Restless legs syndrome is an irresistible, often maddening urge to move the legs that usually starts when you’re at rest. The legs become uncomfortable, you feel the need to move them to alleviate the sensation and the cycle repeats itself, sometimes making it difficult to relax or sleep.
Dr. Amber Hairford, a family medicine specialist at Novant Health Mountainview Medical in King said restless legs syndrome, along with other sleep-related issues, are things she sees sometimes with some of her primary care patients.
“We see several patients who say they have troubled sleep on a regular basis. That includes some patients with restless legs syndrome symptoms,” Hairford said. “Adequate sleep is necessary to maintain optimal health. Other patients have various reasons for why they are not sleeping well, including difficulty falling asleep, difficult staying asleep or waking up several times during the night.”
Below, Hairford’s Novant Health colleague, Dr. Nancy Behrens, a sleep medicine specialist at Novant Health Sleep Medicine, explains restless legs syndrome (RLS), why it’s more common in women and options for treatment.
Patient descriptions of the symptoms tend to run the gamut. “They might say ‘creepy-crawly,’” Behrens said. “Or they may even say it’s ‘worms’ moving in the legs, ‘soda’ bubbling in the veins or even ‘itching’ bones.”
The condition is fairly common — Behrens estimates about 10 percent of people and roughly one-third of her sleep patients suffer from RLS. The severity of the symptoms also vary. Most RLS patients have the sensations in their calf but it may be felt anywhere from the thigh to the ankle and one or both legs may be affected. Occasionally, for some people, the sensations occur in the arms.
Partially due to patients’ descriptions of their discomfort or pain, proper diagnosis isn’t always easy.
“For adults, if they don’t look at what the symptoms really are, they might think the symptoms are related to arthritis or other painful or uncomfortable conditions that affect the legs,” Behrens said. “For kids, one of the big misdiagnoses is the family thinking the kid is just having growing pains when they actually may have restless legs syndrome.”
Not something new
Its exact causes are still largely unknown. Some cases, especially those in younger patients, are believed to be inherited.
The first known description of restless legs syndrome being associated with sleep problems was in an article by English physician Sir Thomas Willis in 1672. Swedish neurologist Karl-Axel Ekbom introduced the disorder to medical literature in the 1940s. RLS is sometimes called Willis-Ekbom disease. “In the past, it actually used to be considered a psychiatric issue,” Behrens said. “People were told it was all in their heads, and it’s definitely not.”
More common in women
“RLS is more common during pregnancy,” Behrens said. “It’s also associated with low iron levels for a lot of people and when women are at reproductive ages as they lose iron every month, and that contributes to RLS being more common in women. But men get RLS, too, she added. “As everybody gets older there’s a higher prevalence of restless legs in both men and women.” People with kidney failure are also more prone to restless legs syndrome.
Iron-rich food suggestions
Low iron levels are associated with restless legs for both women and men. Behrens suggested spinach, black beans, meats (she notes that a lot of people are getting plenty of meat already), iron-fortified cereal and bread and dried raisins and apricots for patients interested in raising their iron levels. For those taking iron supplements, Behrens suggests vitamin C supplements as well to help the body absorb the iron.
Getting regular exercise and cutting back on caffeine are two other great ways to reduce chances of having restless legs syndrome symptoms, Behrens said. In particular, she suggests getting 30 minutes of cardiovascular exercise three times per week. Stretches before bed may also be helpful.
Considering a beer or glass of wine before bed? Behrens said that although alcohol right before bed does make it easier for some people to fall asleep initially, she would not recommend drinking right before bed because it makes overall sleep worse. Like too much alcohol, nicotine also makes restless legs worse. In the moment of symptoms flaring up, Behrens said leg massages can help and also suggests a warm bath or putting a heating pad on the legs. A sleep specialist can prescribe pill medications or a patch. Behrens said both prescription pills and the patch act on the dopamine receptors in the brain to increase their activity and that calms RLS symptoms.
Sleep test options
There are two methods of sleep tests commonly used to diagnose sleep disorders: an at-home test and a lab test. While Behrens said an at-home test works well for diagnosing sleep apnea, she said a trip to the sleep lab can be a good option for patients trying to figure out their overall sleep issues and movement concerns like restless legs.
“It’s set up like a little hotel bedroom,” Behrens said. “We put sensors on the patients so we can monitor their brain waves and can see when they’re awake and when they’re asleep, their breathing and leg movements. That gives us a lot of information.”