Do you have trouble sleeping at night? Do you continuously change positions and are told that you are fidgety? What if it was restless legs syndrome?

What is restless legs syndrome (RLS)?

Restless legs syndrome is a neurological disorder characterized by an irresistible urge to move the lower limbs, especially at night. It can also affect other parts of the body, such as the arms. It is sometimes referred to as “leg twitching” or “nighttime leg twitching”. This syndrome affects roughly 10% of the Canadian population.

What are the symptoms and repercussions of RLS?

The urge to move is usually accompanied by unpleasant sensations: discomfort, pain, numbness, tingling, itching, warmth or burning sensation, etc. These symptoms are normally manifested during periods of inactivity or rest and are relieved by movement. They are generally amplified in the evening and reach their peak at night.

The symptoms experienced can vary in intensity and frequency from one person to the next and from one period to another. They can be intermittent or chronic. People affected by RLS must also cope with other consequences, such as:

• insomnia
• disrupted or insufficient sleep
• daytime fatigue
• attention or concentration problems
• effects on cognitive abilities
• stress or anxiety
• compromised well-being or quality of life

Who is at risk of being affected by RLS?

RLS is especially manifested in adults and affects twice as many women as it does men. Its frequency increases with age, with people in their forties being particularly affected.

It seems to involve a hereditary component.  In fact, RLS often affects several members in the same family. Moreover, people who smoke, are obese or have a sedentary lifestyle have a higher risk of being affected by it.

Some other risk factors include:

• an iron deficiency or anemia
• pregnancy
• stopping certain medications (e.g., benzodiazepine)

Although it is not a cause per se, stress can worsen symptoms that are already present.

RLS can be a manifestation of certain chronic diseases. Here are some examples:

• Parkinson’s disease
• multiple sclerosis
• diabetes
• end-stage kidney disease
• rheumatoid arthritis, and
• fibromyalgia

The exact mechanism at the root of RLS is not yet known. However, it is believed that it could be linked to deficient activity of certain nerve cells (neurons) that use dopamine to transmit nerve signals. 

How can RLS be prevented?

Certain measures can help to prevent, reduce, or ease the symptoms of RLS:

• Reduce your consumption of stimulating substances such as coffee, tea, energy drinks, alcohol, drugs, etc.
• Make sure you are getting a sufficient intake of iron to avoid deficiencies.
• Consider passing a blood test to check your iron levels. If they are too low, your doctor will tell you how to resolve the problem.
• Avoid taking medications that could worsen symptoms (for example, neuroleptic drugs and antihistamines). Ask your pharmacist if the medications you take could have this effect.
• Learn to better manage stress.
• Practise moderate regular exercise.
• Apply warm compresses to your legs or take a hot bath.

How is RLS treated?

Mild cases of RLS generally do not require a drug treatment. However, there are medications available to ease or reduce symptoms of RLS when they are more serious, unpleasant or debilitating. These medications have an effect on the nervous system.

As is the case with all medications, they may involve side effects, drug interactions and warnings. Always speak to your pharmacist before taking a new drug.

Additionally, when the cause of RLS is known, taking action can help to alleviate the problem. For instance, if symptoms are caused by kidney failure, the use of dialysis can be of great assistance.

When and who should you see?

If you believe you have RLS or if you have unexplained sleep problems that affect your quality of life, you should see a doctor. In order to make a diagnosis, they will examine you and ask you a number of questions. Your doctor may recommend that you see a neurologist or specialist at a sleep clinic.

A confirmed diagnosis of RLS relies on a medical exam called a complete polysomnography. During this test, the individual sleeps in a laboratory and various parameters are recorded during sleep to analyze its duration and quality, with the objective of pinpointing sleep problems and their cause. A polysomnography is completed by sleep professionals, including a respiratory specialist.

Don’t hesitate to speak to your pharmacist for additional information about sleep disorders like RLS.