable urge or a panic attack, only in their limbs. Their legs jerk, tingle, pulse, spasm and throb when they hold still. RLS patients can’t ignore the feelings, and often feel compelled to move.
Moving helps, but doesn’t necessarily placate RLS. As soon as people settle back down to rest, the distressing sensations often strike again. Soon sports stadiums, movie theaters and couches, the very places where people want to feel most relaxed, start to make RLS sufferers anxious. Not even bed feels like a refuge anymore.
A “mild” version of RLS can be quite uncomfortable. At its worst, RLS can wreck one’s quality of life and be so disruptive it leads to insomnia. The combination of discomfort and sleep loss can be so draining, it can cause stress, anxiety and severe depression. RLS affects seven to ten percent of Americans overall, so it’s not that rare, even if people don’t talk about it much.
How do I know whether I have Restless Leg Syndrome?
People with RLS often go a long time without an official diagnosis. RLS isn’t a high-profile condition, so people may not realize how common it is, or how much they can do to manage it.
You may be dealing with RLS if the following criteria sound like you:
- Odd feelings in your legs make you want to move them. (RLS may show up in your arms as well)
- Moving seems to help, but doesn’t stop the feelings
- The disruptive sensations usually get worse when you’re trying to sleep
- Nothing else explains what you’re feeling
- Your legs may twitch even when you’re sleeping
What are the causes of Restless Leg Syndrome?
Though it’s been recognized since 1685, RLS continues to mystify clinicians, because it’s not always clear why it happens. Researchers have confirmed that genetics play a part. Iron deficiency also seems associated. Finally, problems with the brain’s ability to handle dopamine are also implicated. Dopamine helps regulate muscle control, so glitches in the brain’s dopamine pathways can make muscles move in a jerky, sudden way.
Technically, there are two types of RLS: primary and secondary. Primary RLS tends to surface before the age of 40, and often lacks a clear cause.
With secondary RLS, a different disease or condition appears to trigger the RLS symptoms. Patients with liver diseases, iron deficiency and certain neuropathies have a higher risk of developing secondary RLS. Pregnancy can cause secondary RLS as well, with 10 to 25 percent of pregnant women experiencing it (fortunately, however, it usually doesn’t persist after the pregnancy).
If you’re concerned about your risk of RLS, you may want to consider the following questions:
- Are your kidneys functioning well? Compromised kidney functions can lower the available iron in your blood, and so you might want to get your kidneys checked.
- Low iron levels can be linked to RLS development. It might be a good idea to talk to your doctor about your iron level.
- Does anyone in your immediate family have symptoms? RLS can be inherited.
- Are you taking antihistamines, anti-nausea medications, antidepressants, allergy meds, antipsychotics? Medications that affect dopaminergic pathways can worsen RLS.
At-home strategies for Restless Leg Syndrome
RLS is bad enough on its own, and worse when it robs you of precious sleep. Technically RLS is considered both a neurological condition and a sleep disorder, so the strategies for managing it should be multi-pronged.
If you’re dealing with RLS, you may want to think like a scientist by forming different hypotheses about what might work for your personal situation. It may take some time and experimentation to arrive at the right combination of strategies for you, but it is definitely possible.
Set yourself up for RLS success by experimenting with the following tips:
- Exercise: Stretching and regular exercise can help quell uncomfortable sensations in the legs. Try 30 minutes of walking, yoga or aerobics at least three times a week. If that’s too much, start small. Ten minutes is better than nothing!
- Find better substances: Alcohol, especially in the evening, seems to spur on RLS, and nicotine and caffeine don’t appear to help either. Replacements might be your friend. Instead of alcohol, consider alcohol-free beer or mocktails. Rather than cigarettes, gum or carrot sticks. And see if replacing caffeine with chicory tea helps.
- Eat for your legs: Think low-sugar, high protein, and greens. Beans, tofu, eggs, watermelon, spinach and sweet potatoes all supply you with iron, especially if you drink orange juice or take vitamin C as well (to improve iron absorption). The Red Cross features a list of iron-rich foods. For RLS control, eat kiwis and nuts, and drink cherry juice. Finally, add in some vitamin D.
- Sleep soundly: Stack the odds of getting deep, restful sleep in your favor by following the usual tips. These include sleeping in a dark room, using black-out curtains or a sleeping mask. Stay off screens for two hours before bed, since their blue light waves can throw off your sleep rhythms. If RLS keeps waking you, plan ahead. Keep a stack of books ready, as well as a plan to stretch, do yoga, meditate, journal, or do something else that keeps your brain and legs busy. Some people report that a hot bath before bedtime helps.
- Think ahead: If you’re taking a flight, ask for an aisle seat so you can get up when you need to. If you’re going to a cinema, stadium or meeting, sit near the door. Making plans for how to fit RLS into your life instead of feeling bossed around by your legs can really help.
Whatever you try, remember to take RLS seriously. Know that RLS-related insomnia can lead to depression or other mood problems, and can decrease your productivity by about 20 percent. It can also fog your brain, wreck your short-term memory and hurt your personal relationships, so it’s not “just twitchy legs.” Also know that you can manage RLS.
Clinical care for Restless Leg Syndrome
Some cases of RLS need clinical support. If you’re finding yourself too deeply impacted by RLS, it may be time to seek professional care. Make sure that your care team is familiar with RLS and takes your concerns and questions about it seriously.
The Mayo Clinic has released updated recommendations for how to treat RLS that incorporate the latest scientific studies. Their guidance breaks down into three sections:
Non-pharmaceutical therapies (best for milder RLS)
These include some of the approaches mentioned above, starting with a strong foundation of healthy food, exercise and sleep. Also consider:
- Iron supplementation, which can be pills or IVs, though be sure to consult a doctor before supplementing, since too much iron can be dangerous
- Mental techniques, such as cognitive behavioral therapy (CBT) or acupuncture
Frequently prescribed medications (for medium to severe RLS)
A class of medications called nerve calcium channel blockers are a good place to start exploring clinical treatment. Common medications in this class are called gabapentin and pregabalin.
Other medications prescribed for RLS
Dopamine agonists, medications that enhance dopamine activity in the brain are sometimes recommended. Common drug names in this category include ropinirole and pramipexole. Benzodiazepines are not generally recommended.
You’ll also want to watch out for:
- Side effects, which may include nausea or problems with impulse control
- Rebound, which is when RLS symptoms stabilize, but then return worse than before if the body becomes tolerant to medications, for example
A final tip: Levodopa may provide short-term RLS relief for attending a meeting or taking an airplane flight, for example. If you’re concerned about RLS disrupting your everyday life, you may want to ask your doctor if it could be a good fit for you.
Clearing can help you with Restless Leg Syndrome
Here at Clearing, we take a big-picture view of what you (and your legs) are going through. We advocate holistic, non-opioid approaches and specialize in customized chronic pain treatment. If you’d like to explore pain relief according to our evidence-based approach, you may be interested in our prescription compound creams, tailored at-home exercises and exclusive access to pain specialists.
This article is for informational purposes only and does not constitute professional medical advice. Always seek the advice of your healthcare professional with any questions or concerns you may have regarding your individual needs and medical conditions.