What Is Restless Legs Syndrome and How It Affects Sleep and Daily Life
Restless Legs Syndrome (RLS), also known as Willis-Ekbom Disease, is a common neurological disorder that primarily disrupts sleep and affects quality of life—especially among middle-aged and older adults. This condition is characterized by an overwhelming urge to move the legs, typically triggered during periods of rest or inactivity, such as when sitting or lying down in the evening or at night.
Understanding the Symptoms of Restless Legs Syndrome
The hallmark of RLS is uncomfortable sensations deep within the legs. These feelings are often described as tingling, crawling, burning, aching, or even electric-like pulses. Many patients report that the sensations are difficult to articulate but create a powerful need to shift positions, stretch, or walk around to gain relief.
Key symptoms include:
- Unpleasant leg sensations that begin or worsen during rest
- Symptom relief through movement, such as walking or stretching
- Nighttime worsening of symptoms, particularly in the evening or before bedtime
- Periodic limb movements during sleep (PLMS), which can disrupt both the patient and their partner's rest
Who Is Most Affected by RLS?
While RLS can occur at any age, it becomes more prevalent with advancing age and is more commonly diagnosed in women than men. Some individuals experience mild episodes occasionally, while others suffer from chronic, severe symptoms that significantly interfere with sleep and daily functioning.
Primary vs. Secondary Restless Legs Syndrome
There are two main types of RLS: primary (idiopathic) and secondary (symptomatic). Primary RLS often has a genetic component and tends to run in families, following an autosomal dominant inheritance pattern. Symptoms usually appear earlier in life, sometimes even in adolescence.
In contrast, secondary RLS develops later and is associated with underlying medical conditions or external factors. Researchers have identified several health issues that increase the risk of developing RLS, including:
Common Triggers and Associated Conditions
Iron Deficiency Anemia: Low brain iron stores may disrupt dopamine signaling, contributing to RLS symptoms. Even mild iron deficiency without anemia can play a role.
Chronic Kidney Disease and Uremia: Patients undergoing dialysis frequently report RLS, likely due to electrolyte imbalances and toxin buildup.
Pregnancy: Up to 20% of pregnant women experience RLS, especially in the third trimester. Symptoms usually resolve after delivery.
Diabetes and Peripheral Neuropathy: Nerve damage caused by high blood sugar levels may trigger abnormal sensations similar to RLS.
Parkinson's Disease: Although the connection is complex, both disorders involve dopamine pathways in the brain, suggesting a possible neurochemical link.
Gastric Bypass or Other GI Surgeries: Altered nutrient absorption, particularly of iron and vitamins, can lead to secondary RLS.
Why Does RLS Worsen at Night?
The circadian rhythm plays a significant role in symptom severity. Dopamine levels naturally decrease in the evening, which may explain why discomfort intensifies at night. Additionally, reduced physical activity during rest allows abnormal sensory signals to become more noticeable.
Many sufferers find themselves pacing the floor, constantly shifting in bed, or needing to massage their limbs just to fall asleep. In severe cases, insomnia and sleep fragmentation lead to daytime fatigue, poor concentration, and mood disturbances like anxiety or depression.
Diagnosis and Treatment Approaches
Diagnosing RLS is primarily clinical, based on patient history and symptom patterns. There is no definitive lab test, though doctors may order blood work to check iron levels, kidney function, and glucose control.
Treatment focuses on managing triggers and relieving symptoms. Options include:
- Lifestyle changes: regular exercise, good sleep hygiene, avoiding caffeine and alcohol
- Iron supplementation for those with low ferritin levels
- Dopaminergic medications (e.g., pramipexole, ropinirole) for moderate to severe cases
- Anticonvulsants or benzodiazepines in select patients
For pregnant women or those with comorbid conditions, treatment must be carefully tailored to minimize risks.
Living Well with Restless Legs Syndrome
Though RLS is not life-threatening, its impact on sleep and well-being should not be underestimated. With proper diagnosis and management, most patients can achieve meaningful symptom relief and improved sleep quality. Awareness, early intervention, and addressing underlying causes are key to long-term control.
If you or a loved one experiences persistent leg discomfort at night accompanied by an uncontrollable urge to move, consider discussing the possibility of RLS with a healthcare provider. You're not alone—and effective solutions are available.