Restless legs syndrome (RLS), a familial disorder causing unpleasant crawling, prickling, or tingling sensations in the legs and feet and an urge to move them for relief, is emerging as one of the most common sleep disorders, especially among older people. This disorder, which affects as many as 12 million Americans, leads to constant leg movement during the day and insomnia at night. Severe RLS is most common in elderly people, though symptoms may develop at any age. In some cases, it may be linked to other conditions such as anemia, pregnancy, or diabetes.
Many RLS patients also have a disorder known as periodic limb movement disorder or PLMD, which causes repetitive jerking movements of the limbs, especially the legs. These movements occur every 20 to 40 seconds and cause repeated awakening and severely fragmented sleep. In one study, RLS and PLMD accounted for a third of the insomnia seen in patients older than age 60.
RLS and PLMD often can be relieved by drugs that affect the neurotransmitter dopamine, suggesting that dopamine abnormalities underlie these disorders' symptoms. Learning how these disorders occur may lead to better therapies in the future.
Overview of Restless Legs Syndrome
Four criteria must be met in order to be diagnosed with RLS.
1. There is a strong urge to move legs with other accompanying sensations.
2. Symptoms start or become worse when resting.
3. Symptoms improve with movement.
4. Symptoms are worse in the evening especially when lying down, and are not present during the day.
A careful history and physical exam as well as blood tests to rule out treatable causes.
It is important to treat the underlying cause. For example, if there is a deficiency in iron, folate, or magnesium, supplementation is helpful. It is also recommended to avoid excess caffeine and alcohol as these can contribute to the symptoms. Regular exercise is recommended, although excessive exercise can worsen symptoms. Medications including anticonvulsants, benzodiazepines, and dopaminergics can also be prescribed by your health care provider to alleviate symptoms.