Not all people can sleep soundly. Some tend to move their legs constantly while sleeping. A few among them also move their hands occasionally. As you can probably understand by now, it is a disorder of the nervous system. Since it interferes with the quality of sleep, experts categorize it as a sleep disorder. The seriousness of this disease can vary among the affected people. Restless legs syndrome or Willis-Ekbom Disease (RLS or WED) is not a new disorder. It has been around since the beginning of humanity. It begins with an irresistible urge to move the legs. Some describe this sensation as “itchy” or “pins and needles.” The seriousness usually depends on how bad these sensations are. People often find respite during constant motion of the limbs. The feelings typically become worse during the evenings and nights. The itch or the pain can become intolerable when a person is in bed. We often have trouble if we manage to hurt our leg or pull a muscle. It is easy to understand how disrupting persistent discomfort and itching of their lower limbs can be. It often leads to excessive daytime sleepiness, and RLS interferes with the daily quality of the affected individual’s life.
How commonly does Restless Legs Syndrome occur?
Restless legs syndrome affects about 10% of the US population. It affects both genders, but it is more common among women. Sometimes, women experience periodic limb movement and restless legs for the first time during pregnancy. There is no particular age for the onset. There are cases of children suffering a case of restless legs as well. The prognosis is usually severe in the event of a middle-aged patient. It is a disorder that is not easy to diagnose. Doctors often misdiagnose it as other sleeping disorders. It is usually prevalent among Caucasians who are around 59 years old. It has a high incidence in the North American and European countries. It is not as familiar in Asia.
In the last decade, there has been a significant rise in the number of people suffering from WED. The numbers rose higher with each survey and study between the early 1990s and late 2000s. Since it is relatively easy to misidentify the syndrome and its symptoms, thorough diagnosis as per the ICSD criteria is necessary to confirm the presence of the disorder in predisposed individuals.
What are the symptoms of primary and secondary RLS?
The symptoms of RLS are diverse that can range from “mild persistent itching” to “creeping crawly” feeling that won’t cease. Relaxing, sitting, reading or lying down exacerbates the symptoms. Experts have classified this as a “spectrum” disorder that potentially results in sleep deprivation and impairs the quality of life. The symptoms can start during the childhood of the affected person. The uneasiness during resting state usually disappears on its own, but for a few the sensation and difficulty to commit to a state of rest can continue well into adulthood. The Restless Leg Syndrome Foundation conducted a study that showed 45% of their patients experienced their first case before they were 20 years old.
The descriptions of the uneasy feeling due to RLS, as per the accounts of people suffering from this disorder, are as follows –
- The unstoppable urge to move the lower limbs that results from uncomfortable feelings in their legs. It can occur in the arms and other body parts as well.
- The constant motor restlessness that relieves the urge and the unease.
- Relaxation and lying down usually worsens the situation.
- There is significant variability in the symptoms according to the day-night cycle. The symptoms worsen with progressing night.
Depending on the symptoms and the causes, experts have categorized restless legs syndrome into two categories.
Primary RLS: The primary form of the disorder is idiopathic. It means it has no known cause and it begins late in one’s life. Primary RLS progresses slowly after the 40s, and it can disappear without any indication for months or even years. The primary form is often progressive, and the symptoms worsen with age. In case of children with restless legs, doctors often misdiagnose it as growing pains.
Secondary RLS: The Secondary form does not have a progressive nature. The restlessness, itching or pain can appear suddenly after the age of 40. It is usually continuous. People do not find a week’s or a month’s respite like in case of the primary disorder. In most cases, it is a result of side-effects of other medications or medical conditions.
What are the leading causes of Willis Ekbom Syndrome or restless legs syndrome?
Since the manifestation of the disorder is diverse in individuals, the causes of RLS can also vary. In the last two decades, there have been several studies that have reported multiple contributing factors to the Willis Ekbom Syndrome.
- Iron deficiency is common among 20% of the cases that experts have studied up until today. A foundational study on RLS noted that out of the observed facts of RLS, 34% of the patients had iron deficiency. Over 80% of the children, who were part of a study that investigated the cause of the disorder, had ferritin or stored iron deficiencies.
- Many other conditions occurring alone or simultaneously can lead to the development of RLS. Varicose veins, folate deficiency, magnesium deficiency, Parkinson’s disease, POTS, thyroid diseases, peripheral neuropathy, celiac disease, rheumatoid arthritis and other autoimmune diseases can be the underlying causes of RLS.
- Pregnancy can worsen the symptoms of this disorder. It can be due to the reduced levels of iron in the mother’s system or due to new reasons arising from a change in hormone levels and neurotransmitter levels.
- Individuals with ADHD often exhibit periodic limb movement disorder and RLS. The association often depends upon the dysfunctions of the neurotransmitter dopamine. A study from 2005 showed that people with ADHD had a higher chance of developing RLS. In fact, according to this study, up to 26% of the patients with RLS had ADHD, and about 44% of the patients with ADHD suffered from co-existing RLS.
- The presence of several RLS loci increases the person’s predisposition towards the disorder. The studies reveal that over 60% of the cases are familial and the disease passes down from one generation to another in an autosomal dominant fashion. The penetrance varies significantly depending on the extent of linkage between the six loci scientists have isolated this far. The MEIS1, MAP2K5, and BTBD9 contribute to the pathogenesis of RLS. Periodic limb movements in sleep depend on several genes and chromosomes including the BTBD9 gene and the PTPRD gene.
- Several medications can accelerate the progression of RLS. Medicines can even cause it secondarily. These medicines include antidepressants, withdrawal from benzodiazepines, antihistamines, antiemetic, antipsychotics, anticonvulsants and rebound from alcohol can create secondary RLS as well.
- Primary and secondary RLS can become worse with surgeries of any kind. Back injuries and subsequent operations often contribute to restless legs. The cause and effect of injuries and surgeries are still not well established.
The mechanism of the disease relies on the dopamine and iron system. Experts have noted several differences in the dopamine and iron-related markers in the cerebrospinal fluid of patients with diagnosed cases of RLS.
How do experts diagnose WED?
Currently, there are no specific tests for the diagnosis of restless legs syndrome. However, several non-specific laboratory tests can rule out vitamin deficiencies. Four symptoms confirm the diagnosis in adults and children –
- The restlessness creates an insatiable urge to move the lower limbs. Sensations of pain, pricking, tingling, burning and numbness accompany the call to be mobile.
- The sensation begins with relaxation or an extended period of staying still.
- The symptoms of RLS become more severe as the night progresses. In a few cases, the restlessness can persist during the daytime.
- The movement of the legs or arms provides temporary relief from the agitation and painful sensation temporarily.
Apart from these four symptoms, there can be several indicators that your doctors should be able to diagnose. It is wiser to consult a sleep specialist or a neurologist. Doctors need to conduct physical examinations on the patients for determining the underlying physical discomforts that can trigger RLS.
Sleep studies rarely help with the diagnosis of WED. A sleep study can measure the quantity and the quality of sleep. The disorder can cause sleep deprivation, but that is not sufficient to diagnose the disease. Research has been going on for improving the diagnostic procedures that can determine RLS.
Your GP can assess the intensity of your symptoms, for example –
- The frequency of your symptoms.
- The intensity of the unrest.
- The distress your symptoms may cause on a regular basis.
- The extent of interruption it causes to your daytime routine due to the lack of rest.
Maintaining a sleep diary can help your GP or your sleep expert understand the progression of RLS. Recording your daily bedtime, wake-up time and other sleeping habits can help them understand the underlying cause of the disorder and the seriousness of it.
Are there medicine-free ways to treat Willis Ekbom Disorder?
In most patients, the symptoms disappear and reappear autonomously. Till date, there is no particular cure for the disorder, yet there are ways to alleviate the unease it causes. Some medications lessen the crawling feeling or electric pain in the legs, but there are several alternative treatments you should try to improve the quality of your night-time rest. Here are a few drug-free steps you can attempt to enjoy some relief from the symptoms.
Good sleep routine: not having a regular sleep schedule can make RLS worse. Going to bed at the same time every night helps regulate your sleep regime. It helps your body conform to resting hours. It might help to get in bed at around 11 pm, or 12 am. Going to bed a couple of hours later than usual can help you fall asleep faster and stay asleep longer. Use non-blue LEDs, dim lighting and keep digital screens out of your bedroom. Keep your bedroom dark, comfortable and relaxed.
Mind your supplements: iron plays a vital role in determining the severity of the disease. In the event of a definite diagnosis, your doctor is most likely to recommend regular iron supplements. Folic acid, magnesium, and Vitamin B12 level fluctuations worsen the effects of this disorder. GPs often recommend daily supplements of the vitamins and minerals to combat restless legs.
Temperature: try taking a hot shower or soaking in a warm bath before bedtime. Try using a heating pad under your legs or put an ice-pack under your calves. Try altering the temperature of the muscles that suffer the most during the episodes. Sometimes, a change in the heat can help relieve the stress.
Massage: you can go for the occasional spa or give yourself a nice warm massage to soothe your worn muscles. Rubbing your calves can loosen the muscles and reduce the pain. Ligaments and tendons often suffer from tiredness due to the constant contractions. Massaging can help you get a good night’s sleep.
Electrical stimulation: a neuromuscular disorder like this one often benefits from electrical stimulation. This process involves controlled electrical vibration of your toes and your feet. People often find relief from the symptoms, when the practice this for a couple of minutes before sleep.
Acupuncture: it is a prevalent practice among people with RLS. No scientific study seconds this method. However, people try this to relieve their symptoms.
Exercise: simple stretching exercises, yoga, and even regular walks can help with RLS. Working out on a regular basis can help you reduce your anxiety and stress levels. You can also try deep breathing and mindfulness meditations every day for relief. Research shows that Tai Chi, meditation, and progressive muscle relaxation helps with busting stress.
What are the medicines that can combat the effects of WED?
Several medications can make a difference. In several instances, RLS occurs sporadically in patients and GPs prescribe medications only when they have the symptoms.
Here’s a list of medications that treat RLS –
Dopamine agonists: these are the first line of defense against RLS. This class of drugs includes pramipexole, rotigotine, and ropinirole. They act as a neurotransmitter in the brain. Dopamine agonists act like the molecule and bind to dopamine-receptors in the organ. It is not devoid of side effects; they include nausea, lightheadedness, and excessive daytime sleepiness.
Dopaminergic agents: these molecules increase the level of dopamine in the brain. It can improve RLS symptoms over time. Some people often experience worsening of symptoms after daily use. Side effects can also include vomiting, dyskinesias, and hallucinations.
Opiates: these are common pain relievers, but they also work wonders on RLS. Hydrocodone is the most popular opiate that can treat this syndrome. However, they are highly addictive, and people can become dependent on them. Doctors usually prescribe opioids only when there are no alternatives available.
Benzodiazepines: alprazolam, clonazepam, and temazepam are benzodiazepine derivates that work as sedatives. Although they do not help with relieving symptoms, they help you sleep through the unrest.
Anticonvulsants: restless legs syndrome is not a manifestation of convulsions or cerebral seizures, but medications like gabapentin can relieve RLS. It can ease nerve pain and chronic pain that people experience during WED.
Alpha2 agonists: these molecules activate nerve cells that can control the movements of the nervous system. They stimulate the alpha2 receptors in the hind part of the brain and dampen the involuntary movements.
Physical therapy is beneficial for the treatment of restless legs syndrome. However, all sorts of physical therapy give better results when patients couple them with proper sleep hygiene. Additionally, staying away from caffeine, nicotine, alcohol, and tobacco can help with redressal of the symptoms of the disorder.
Dopamine medications usually lose their effectiveness over time. You might even notice the symptoms returning earlier during the day. This process is augmentation, and during this stage, doctors typically substitute these medications with newer ones to combat the problem. Many of the drugs that treat RLS are not safe during pregnancy. Sometimes, alternative therapies work during the first two trimesters, but the last trimester can be particularly bothersome. Sometimes, antipsychotic medications, anti-allergic medicines, cold medication and antiemetic can exacerbate the symptoms of RLS/WED. During medical treatment of restless legs, it pays off to stay away from stimulants like caffeine.
What are the triggers of RLS in adults?
There might be multiple genetic factors that contribute to the incidence of the disease, but several environmental factors contribute to the beginning of each episode. There is more than one daily trigger of RLS and knowing them may help you control the symptoms and progression of the disorder.
- Sitting still for long periods: when people sit for long forcibly, the flare can increase and they can experience worse pain. The only way to reduce the flare or avoid it is by booking aisle seats on flights, using standing or adjustable desks so you can work standing up and move around more during the day.
- Boredom: that sounds generic, but not working out or not being active enough can increase the symptoms of RLS. Activeness can improve the symptoms of RLS and enhance the mental state. It also helps people fall asleep faster.
- Working out too much: this can be a leading cause of your discomfort. Activity can improve cases of RLS, but strenuous workouts can aggravate inflammation of tissues and contraction of muscles.
- Too much caffeine: drinking too much coffee can make your muscle tissues more restless than usual. Caffeine can interfere with the regular sleep onset patterns and sleep quality. Drinking a lot of caffeine can increase wakefulness and delay the sleep onset time.
- Varicose veins: older people often find it difficult to fall asleep due to the pain weak veins or venous insufficiency. Blood usually pools instead of flowing in the correct direction. It can induce strain in the lower extremities, swelling, fatigue and night cramps. Thermal ablation and laser therapy can help with cases of varicose veins.
What are a few ways of preventing the recurrence of RLS?
Keeping a few daily triggers of RLS in mind can prevent you from staying awake all night or pacing around to alleviate the uneasiness.
- Finding relief from this sensorimotor condition can be very difficult. Creeping, prickling and crawling sensations in your legs can be classic symptoms of restless legs. A few personal improvement steps can help you work on the symptoms of your disorder.
- Avoid napping during the bedtime. Biphasic sleep or polyphasic sleep works marvelously for a few, but those with RLS usually do not do so well with regular daytime naps. Not giving in to your daytime sleepiness can help you get better quality sleep.
- Relax during your bedtime. Apart from literally warming your bed up with heating pads or hot water bottles, you need to warm up to the idea of sleep. You need to keep your mind occupied. Count sheep or imagine going on a date with Zac Effron, either way, make sure your thoughts are far away from worrying.
- Try taking a walk after dinner. Walking your dog or strolling in the neighborhood with your kids can help you get just the right amount of sleep you need for proper rest. After returning from your walk, soothe the sore muscles on your leg with a nice warm bath. Add lavender essential oils, ylang-ylang oil or bergamot extract for enjoying the right muscle relaxing properties of natural compositions.
- If you are experiencing the attacks of RLS only recently, after you have started a new medication or a new supplement, you need to speak with your doctor. Willis Ekbom Disease can be a side effect of several drugs, including herbal medicines. Find out if any new medication you are consuming can cause the symptoms of restlessness in your limbs.
- Work hours have a significant impact on your health and the RLS symptoms. Ease out the pressure at work by taking 5-minute breaks every hour. You will feel the difference once you manage to get out of that chair and walk around a bit. In fact, try to skip that post-lunch coffee. Replace it with a short walk or some easy (publicly accepted) stretching.
Your lifestyle choices will have significant effects on the outcome of your RLS. Everything you do, eat and drink throughout the day contributes to the comfort level you experience while in bed at night. If you are suffering from WKD at the present moment, you need to ensure that you make all the right choices that may lead up to a sound night’s sleep. Releasing the stress at the end of a long day makes a lot of difference to people suffering from a severe case of RLS.
EDS and RLS: what is their relation?
Patients with restless legs syndrome often find themselves wide awake at night. The pain, discomfort, and anxiety keep them sleepless night after night. Several studies show a strong correlation between RLS and excessive daytime sleepiness. It is understandable that people with RLS will not get enough rest during the night. That is why they often feel overwhelming tiredness and the desire to rest by 10 am next day. However, without professional medical assistance, they might find it difficult to fall asleep due to the chronic discomfort in their lower limbs. Persistence of RLS for more extended periods often leads to similar crawling feelings, tugging sensations and pain in their hands as well. An article in the Journal of European Neurology states that treating RLS and EDS with dopaminergic agents can improve both cases dramatically.
Periodic Limb Movement Disorder vs. Restless Legs Syndrome
Periodic Limb Movement Disorder (PLMD) and Restless Legs Syndrome (RLS) may appear to be synonymous with many, but they are two distinct disorders that disrupt regular rest for the patients. Since they have different causes and effects, it is essential for the doctors to figure out which disease you have to treat it effectively.
During PLMD, a patient’s limbs move multiple times during a particular period. It is different from the spasmodic movement of legs as one tries to fall asleep. These happen during the non-REM stage of sleep, and people often do not know if they suffer from this condition. It is possible since PLMD is an involuntary action and the patient can sleep uninterruptedly through the episodes.
In case of RLS, patients do not experience involuntary movements. They move their legs in the hope of finding relief from the unnatural feeling that arises from sensorineural dysfunction. It keeps the patient awake and interferes with the quantity of one’s sleep.
While RLS can occur in about 15% of the population in the US, PLMD is common among only 4% of the population. At the same time, excessive daytime sleepiness and extreme fatigue are effects of both conditions.
Several prevailing medical conditions can lead to Periodic Limb Movement Disorder and Restless Legs, including the following –
- Isaac’s syndrome
- Chronic lung disease
- Vitamin B12 deficiency
- Anemia and hemoglobin deficiency
- Peripheral neuropathy
- Huntington’s Chorea
- Amyotrophic Lateral Sclerosis (ALS)
- Uremia (kidney related toxicity)
- Diabetes mellitus
Similar to RLS, several medications can cause PLMD.
What is the prognosis of restless legs syndrome?
Restless legs syndrome can worsen with age. That usually happens when the person does not seek medical assistance. The progression is typically slow for those with idiopathic RLS. Present day medical science and research recommends many physical therapies and medications that can levy the symptoms of the disorder. Some patients experience long periods of remission. During these brief periods, the restlessness may disappear for days or weeks, but they eventually reappear. However, the presence of restless legs does not always indicate the presence of other neuropathologies.
Coping and support
Living with RLS or WED can be challenging due to the lack of sufficient rest and the extreme levels of fatigue. Here are a few things you can do to make it easier for yourself –
Tell others about your disorder: speak to your spouse or significant other about your case of RLS. It is not pleasant for anyone to sleep with a “kicky” partner. Talk about your problem to your coworkers and your friends, so when they catch you pacing up and down the aisle they will understand your obligation.
Do not be lazy: we know how much a comfortable chair or a bed can entice a sleep-deprived soul, but you need to resist the temptation. Make it a habit of moving around and taking the stairs to your office every day. Working out on a regular basis can be impossible for any office-goer, so make the best of the time you have in hand.
Maintain a sleep journal: a sleep journal should contain each bit of information about your bedtime, waking time, alarm details, quality of sleep, dream quality and incidences of restless legs. If the symptoms of RLS occurred twice this month, you need to write down every detail about it including at what time it happened and how long it continued.
Ask for professional help: several support groups put people with RLS in touch with each other and their families too. Participating in a group discussion or regular meetings can help you gain new insights on pain management, alleviation of restless symptoms and improvement of sleep quality.
Preparing for facing your RLS with the help of a professional –
During your first visit to a sleep specialist or a neurologist, you can expect a flurry of questions. It always pays off to prepare in advance. Find out the following information to help your doctor –
- Which words would you choose to describe your symptoms?
- Are you tired during the daytime?
- Do you consume caffeine?
- Are you a regular drinker and smoker?
- Do you get enough exercise?
- What is your sleeping schedule?
- How much do you move about at night?
- When do the symptoms usually start and how long do they continue?
- Do you have trouble while lying down, sitting or sleeping?
- What is your diet type? Do you suffer from nutritional deficiencies?
The RLS is a severe disorder that compromises the quality and extent of sleep in adults as well as children. It can take a hefty toll on regular productivity and daily functions. Seeking professional help can help you overcome the discomfort and embrace the pleasure of sleep once more.