The Question: How can I tell if I have restless legs syndrome?
The Answer: No matter how hard you may try, there are just some nights where the quality of your sleep is downright pitiful. But if tossing and turning feels more painful than frustrating, then you might be one of the more than 3 million people in the United States who suffer from the neurological condition restless legs syndrome (also known as Willis-Ekbom disease).
We spoke with Timothy Morgenthaler, a sleep medicine doctor and past president of the American Academy of Sleep Medicine, to learn more about how the disease arises, what symptoms set it apart from other conditions, and what can be done about it.
What it feels like
According to Morgenthaler, there are four "cardinal symptoms" of restless legs syndrome: An urge to move the legs, whether you actually move them or not, that happens most often when you're at rest, is relieved by movement, and is more likely to occur in the evening or at night rather than in the morning. For some people, the pains can occur in the arms as well.
"[This is] different from many kinds of discomfort in the legs or arms: Usually things feel better if you leave them alone instead of move them," said Morgenthaler.
What causes it
It's fairly straightforward to diagnose a person with RLS, using these symptoms as a guide and ruling out other potential pain causes such as arthritis or myalgias related to statin drug use. Taking a thorough medical history is key to ruling out other causes, and can also reveal important information that informs the likelihood of having RLS.
"About 50 percent of the time, it's familial," said Morgenthaler. "There's nothing you can do about it -- you inherit it. But it can also be related to certain conditions, especially iron deficiency or chronic kidney failure."
Restless legs syndrome may be associated with low iron stores in the brain, and that might have to do with a defective iron transport mechanism across what's called the blood-brain barrier. Iron is an essential ingredient to how certain neurotransmitters work in the brain, particularly dopamine. Not only is iron deficiency often related to RLS, but if you have restless legs, the symptoms generally are worse if you're also iron deficient.
RLS can arise at any stage in life, even childhood. But it's most commonly noticed in women as they reach child-bearing age, perhaps because mild iron deficiency often accompanies pregnancy. Men over the age of 40 are also more susceptible.
How it's treated
The treatment for RLS depends on the severity of symptoms. For those who experience symptoms once in a blue moon, it tends to not be bothersome enough to do something about it. But in those who have intermittent restless legs -- symptoms troublesome enough to require treatment but occurring less than twice a week, on average -- Morgenthaler says he would measure their iron stores and recommend mental alerting activities, such as working a crossword puzzle before bed.
"When you distract the brain that way, the symptoms of restless legs can get quieter for a while," he said. "We also often recommend a trial of abstinence from caffeine, and then we also review what other medications they're on. Some make restless legs symptoms worse, like antidepressants, anti-nausea medications or sedating antihistamines (over-the-counter sleep aids)."
Chronic, persistent restless legs is defined as frequent and troublesome enough to require daily treatment. In addition to the non-pharmacological remedies above, doctors treating such cases will recommend prescribed dopamine agonists, or medications that increase the dopamine levels inside the brain; calcium-channel ligands; or even opioids.
Worried you might have RLS? Schedule an appointment with your family physician or a sleep medicine doctor before it becomes to debilitating for your sleep and overall sense of well-being. The phrase "restless legs" may seem trivial, but this neurological condition can wreak havoc on your body if ignored.
"Ask Healthy Living" is for informational purposes only and is not a substitute for medical advice. Please consult a qualified health care professional for personalized medical advice.
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