What is RLS? Symptoms, Causes & the Latest Treatment Options

You have finally made yourself comfortable on the sofa after a tiring day, or you have just laid down in your bed, and it is time for you to get a good night's sleep. Then there comes the weird, tingling, aching, or “creepy-crawly” feeling that is very deep inside your legs.

It is an irritating, but an irresistible urge making you think you must move. You get up, stretch, may be take a little walk around the room, and the feeling disappears. But as soon as you stop, it is back again.

If this is what you are going through, then, most probably, you are one of the many people in the UK who have Restless Legs Syndrome (RLS), also called Willis-Ekbom disease. It is a very real, annoying, neurological ailment that can badly affect your sleep and life quality, but the nice thing about it is that it can be treated.

Let's discuss what this condition is really about that is frequently misunderstood.

What Exactly is RLS? The Symptoms

RLS, or restless legs syndrome, is fundamentally a sensorimotor disorder that gives rise to an excruciating, frequently overpowering, and relentless desire to move one's legs. The term might imply restlessness, but it is not merely about losing one's patience—very discomforting and indescribable sensations drive it.

The four requirements of diagnosis

The medical professionals identify four primary manifestations to confirm the presence of RLS:

An uncontrollable need to move: The patent trait defines it. An intense yearning to shift one's limbs comes with a bad feeling. It does hurt mainly the legs, but at times a few people have it in their arms, torso, or even head.

Symptoms set in or get worse while resting: The dilemma starts with inactivity, like during a meeting, at the movies, or when lying in bed. Doing nothing is what triggers the problem.

Movement gives relief: The relief provided is quick, though only momentary. Typically the sensations disappear after walking, stretching, or rubbing the limb affected.

Evening or night is the worst period: Symptoms pretty much always get worse towards the end of the day, thus causing one not to fall asleep or wake up during the night.

Conveying the feeling

Those who have RLS find it hard to describe their sensations since it is neither a cramp, muscle pain, nor even simple numbness. They could say it is:

• A feeling as if little bugs are crawling on or under the skin.
• An electrifying sensation or deep aching.
• The feeling of carbonated water or ants crawling inside their blood veins.
• Tingling, burning, or throbbing sensations.

These can vary from mild discomfort to such intense pain that one has to get out of bed several times at night. This unending disruption of sleep can result in professional tiredness, poor concentration, and low mood during the day, which underlines the importance of RLS treatment.

Related Condition: Periodic Limb Movement in Sleep (PLMS)

PLMS or periodic limb movement in sleep is experienced by 80% of RLS patients at least once in their life. The legs (and sometimes arms) jerking or twitching without control every 10 to 60 seconds during sleep is one of the types of PLMS. Although you may not notice these movements, they drastically reduce your sleep and are usually the main cause of your poor sleep quality.

Why Does RLS Happen? The Causes

Although RLS can be experienced by anyone at any time, even kids, it is mostly seen in women and their problem sleeps get deeper with age.

RLS is differentiated into two categories- Primary and Secondary.

Primary or Idiopathic RLS (No Known Cause): It is estimated that in the 85% of the cases there is no reason responsible for the disorder and this is referred to as primary RLS which is also known as idiopathic. Symptoms normally appear before the age of 40 and these people tend to have family members with the same condition which gives the impression of a strong genetic connection. Some researchers have pointed to certain locations on chromosomes that could be associated with the disorder.

The leading theory in scientific circles today is that it is caused by an obstruction in the way a certain brain chemical called dopamine acts. Dopamine is a neurotransmitter which is very important in the regulation of muscle movement.

Because of various factors such as the genetic nature of the condition, the person's physiology and the environmental conditions, it is believed that the brain is not capable of producing, utilizing or processing dopamine properly which is the root cause of primary RLS. Since dopamine levels fall naturally in the evening, this may also explain why the symptoms are most severe at night.

Secondary RLS (Associated with Other Conditions): To a certain extent, RLS is due to or associated with some other health problem. This condition is termed secondary RLS and in most cases, it is the treatment of the main disease that leads to the resolution of the RLS symptoms. The leading ones are:

Iron Deficiency: This is one of the strongest associations. Even if you are not really anaemic, low ferritin levels (which measure iron stores) in the blood can be a major factor in RLS. For the brain to function normally with respect to the dopamine, iron is needed.

Pregnancy: Many future mothers have RLS, especially during the last three months. Luckily, the symptoms often go away soon after delivery.

Chronic Renal Failure (Uraemia): RLS is often seen in patients with renal failure, mainly because they are also iron-deficient.

Other Disorders: Diabetes, nerve injury (peripheral neuropathy), Parkinson's disease and some thyroid disorders could be other links too.

Medications and Lifestyle Factors: Certain medications are sometimes the ones responsible for the triggering or aggravating of the RLS symptoms. These include some categories of antidepressants, cold, and allergy medicine (antihistamines), and anti-nausea drugs. It is always recommended to report any new or worsening symptoms to your doctor whenever you go for a new prescription.

Moreover, certain lifestyle options can be the triggers among people:

• Use of caffeine, alcohol, and nicotine, particularly in the hours that precede sleep.
• Tension and a chronic lack of sleep.

The Latest Treatment Options

After lifestyle modification, your physician will consider medical therapy. Generally, the management is done through a step-wise approach first tackling any cause that is underlying.

Step 1: Correcting underlying issues

Your doctor will probably recommend iron supplements if your blood test reveals that you have low ferritin levels. The supervision of a doctor is crucial, as excessive iron may be detrimental. In extreme cases where taking iron orally does not work, intravenous infusion is the method of choice for delivering iron directly into the bloodstream. That treatment is known to be very efficient.

Step 2: Prescription medication

In case your RLS is primary and chronic (occurring four or more nights a week), you will most likely get a prescription to alleviate the symptoms. In the UK, the modern medical recommendations often advocate two principal classes of drugs:

First-Line Choice: Alpha2-delta Ligands

These medicines, which consist of gabapentin and pregabalin, were initially aimed at epilepsy and nerve pain but now are often the first option for chronic RLS. The drugs work by affecting nerve signals in the central nervous system. The administration involves taking the drugs usually in the evening, aiming at maximum effect coinciding with the worst period of RLS symptoms. The treatment has a high rate of success among patients and also avoids some of the main long-term issues that come with older medications.

Second-Line Choice: Dopamine Agonists

Such medications, including pramipexole and ropinirole, aim at activating the dopamine-using parts of the brain. These medications were once considered the main therapy for RLS but are nowadays often regarded as a second option for prolonged use because of the major side effect, augmentation.

A Crucial Note on Augmentation: This is when the medicine, rather paradoxically, gets to worsen the condition over time. The condition might spread and get more intense or even start at an earlier time of the day. This adverse effect is largely responsible for the fact that now-gabapentin and pregabalin have become the first-line drugs, or dopamine agonists are given at the lowest effective dose.

Other options: Opioids and Levodopa

In the most difficult cases or in case the patient hasn't reacted well to the first line of treatments (refractory RLS), a psychologist may think about giving low-dose opioids as a prescription. When monitored and given at low doses, they can be very effective in treating RLS of tough nature. In case of sporadic, unpredictable RLS (e.g., before a long flight), a quick acting drug like levodopa may be prescribed for use 'as needed', but not on a daily basis due to the high risk of augmentation.

Final word

RLS or Restless Legs Syndrome often gets mistaken for simple "fidgety legs." It is, however, a serious neurological sleep disorder that can take away your good night sleep and also severely affect your functioning in the daytime.

If you think you have RLS, keep in mind that it is a twofold issue: it is prevalent and it can be cured. First, make some changes in your everyday habits and sleeping pattern. If the relief is still too little, then the most significant thing you can do is to consult your GP.