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Restless Legs Syndrome

Published in For the Health of It  Author: Troy Payne, MD, FAASM

Medical Director
St. Cloud Hospital Sleep Center

Restless Legs Syndrome (RLS) has been recognized for centuries. Sir Thomas Will wrote in 1672, “Wherefore to some, when being abed they betake themselves to sleep, presently in the arms and legs, leapings and contractions on the tendons and so great a restlessness and tossings of other members ensure that the diseased are no more able to sleep than if they were in a place of the greatest torture.” Karl-Axel Ekbom (1907-1977) coined term Restless Legs Syndrome. Sometimes RLS is called Willis Ekbom syndrome.

The acronym URGE defines the major components of RLS:

U – Urge to move the limbs, usually associated with an unpleasant or uncomfortable sensation
R – Resting makes it worse
G – Gets better when up and walking around
E – Evening worsening

When does RLS occur?
There is a circadian rhythm to RLS as it always seems more severe later in the day. It bothers some people when watching TV or reading in the evening. RLS also can happen during the day when people sit for a long time — being a passenger for a lengthy car or airplane ride. Some people do not notice it until they get into bed to go to sleep. It can cause insomnia.

Once asleep, people tend to move their legs a lot. Periodic limb movements while sleeping can move the bed covers a lot or even wear through the bedsheet.

Who is a risk for RLS?
About 10 percent of people have had RLS at one time or another. About three percent of people have a more severe case. About 50 percent of people with RLS have someone in their immediate family who also has RLS. It can run in families.

What is the cause of RLS?
The cause is felt to be due to an abnormality in the nervous system that affects dopamine and iron. Iron is needed to make dopamine.

Certain things can make RLS worse:

  • Medications that affect dopamine levels, such as Reglan
  • Some antidepressant medications, such as Prozac or Effexor
  • Over-the-counter antihistamines, such as Benadryl
  • Low iron levels

How is RLS treated?
If your iron saturation or ferritin (a measure of total body iron) is low, sometimes supplemental iron can help. However, you should have a blood test for your iron saturation and ferritin and talk with your provider before considering supplemental iron for RLS. 

For many people with RLS, just getting up and walking around for a few minutes really helps and they do not need to do anything else. Some people who had RLS start or worsen after starting a medication may benefit from seeing a medical provider and choosing an alternative drug.

There are four FDA approved medications to treat RLS: Horizant (which is metabolized into gabapentin slowly over time), Mirapex, Requip and the Neupro patch. Lyrica is another medication that is sometimes used to help RLS. Each of these medications have side effects which should be discussed in detail with a provider before considering one. 

Restless Legs Syndrome can be distressing but it can be diagnosed and treated very successfully.