Restless legs syndrome RLS, also known as Willis-Ekbom Disease, causes unpleasant or uncomfortable sensations in the legs as well as an insatiable desire to move them. Symptoms usually appear in the late afternoon or evening hours, and they are often the worst at night when a person is resting, such as sitting or lying in bed.   

It can also happen when someone is inactive and sits for long periods of time (for example, when taking a trip by plane or watching a movie). Because symptoms can worsen during the night, it may be difficult to fall asleep or return to sleep after waking up. Moving the legs or walking usually alleviates the discomfort, but the sensations frequently return once the movement is stopped.

RLS is classified as a sleep disorder because the symptoms are triggered by resting and attempting to sleep, and it is classified as a movement disorder because people are forced to move their legs to relieve symptoms. It is, however, best described as a neurological sensory disorder with symptoms generated within the brain.

RLS is one of several disorders that can cause exhaustion and daytime sleepiness, both of which can have a significant impact on mood, concentration, job and school performance, and personal relationships.

Many RLS patients report being unable to concentrate, having impaired memory, or failing to complete daily tasks. Untreated moderate to severe RLS can reduce work productivity by up to 20% and contribute to depression and anxiety. It can also make travel difficult.

More than 80% of RLS patients also have periodic limb movement during sleep (PLMS). PLMS is characterized by involuntary leg (and sometimes arm) twitching or jerking movements during sleep that occur every 15 to 40 seconds, sometimes all night.

Although many people with RLS develop PLMS, the majority of people with PLMS do not have RLS. Fortunately, the majority of RLS cases can be treated with non-drug therapies and, if necessary, medications.

Types of Restless Leg Syndrome (RLS):

RLS is classified into two types:

primary or Idiopathic RLS:

Idiopathic RLS:

The term idiopathic refers to a condition in which the cause is unknown.

It is the most common and has the following features:

• It typically starts before the age of 40.
• It can begin as soon as a child is born.
• It could have a genetic basis.
• Once primary RLS develops, it is usually permanent.

Symptoms can be sporadic or gradually worsen and spread over time.

In mild cases, the person may experience no symptoms for an extended period of time.

Secondary RLS:

Another disease or condition causes a secondary RLS.

Secondary RLS usually appears after the age of 45, and it is not hereditary. This type of RLS is quite distinct:

• The onset is abrupt.
• Symptoms rarely worsen over time.

The symptoms could be more severe and might include:

• diabetes
• a lack of iron
• kidney disease
• Parkinsonism which is a neurological disorder.
• Neuropathy
• Pregnancy
• Rheumatoid arthritis which is a type of arthritis that affects the joints.

Signs and Symptoms of Restless Leg Syndrome (RLS):

Restless legs syndrome is characterized by unusual sensations in the legs (such as itching, crawling, pulling, aching, throbbing, or pins and needles) as well as a strong desire to move the legs to relieve the sensations.

The condition can also occur in other parts of the body, such as the arms, chest, or head. It is felt on both sides of the body. They can also occur only on one side, or they can begin on one side and then move to the other.

RLS symptoms can range from mild to excruciating. They may appear and disappear, and their intensity may vary between episodes. They tend to be worse in the evenings and at night.

Because symptoms almost always disappear in the early morning, people with RLS can often sleep well at that time.

Symptoms can appear and disappear, and their severity can also vary. The symptoms tend to be worse in the evenings and at night. Some people may experience severe nightly sleep disruption as a result of their symptoms, which can significantly impair their quality of life.

Causes of Restless Leg Syndrome (RLS):

The majority of the time, the cause of RLS is unknown (called primary RLS). RLS, on the other hand, has a genetic component and can be found in families where symptoms appear before the age of 40. RLS has been linked to specific gene variants. RLS may also be caused by low iron levels in the brain, according to evidence.

Considerable evidence also suggests that RLS is linked to a malfunction in one of the brain sections that control movement (called the basal ganglia) that uses the brain chemical dopamine. Dopamine is required for muscle activity and movement to be smooth and purposeful.

When these pathways are disrupted, involuntary movements occur frequently. Individuals who have Parkinson's disease, another disorder of the basal ganglia's dopamine pathways, are more likely to develop RLS.

RLS appears to be linked to or associated with the following factors or underlying conditions:

• Iron deficiency due to end-stage renal disease and hemodialysis
• Certain medications, such as anti-nausea medications (e.g., prochlorperazine or metoclopramide), antipsychotic drugs (e.g., haloperidol or phenothiazine derivatives), antidepressants that increase serotonin (e.g., fluoxetine or sertraline), and some cold and allergy medications that contain older antihistamines, may aggravate RLS symptoms (e.g., diphenhydramine)
• use of alcohol, nicotine, and caffeine
• During Pregnanc, particularly in the last trimester; in most cases, symptoms usually resolve within 4 weeks after delivery
• neuropathy (nerve damage)

Sleep deprivation and other sleep disorders, such as sleep apnea, may also aggravate or trigger symptoms in some people. Reducing or eliminating these factors may help to alleviate symptoms.

Risk Factors:

Certain factors may place you in a higher risk category for RLS. However, it is unknown whether any of these factors actually cause RLS.

Among them are:

Gender: RLS affects women twice as much as men.

Age: Although RLS can occur at any age, it is more common and severe after middle age.

Family history: If others in your family have RLS, you are more likely to have it as well.

Pregnancy: Some women experience RLS during pregnancy, especially in the third trimester. This usually resolves itself within a few weeks of delivery.

Chronic diseases: RLS can be caused by conditions such as peripheral neuropathy, diabetes, and kidney failure. RLS symptoms are frequently relieved by treating the condition.

Medications: Anti-nausea, antipsychotic, antidepressant, and antihistamine medications may cause or worsen RLS symptoms.

RLS can affect anyone, but it is more common in people of Northern European descent.

RLS can have an impact on your overall health and quality of life. If you have RLS and chronic sleep deprivation, you may be more susceptible to:

• coronary heart disease
• stroke
• diabetes
• kidney disorder
• depression

Complications:

 Although RLS does not cause other serious conditions, symptoms can range from insignificant to incapacitating. Many people with RLS have difficulty falling or staying asleep.

Severe RLS can significantly impair one's quality of life and lead to depression. Insomnia can cause excessive daytime drowsiness, but RLS can make napping difficult.

When you should see a doctor:

You should see a doctor to confirm the diagnosis of RLS and to rule out other conditions that may be mistaken for RLS. The doctor can treat related issues such as iron deficiency.

If you have RLS, you should see a doctor if you are experiencing any of the following symptoms:

• Sleep deprivation is common.
• Feeling down or anxious?
• Having difficulty concentrating

Diagnosis:

Your doctor will review your medical history and ask you to describe your symptoms. The International Restless Legs Syndrome Study Group established the following criteria for diagnosing RLS:

• You have a strong, often irresistible desire to move your legs, which is usually accompanied by unpleasant sensations.
• When you're resting, such as sitting or lying down, your symptoms begin or worsen.
• Activity, such as walking or stretching, temporarily or partially relieves your symptoms.
• Your symptoms are exacerbated at night.
• Symptoms cannot be attributed to another medical or behavioral condition.

Your doctor may perform a physical as well as a neurological exam. Blood tests, especially for iron deficiency, may be ordered to rule out other potential causes of your symptoms.

Your doctor may also refer you to a sleep specialist. If another sleep disorder, such as sleep apnea, is suspected, this may entail an overnight stay at a sleep clinic where doctors can study your sleep. RLS, on the other hand, usually does not necessitate a sleep study.

Treatment of Restless Leg Syndrome (RLS):

Depending on the individual's condition, medication may include:

• Iron supplementation may benefit people with low iron levels. This, in turn, may aid in the alleviation of symptoms.
• Alpha 2 agonists: These may be helpful in cases of primary RLS, but they have no effect on periodic limb movement while sleeping.
• Ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID), may be used to treat mild symptoms.
• Anticonvulsants: These medications are used to treat pain, muscle spasms, neuropathy, and daytime symptoms. Neurontin, also known as gabapentin, is a well-known anticonvulsant.
• Benzodiazepines are sedative medications that help people with persistent and mild RLS symptoms to sleep through the effects of the disorder. Restoril (temazepam), Xanax (alprazolam), and Klonopin (clonazepam) are a few examples.
• Dopaminergic agents: These medications increase dopamine levels in the brain, which is a neurotransmitter. They can alleviate the nagging leg sensations associated with RLS. Dopaminergic agents such as levodopa and carbidopa are widely used.
• Dopamine agonists: These also increase dopamine levels in the brain and treat unpleasant leg sensations. They may have negative effects in elderly patients, though some people experience more side effects with levodopa.
• Opiates: These drugs are used to treat pain and can help with RLS symptoms. When other medications have failed, doctors may prescribe these. Low-dose opiates include codeine and propoxyphene, while high-dose opiates include oxycodone hydrochloride, methadone hydrochloride, and levorphanol tartrate.
• Drugs used to treat Parkinson's disease and epilepsy are sometimes used to treat RLS because they can reduce involuntary movements.

If the underlying conditions that cause the RLS are treated, the RLS may disappear or improve. Iron deficiency and peripheral neuropathy are two examples of this.

Home Remedies and Prevention of Restless Leg Syndrome (RLS):

Making simple lifestyle changes can help alleviate RLS symptoms:

• Baths and massages are two options.
• Apply warm or cold compresses. Heat or cold, or alternating between the two, may reduce your limb sensations.
• Establish good sleeping habits. Because fatigue exacerbates RLS symptoms, it's critical to maintain good sleep hygiene. Have a cool, quiet, and comfortable sleeping environment; go to bed and wake up at the same time every day; and get at least seven hours of sleep per night.
• Exercise. Moderate, regular exercise may alleviate RLS symptoms, but overdoing it or working out too late in the day may exacerbate symptoms.
• Caffeine should be avoided. Stopping the use of caffeine can sometimes help with restless legs syndrome. For a few weeks, try to avoid caffeine-containing products such as chocolate, coffee, tea, and soft drinks to see if this helps.
• Use a foot wrap if necessary. A foot wrap designed specifically for people with RLS applies pressure to your foot and may help relieve your symptoms.

Coping and Support: RLS is a chronic condition that most people live with for the rest of their lives. Living with RLS necessitates the development of coping strategies that work for you, such as telling others about your condition. Sharing information about RLS will help your family, friends, and coworkers understand why you are pacing the halls, standing in the back of the theater, or walking to the water cooler multiple times throughout the day.

• Don't fight your desire to move. If you resist the urge to move, you may find that your symptoms worsen.
• Keep a sleep diary. Keep track of the medications and strategies that help or hinder your RLS battle and share this information with your doctor.
• Stretching exercises or gentle massage should be performed at the start and end of each day.
• RLS support groups bring together family members and people who have the condition. Participating in a group allows you to share your insights with others, which can benefit both of you.