When someone cannot sit straight for a while or keeps having shaky legs, we often say that he or she have restless legs. In the standard language, we often use the term to describe impatient folks, who have a penchant for continuous movement. However, in most of these cases, the person in question is a slave of habit. He or she moves his limbs continually because they are anxious or bored. They are not even aware of the constant shaking.
In reality, restless legs syndrome is a severe disorder. You must have heard about the strange affliction of a distant aunt or the curious “night-time tingles” your grandma used to experience in bed. It turns out. It is not as uncommon as people previously thought it to be.
Who gets restless legs syndrome?
Restless legs syndrome or RLS usually affects adults. An increasing number of men than women find themselves awake in the middle of the night with strange crawling, tingling, itchy or painful sensations in their legs. Sometimes, their arms aren’t spared as well. Older women and men have mistaken it for muscle fatigue, a prelude to Charlie Horses, cramps, dehydration and even symptoms of stroke.
In contrary to muscle fatigue and nightly cramps, these movements are periodic. As a result, many doctors and sleep specialists refer to it as periodic limb movements of sleep (PLMS). It is evident that such sudden and intense movement can cause difficulty in staying asleep.
What causes restless legs among people?
Sadly, in most of the cases, RLS does not have any known or proven cause. There are a few verified and stipulated secondary causes including pregnancy, iron deficiency, kidney diseases, chronic kidney failure and stubborn nerve problems or previous injuries to the sensory nerves. The severity of the symptoms of the disorder can vary from mild to intense. The impact of the movements depends upon the intensity, and the disease can wreak havoc on your regular sleeping regimen.
Restless legs do not just cause trepidation in the minds of those experiencing it each night, but it also affects their social life and family life drastically. Imagine staying awake night after night without a justifiable cause that your friends and family cannot see. Remaining awake all night, the inability to rest during the daytime and the discomfort of sitting for long periods during the day always takes a toll on the general health, cognition, and psychological health.
The exact causes of RLS are still not precise. In fact, it was not a part of the medical glossary up until a few years ago, when doctors finally decided to include restless legs in the purview of a medical disease. At present, some doctors believe that it is a result of dopamine deficiencies in the brain and others cite insufficient circulation for the cause of the disorder.
How is the ongoing research on RLS helping with modern treatment options?
The ongoing research on RLS sheds some light on the complex nature of the cause-and-effect mechanism of the disorder. Firstly, it shows a highly heterogeneous character of the disease and its triggers. Secondly, the research uses advanced magnetic resonance imaging (MRI) to study the chemical changes in the brain of RLS affected individuals during the day and night. It highlighted a significant role of iron traffic mechanism of the blood-brain barrier (endothelial) cells.
Right now, the founding research and treatment of RLS stand upon the fact that the regulation of cerebral iron levels can determine the resting state of the limbs of an individual. As a result, multiple publications carry data on the treatment of affected groups with iron supplements for a period to study the effects on their symptoms. Further research on the dependence of this disorder on the brain’s iron levels may even help with the treatment of movement symptoms and cognitive challenges associated with RLS and similar syndromes.
What are the current treatment options for those suffering from restless legs?
Since the cause of RLS is not clear, finding treatments and potential cures is tricky. It is like battling a computer virus blindfolded without knowing how it got in or what its weaknesses are. In medical science, treating any disease or disorder is close to impossible, when you do not understand the epidemiology of it. At present, RLS affects about 10% of the population in the USA.
The penetration level of this sleeping disorder is constant for most of the countries and their communities. The only exception is Asia, where RLS is not common at all. Studies on patients in the US and Europe show that it follows a chronic course. The symptoms become worse with time, and the prognosis worsens with the age of the patient. At the moment, the studies on the demographics, intensity of the disease and other epidemiological evidence show that RLS has its roots in the neural network of man.
Isolate all probable personal causes of RLS.
The first step in treating RLS is finding out what causes it in the first place. Apart from kidney problems and neuronal disorders, it can have roots in metabolic upheavals during pregnancy, post-surgical complications and a sudden threat to the immune system. Apart from these, daily habits, new medications, and other health conditions can also contribute to the potential causes. Research shows that the increasing use of alcohol, tobacco, and caffeine can also exacerbate the symptoms of RLS.
Effects of specific medication on the restless legs syndrome.
Before going into the genetics of neurodegenerative or muscle degenerating diseases and other apocalyptic disorders, let us find out what kinds of drugs can aggravate the symptoms of RLS.
- Antihistamines including Benadryl (diphenhydramine).
- Antiemetics and anti-nausea compounds including Reglan (metoclopramide) and Compro (prochlorperazine).
- Antipsychotic medications including Haldol (haloperidol), olanzapine (Zyprexa) and lithium.
- Antidepressants including a class of selective serotonin reuptake inhibitors (SSRIs) including Prozac (fluoxetine), Zoloft (sertraline) and Lexapro (escitalopram).
- Elavil (amitriptyline) and Asendin (amoxapine) like a tricyclic antidepressant.
- Levoxyl (levothyroxine) that can treat hypothyroidism.
While seeking redressal from restless legs syndrome, always mention all medications you are taking, including the most straightforward digestive aid the new doctor has prescribed for daily consumption. Even the slightest change in medication doses like that of Haldol or Lithium can cause the symptoms of RLS to appear for the first time or worsen within a record short period.
How do underlying health conditions challenge sleep quality?
If your spouse or friend complains about sleeping irregularly or waking up in the middle of the night since putting on weight, they are probably right. Obesity can compromise the quality of rest you get each night, just like rheumatoid arthritis, neuritis, renal disease, and diabetes can. People can experience permanent nerve damage from rising blood glucose levels, and that can take a toll on the quality of life they lead.
Make it a point to eat healthier before bedtime. Do not eat a lot of high sugar and high-fat foods. Do not wear your yoga pants to bed since tight clothing can make the symptoms worse. However, in your case, it might be true that none of these causes give rise to RLS. Therefore, it is indispensable to invest some time in combining these precautionary measures to see which affect your symptoms.
Picking up healthy sleeping habits.
Sometimes, working overtime or spending two extra hours in front of the TV can compromise the quality of rest you get at night. The blue-light from digital screens is enough to cause sleeplessness, increased fatigue and exacerbate the symptoms of sleeping disorders like RLS.
Sleeping sounds are preposterous to anyone who has experienced RLS. However, following a dedicated sleeping routine can help you get into the habit of going to be earlier than usual and make the best of your quiet hours, even when you have to wake up twice. You should try the following to combat your RLS.
- Try to go to bed at the same time each day.
- Maintain a steady temperature and humidity inside the bedroom.
- Use dim lights and keep the sleeping area dark.
- Keep your legs covered, since many RLS sufferers report feeling more comfortable holding a little weight on their legs.
- You can try using leg warmers and heating blankets to rest the soreness in your leg muscles during sleep.
- Always keep your phone silent and switch your TV off before falling asleep.
- Invest in a good white noise machine for your bedroom.
Take the correct dietary supplements.
Scientists and doctors have been finding plausible links between restless legs and iron deficiency in the recent years. According to the latest studies, a severe iron deficiency leading to anemia can cause significant difficulty in falling asleep. A simple blood test is all you need to determine if the cause of your RLS is deficiency related.
Apart from organic iron, deficiencies in Vitamin D levels in the body also influence the extent of RLS. Treatment of patients with Vit D supplements has shown significant improvement. Sometimes, patients require an intravenous dose of iron instead of an OTC medication. The method of administration and the treatment will depend upon the results of your blood test.
People on hemodialysis complain of RLS and supplements of vitamins C and E relieve their symptoms to a great extent.
Take up exercising regularly to improve muscle control.
Sometimes, working out helps reduce the RLS symptoms. The National Institutes of Health studies point towards the lack of muscle tone and degrading muscle strength with age as leading contributors to restless legs. In a 2006 study on 23 participants with RLS, daily aerobic exercises along with lower body training for 12 weeks decrease the discomfort. People with end-stage renal disease (ESRD) feel better after working out lightly for about 10 to 15 minutes per day.
The underlying complications might require you to consult a specialist and physiotherapist before you begin your work out. Regular activity does help people fall asleep quicker. However, the restless legs foundation does emphasize the importance of light exercise that does not increase muscle fatigue or challenge the situation further. You must be sure not to work out so intensely that the joints and muscles begin to ache.
Indulge in therapeutic massages.
We are not talking about spas after mud baths. When we say “massage,” we mean the full physiotherapy deal you can get for your lower limbs. The recurring bouts of restless legs can leave you feeling tired and worn out after a couple of days. Eminent research organizations like the National Sleep Foundation recommend in-house treatment to address the symptoms.
The frequency of studies en-masse is scarce, but over the years there have been individual reports of men and women experiencing relief from regular massages. One theory suggests that massages stimulate the production of dopamine and serotonin. The increased levels of the “happy hormones” can reduce the discomfort.
Another prevailing theory cites that improvement of blood circulation post massages can be a contributing factor to the relaxation. Even if you don’t believe in these theories, you can try massaging regimens since they can enhance your sleep quality.
Yoga and Pilates
Mindfulness meditation has been a solution to almost anything in the recent years. Starting from anxiety to depression; meditation has helped people find themselves, rest better, and feel better. When you combine mindfulness with the workout, you get yoga. This ancient form of exercise helps people get to know their bodies better. Once you start with guided asanas and stretches, you will start feeling a kinship with your body. It will help you regain the control of your systems and your mind. Yoga improves external appearance, but, most importantly, it enhances the metabolic balance and organ systems of an individual.
An eight-week study in 2013 shows that ten women with RLS experienced an alleviation of their symptoms when they shifted to a daily yoga routine. Unlike jogging or running, yoga is intricate, and you will need a guide to help you achieve the relaxation you want. There are asanas and mudras for almost all kinds of human afflictions, so you need to be sure about the ones you want to practice each day.
Pilates is a smart option for homemakers, busy office workers and the elderly. It is lighter and more comfortable than yoga. It has lesser chances of injury as compared to yoga. Moreover, anyone can perform Pilates without worrying about old wounds and joint pain. The main aim of Pilates is to increase the mobility of your body, help you know your physiology better than before, and to aid balanced metabolic functions.
You might doubt the effectiveness of yoga and Pilates in treating something as cryptic and complicated as RLS. However, several studies have shown that these forms of light, full-mat exercises along with stretching can reduce the tingling feeling and cramping sensations you go through each night.
Give Pneumatic compression a try.
Pneumatic compression sounds like a complicated procedure, but it is a simple way of increasing pressure on your legs by putting a pressure-regulating sleeve on it. If you have visited a hospital recently for edema of the lower limbs, rheumatoid arthritis treatments or the treatment of deep vein thrombosis (DVT), you must have experienced at least one round of pneumatic compression.
The intermittent pneumatic compression (IPC) devices prevent accumulation of fluids, protect the system from blood clots and it helps to keep the blood in your lower limbs in continuous circulation. The circulation determines the level of discomfort and the improvement in blood flow can directly affect the RLS symptoms.
Several sleep experts believe that the falling levels of oxygen in the limbs contribute to the periodic muscle contraction when a person falls asleep. Pneumatic compressions help the RLS sufferers significantly. Over 35 people participated in a 2009 study that showed the use of PCD for at least one hour per day for almost a month. It improved the symptoms, daytime productivity and sleep quality of the participants significantly.
You can purchase the setup, but you will require the help of a professional physiotherapist to administer the therapy. You may even be able to rent one, over-the-counter, with one prescription from your physician. People have reported finding medical coverage for PCD, especially if they cannot tolerate daily RLS medication.
You should try a scientific foot wrap.
An ergonomic foot wrap can help exert pressure on specific points at the bottom of your feet. It works on the same principle as putting weight on your feet to relieve your symptoms. A foot wrap helps in sending pressure to your brain. That stimulates the neuro-muscular cortexes in your mind to send relaxation signals to your legs. It is a straightforward bi-directional mechanism that the foot wraps leverage to provide relief.
A recent study on about 30 people showed that those who used a foot wrap for about two months enjoyed lesser intense symptoms than the control group. One can set you back by a couple of hundred dollars. However, those who suffer from RLS know that it is a small price to pay for the peace of the night. Before you head out to order one, know that foot wraps require a prescription and regular health insurance might not cover it.
Revisit your list of prescription medications.
There is hardly anyone in the urban US, who has never had any medication. From antacids to anti-depressants, people have had their share of popping in the 21st century. The fast lifestyle and faster acquaintance with diseases have ensured that we depend on some form of medicines each day to remain our productive best. Scientists are coming up with designer drugs and personalized medications for treating the unique of all conditions. Here’s a list of drugs that can help alleviate your RLS symptoms. However, be sure to consult a medical practitioner before starting them.
In simple words, these drugs produce dopamine. Our brains should naturally be able to provide enough to keep us happy and our bodies comfortable, but sometimes, the daily stress, lack of dietary regulations, weight-related issues, and health challenges keep our dopamine levels uncannily low.
Dopaminergic drugs have the power to relieve severe RLS since the condition depends on the dopamine levels in our body. Most of these medications require thorough approval from the FDA. Never take any form of dopamine enhancing supplements without a prescription. Always remember that upon constant use and abuse of these drugs, RLS symptoms can gradually worsen with time. Additionally, it is possible to develop resistance to them.
Benzodiazepines are a category of opioid that commonly treats anxiety and sleep-related problems. It is a class of psychoactive drugs that have the potential to treat RLS. Clonazepam, Valium, and Xanax fall into this category. Although these medications are useful in treating a plethora of mental disorders and physiological diseases, these are highly risky. Developing dependence and addiction is easy.
In combination with dopaminergic drugs, benzodiazepines can improve the quality of rest you get each night. These drugs might not eliminate the signs of RLS, but they will supplement the lack of sleep.
Gabapentin is the fourth drug that the FDA has approved in the recent years for the treatment of RLS. Horizant is the brand name that is most popular among the patients and doctors alike right now. A majority of them fall under the category of ant seizure medication. Research does not shed light on how gabapentin relieves the RLS symptoms, but clinical trials point at the relief of the symptoms with persistent use of the same.
A clinical trial involving the treatment of 24 RLS patients with placebo or gabapentin showed that those, who were under gabapentin prescription for about six weeks experienced a better quality of sleep. Their leg movements and the tingling sensation was almost unnoticeable as well. The group which received the placebo in place of gabapentin did not show improvements at all.
Doctors have been prescribing opioid for a long time to treat almost all kinds of chronic pain. Amidst the surmounting opioid crisis, it has become imperative to exercise caution while starting a new potentially addictive medication. Nonetheless, some people experience relief from their physiological symptoms of RLS only with regular opioid treatments like oxycodone or naloxone extended-release tablets.
These medications have a nerve relaxing effect. They can provide temporary relief to the symptoms. Contractions and discomfort become significantly less after people switch to a new opioid. However, the increased chances of dependence and misuse make it mandatory for patients to remain in close medical care and observation while they are on these drugs. Opioid should be the last resort for any patient suffering from RLS or other pain.
The effects of medication for RLS vary drastically between people. You cannot expect medicine to work wonders for you just because it worked for others.
Near-infrared spectroscopy (NIRS)
NIRS is a non-invasive technique that can treat RLS successfully. It is a painless and discomfort-free treatment that uses guided long wavelength and low energy light beams to pass through the skin. The low-wave light is incident on the localized area of discomfort, and it can dilate the blood vessels of the local area. It increases blood circulation to a great extent.
One of the most popular theories on the cause of RLS states the lack of oxygen due to improper blood circulation as the leading cause. NIRS treatment that dilates arteries and veins in a localized manner increases blood flow. It relieves the RLS symptoms in a non-intrusive and side-effect-free way.
A famous study involving 21 people with RLS shows that NIRS treatment at a frequency of 3 to 4 times per week, for over four weeks in a row can help in redressing the unpleasant symptoms. The therapy session needs to be about 30 minutes in the least to be effective. While you can seek out professionals and clinics that provide NIRS treatments, you can also purchase NIRS equipment online for a discounted price. Your health insurance might not cover the cost of this treatment.
Have you thought about Vibration Pad Therapy?
Vibration pad therapy is not something everyone considers when they experience the first couple of RLS bouts. The discomfort seems too foreign for something as simple as vibration and movement therapy.
A vibrating pad is incredibly easy to use for all ages. We have seen 20-something damsels, and 70-year-old people use them with full gusto. They are comfortable. They do not take up a lot of time. Also, you can use these vibration pads when you are lying down or watching the latest episodes of Dark on Netflix. In fact, several RLS patients even use this vibration equipment when they are asleep. It keeps their lower limbs in constant comfortable motion that lessens the sensation of burning or tingling common to RLS.
Combining the vibration pad therapy with dopaminergic drugs or benzodiazepines or gabapentin has high efficacy. If you are skeptic about the effectiveness of a simple vibrating pad on something as cryptic as your nightly tingles, you can invest in one because they work marvelously on leg mobility, muscle fatigue dissipation and relief of arthritic pain.
The lesser known alternative approach towards treating RLS
These are the most popular, research-backed scientific approaches to address restless legs syndrome and associated sleep disorders. These treatments have recorded evidence to support their effectiveness. However, there are many experimental methods and alternative therapies that do not have enough scientific backup but still provide relief to select RLS sufferers.
In case, you cannot go for dopaminergic drug therapy, opioid treatments, NIRS therapy, vibration treatments or pneumatic compression. You don’t have to give up and accept your sleepless state. You can give the alternative therapies a try. You can try repetitive transcranial magnetic stimulation, hot-and-cold compression, transcutaneous electric stimulation of the nerves and acupuncture. These procedures have helped quite a few people across the USA to enjoy proper sleep at night after months of struggling with new postures, heating blankets, leg weights and ergonomic leg pillows.
We should also mention here that people suffering from varicose veins have a high probability of developing RLS in the future. A varicose vein is the presence of dilated blood vessels in the lower part of the legs. These vessels have a higher than regular blood pressure and removing them surgically leads to temporary relief of the force. In fact, a 2008 study involving 35 people with RLS and SVI showed significant improvement after endovenous laser ablation of their varicose veins reduced the blood pressure in their legs.
Is there a complete cure for restless legs syndrome?
Thousands of people search the web each day for a cure to their restless legs problem. The tingle, burn, itches, and discomfort keep them kicking and throwing their legs around all night. They wake up more tired each morning and wish for a miracle that would redress them of this strange affliction. In reality, medical science is not a platform of miracles, and the effects of the same treatment can be vastly different on two recipients. It is easy to understand why something like RLS does not have a foolproof long-term cure.
In fact, most medical experts pronounce RLS as a lifetime condition. The current medications, treatments, and therapies only give you control over the degree of each incidence. Sometimes, after taking massage, people do not get another episode of RLS for two weeks. Whereas, some people do not experience any relief without benzodiazepines and opioid. The extent of comfort and the effectiveness of each treatment depend upon the current health and physiology of the patient.
Each episode is erratic. Two events can have a gap of two days, two weeks or even two years. The symptoms usually reappear in a person with a confirmed RLS diagnosis irrespective of the treatment type or duration of remission. Therefore, you will often meet doctors, who are reluctant to dish out “solutions” to your RLS problems, in case your symptoms are mild.
Co-founder of Counting Sheep and Sleepaholic