Is your sleep disturbed by sudden arm or leg movements which you can’t control? Or perhaps you experience strange twitching or burning sensations in your legs?
If so, it could be that you have a sleep disorder called restless legs syndrome.
Like many other sleep disorders, the actual causes aren’t very well understood. However, recent research into drug treatments and other techniques has led some experts to question the current thinking about possible causes.
In this article you’ll find out about the symptoms, possible causes and treatment of restless legs syndrome. I’ll also suggest some practical home remedies which might help reduce the distressing symptoms.
Finally, I’ll highlight the recent research on the effectiveness of different medications used to treat more severe cases. It would appear that some of these drugs can have significant and worrying side-effects.
Uncontrollable leg movements
Lots of people have an urge to shake their legs from time to time, but normally you can easily stop the shaking if you wish.
Restless legs syndrome, however, often results in jerky or twitchy leg movements that you can’t control. It’s important to note that this motion is different from the occasional ‘jolt’ which many people experience as they’re falling asleep – known as hypnic Jerks.
The symptoms are generally more common at night. The leg movements can occur every 10-60 seconds and may be so strong that they stop you sleeping or may wake you or a sleeping partner. In some cases the problem can result in severe disruption to your overall sleep.
The uncontrollable limb movement may be accompanied by other uncomfortable sensations in your legs and, less frequently, arms, chest and face. Sensations you experience might include:
- Tingling, burning, itching or throbbing in your legs.
- A crawling or creepy feeling in your legs.
- A feeling like bubbling water in the leg blood vessels.
- Cramps in the legs.
- Electric tingling feeling in the legs.
Often these feelings can be relieved by moving or rubbing your legs, but for some people the relief can be short-lived. The symptoms can range from mild to unbearable, and are usually worse in the evening and the night.
Some people experience symptoms now and again, while others have them every day. And it may also make it difficult to sit for long periods in a car, cinema or airplane.
Sleep disturbance and well-being
The various symptoms can result in frequent disturbance of your sleep. This can result in a lack of quality sleep and a general tiredness throughout the day.
Research into restless legs syndrome has also shown that people with moderate or severe symptoms can also suffer from anxiety and depression.
This may be partly due to the effects on their general well-being from a lack of sleep. But also an understandable worry about whether they might have a serious physical or mental problem.
Around half of people with restless legs syndrome may also experience episodes of lower back pain.
How common is restless legs syndrome?
With the range of severity of symptoms, I suspect many sufferers never seek medical help. According to the International Classification of Sleep Disorders, restless legs syndrome affects more than 5% of the population of the United States.
But some studies have found that nearly 10% of adults report that they have experienced the condition. The more severe cases profoundly disturbs sleep and overall well-being, requiring long-term medication treatment.
Women are twice as likely as men to experience it. The condition is also more common in middle age. But the symptoms can develop at any age, including childhood. There does also appear to be a possible genetic factor, so it may be passed from parents to children.
It also appears that this problem can be more common during pregnancy. An Italian study of nearly 600 pregnant women reported that about 25% described symptoms of restless leg syndrome.
Fortunately, in most cases the symptoms disappear or reduce in the last couple of months of pregnancy or shortly after giving birth.
The association with periodic limb movement disorder
Over 80% of people with the problem are also likely to experience periodic limb movement disorder during the night. Restless leg syndrome and periodic leg movement disorder are classified as two different sleep disorders – even though the symptoms are often very similar.
The main distinguishing feature is that periodic leg movement disorder only occurs whilst you’re sleeping. You may produce involuntary and repetitive movements, and probably won’t be aware of it.
It can range from the gentle movement of toes and ankles to more pronounced kicking and full leg movements. It may also disturb your sleep quality resulting in you feeling sleepy during the daytime.
In contrast, restless legs syndrome can occur at any time, including when you’re awake or asleep. It may be accompanied by more symptoms, including possibly limb movements similar to those experienced with periodic leg movement disorder.
Restless legs syndrome can also prevent you from falling asleep in the first place, as well as waking you up.
Generally, the problem is referred to as either secondary or primary, depending on whether or not you have another underlying medical condition.
Secondary restless legs syndrome causes
Secondary restless legs syndrome can actually be one of the symptoms of an underlying medical condition. The most common cause is Iron-deficiency anemia. But other long-term health conditions can cause similar symptoms. These may include:
- Kidney disease.
- Parkinson’s disease.
- Rheumatoid arthritis.
- Thyroid gland problems.
Your doctor would want to ensure you aren’t suffering from any of these conditions before considering treatment.
Certainly the possible connection between iron-deficiency anemia and the syndrome seems to have increasing support from some medical professionals, for example as reported in this 2011 study.
The condition could also be a side-effect of other medication, such as:
- Dopamine antagonists (see below for a list of drugs in this category).
- Calcium-channel blockers.
If taking any of these, you may wish to discuss your medication options with your doctor to see if they’re having an effect on your symptoms.
Primary restless legs syndrome causes
Assuming that the possibility of an underlying medical condition has been eliminated, then the problem is referred to as primary restless legs syndrome. Unfortunately, the exact cause of the problem is very uncertain.
Based on responses to some existing drug treatments, there’s some suggestion that the cause may be neurological related, perhaps due to low levels of dopamine in the brain.
The level of Dopamine in the body also reduces towards the end of the day. This then lends some weight to the neurological theory since people’s symptoms are often worse in the evening and night.
However, the most recent medical trial casts doubt on the influence of dopamine on restless legs syndrome. This research may well result in changes to recommended treatments in the future. See below for more details about this recent research.
Wider health implications
Medical research in 2015 identified that restless legs syndrome can also be associated with significantly higher risks of suffering from heart problems, stroke, kidney disease and even death. You can read more about the research findings in this article.
Restless legs syndrome treatment
Increasing your iron levels
If an iron deficiency is suspected then it should be possible to treat this, perhaps with simple iron tablet supplements or even iron rich foods.
It’s also important to remember that the body is better at absorbing ‘Heme’ iron found in meat and fish, including some shell fish.
Vegetable sources are termed non-Heme and are less effective in raising your iron level. What better excuse for treating yourself to a steak or oysters!
Here’s a list of other iron-rich food that you may like to include in your diet:
- White and red meat, such as beef, lamb and chicken.
- Fish like sardines, clams, oysters and mussels.
- Dark-green leafy vegetables, such as watercress and curly kale.
- Cereals or bread fortified with iron.
- Brown rice, pulses and beans.
- Nuts and seeds.
- Dried fruit, such as dried apricots, prunes and raisins.
Before taking supplements, doctors do recommend having your ‘ferritin’ levels tested first, as taking too much iron can also have adverse effects.
It may not be as easy as just changing your diet though, as monitoring by your doctor may also be needed to ensure you are getting the right amount of iron.
And in severe cases if might also be possible to have iron intravenously, as this has been found by researchers to be effective.
Therefore, I suggest that if you’re suffering from restless legs syndrome you might wish to consider having your blood iron level tested before trying other medications.
No cure for primary restless legs syndrome
There are unfortunately no reported cures for primary restless legs syndrome. Therefore, any medication you might be prescribed is really aimed at trying to reduce and manage the symptoms.
If the symptoms are mild or infrequent then no treatment may be necessary. Indeed many people may be reassured just to know that they don’t have a serious underlying medical condition or disorder.
If the condition is affecting your quality of sleep, there are many self-help options you can try. You may find it useful to read our articles about sleep hygiene for more about this. You can also find out about lifestyle and dietary choices which disrupt sleep such as caffeine, smoking and alcohol.
There are various home treatments you could try to reduce the level of discomfort, for example:
- Massaging your legs or arms, especially before going to bed. Even just 5-10 minutes might be enough to help.
- Applying a hot or cold compress to your leg muscles.
- Having a hot and relaxing bath in the evening.
- Some non-vigorous exercise – walking or stretching rather than jogging. Or an exercise bike if you have one.
- Gently stretching your legs before going to bed.
- Trying to relax by doing activities such as reading, puzzles or watching television.
- Relaxation techniques such as yoga, meditation or tai-cha.
- There are relaxation techniques you can do in bed to focus your mind elsewhere.
These home remedies may only provide temporary relief. But they may still be worth trying to see if they allow you to relax, reduce the discomfort or even hopefully fall asleep.
You could also try a technique called ‘Counterstrain Manipulation’, which a small trial in the UK has reported can be effective. You would need to find a local chiropractor, osteopath or perhaps masseur who provide this treatment.
There are some chiropractors who also believe that restless legs syndrome originates in the pelvic area of the lumbar and sacral regions of the lower back. These chiropractors may be able to help improve the pelvic instability with adjustments, exercises and stretches.
Other small scale studies have suggested that using a Pneumatic Compression Device can also reduce the symptoms. But these devices are very expensive and require you to use them for around 1 hour each evening. Thus this treatment doesn’t appear to have gained popularity.
Electronic medical device treatment
There’s a growing range of electronic devices which aim to help with RLS. They don’t yet have a strong body of evidence to support the effectiveness, but some patients and researchers are optimistic about their use.
To find out about these, you can read our article discussing new restless legs syndrome treatments.
Could magnesium deficiency play a role?
A number of patients and professionals have suggested that magnesium deficiency can also contribute to restless legs syndrome.
The first comment on this article (see below) is an interesting personal story. And four people also commented on a different magnesium article that it had helped their symptoms.
However, there don’t appear to have been many specific trials to look at the impact of a low level of magnesium on restless legs syndrome.
One trial in 1998 looked at a small sample of 10 people, and did find some evidence that magnesium can help. They found that increased magnesium can reduce the frequency of mild restless legs syndrome and also periodic limb movement disorder symptoms.
In theory healthy people with a good diet shouldn’t suffer from magnesium deficiency. However, there are a number of health conditions that can result in low magnesium levels, and an unbalanced diet may also be a factor.
Low magnesium can also cause a large number of other symptoms as reported here. I suspect that most people with low magnesium levels would notice other symptoms, in addition to restless leg syndrome ones.
So it certainly seems that low levels of magnesium could be a cause of restless leg syndrome in some people. Indeed some professionals believe that low magnesium can be the cause of a large number of medical conditions. Accordingly you might want to raise this possibility with your doctor.
Equally, you could try changing your diet and even taking supplements for a short period to see if it helps. Many of the iron-rich foods mentioned above are also good for magnesium, especially green leafy vegetables and other food with a high fiber content.
There are a number of drugs that your doctor may prescribe for primary restless legs syndrome. Currently drugs which are classified as ‘dopamine agonists’ can be prescribed.
Dopamine is one of the important neurotransmitters in the brain. A dopamine agonist is a compound that activates dopamine receptors in the absence of dopamine.
There are a number of brands of dopamine agonist medicines used to treat restless legs syndrome, including:
These drugs can have significant side-effects in some (though not all) people including:
- Nausea and vomiting.
- Drowsiness and sudden ‘attacks’ of sleepiness.
- Dizziness or fainting due to low blood pressure.
- Hallucinations or delusions and confusion.
So whilst not a cure, these drugs may be effective in relieving the symptoms of restless legs syndrome. However, between 5% and 7% of people taking these drugs over a long period can experience ‘augmentation’ or significantly increased symptoms.
A medicine called Pregabalin may also be prescribed by your doctor. This is an anti-epileptic medicine, although it is prescribed for the treatment of several different conditions. But you need to be aware that this drug can also have worrying side-effects in some people, including making you feel sleepy.
Doctors may also prescribe Benzodiazepines, a class of sedative medications, or painkillers aimed at reducing stress or the discomfort. Again you may experience side-effects with these medications and, in some cases, they can be addictive. Thus long-term use of such medications may need careful and on-going consultation with your doctor.
In February 2014 a group of researchers compared the effect of a dopamine agonist drug (pramipexole) with one which does not have a dopamine enhancement function (pregabalin as mentioned earlier).
The results were reported in the New England Journal of Medicine. Some of their findings appear to raise important questions about the use of medication to alleviate symptoms of restless legs syndrome. Some of their key findings included:
- Pregabalin, which has no effect on dopamine levels, was as effective in controlling the symptoms as the dopamine agonist drug.
- The effectiveness of the alternative medication raises doubt about the relationship between dopamine levels in the brain and restless legs syndrome.
- Dependent on the dosage level, the long-term use of dopamine agonist medication appears to have a higher probability of symptoms in some patients getting worse, compared to the non dopamine related drug.
- They also reported that this long-term worsening or ‘augmentation’ of symptoms was a side-effect of the drug, rather than a natural progression of the condition.
- Many side effects were also less severe when using pregabalin. But some other, worrying, mental state related side effects were seen with the use of this medication.
In October 2014, it was reported in a Reuters Health article that the Institute for Safe Medication Practices in Alexandria, Virginia, had found the following:
Dopamine receptor agonist drugs were linked with higher risks for pathological gambling, hyper-sexuality and compulsive shopping in a new study.
These strong drugs are used mainly for Parkinson’s Disease. But the report does mention that they are sometimes also used to treat restless legs syndrome. Clearly this is a complicated area.
If you’re already taking these types of medications, you may wish to discuss the implications of these recent studies with your doctor. If you’re suffering significant side-effects, or you think the symptoms are getting worse, then your doctor may change your medications or dose.
More research is definitely needed to identify the best drug options to relieve restless leg syndrome symptoms. Hopefully this research may also help to improve the very limited understanding of this sleep disorder.
And if the ‘Counterstrain Manipulation’ technique discussed above is effective, then this might cast doubt on the role of dopamine in restless legs syndrome.
Restless legs syndrome is a fairly common condition. It can occur as a symptom of other medical conditions or a side-effect of other medication. The causes of the condition are not well understood and there’s no known cure.
There are home remedies you can try to see if they alleviate the symptoms, improve your well-being and sleep. There are also medications prescribed, but recent research is challenging the current thinking on the best drugs to use.
Unless you have another medical condition, it may be worth considering having tests done to ensure you aren’t suffering from iron deficiency.
It’s always helpful to hear your experiences of a sleep disorder, and efforts you’ve made to try to manage it. Have you tried any of the medications or techniques discussed above? If so, did they help at all?