Restless legs syndrome

RLS is a condition in which you have an unpleasant feeling or sensation, usually in the calves of your legs, that results in a strong, uncontrollable urge to move your legs.

• The symptoms are usually brought on by rest and are worse in the evening or night.
• Movement such as walking or stretching brings relief for a short time, but the symptoms usually return once you settle into a restful state.
• Both legs may be affected or one may be worse than the other.
• Sometimes other parts of your body, such as your arms or lower back, may be affected.
• RLS can affect your sleep and lead to tiredness, feeling sleepy or trouble concentrating. If this happens, see your doctor and get help to manage your symptoms.

Note: Nocturnal (night-time) leg cramps are different from restless legs. A single jerky movement in the early stages of sleep is common in one third of people and is normal.

The exact cause of RLS is uncertain, but it is thought to involve your nervous system. It may be genetic (a condition that runs in families). If your parents had RLS, your risk of having it is 30–50% higher. 

Pregnancy (usually in the last trimester), can also cause RLS. RLS due to pregnancy often gets better on its own within a month after delivery.

Some medicines may cause RLS, eg, some antidepressants, sedating antihistamines and antipsychotics such as haloperidol, quetiapine or olanzapine.

The common symptom of RLS is that you have a strong, overwhelming urge to move the affected part of your body, usually your leg. Symptoms can range from a mild feeling of restlessness in your legs on some evenings, to a more severe problem that occurs every evening and night (and, sometimes, during the day) which regularly disturbs sleep. Many people fall somewhere in between these extremes.

• You may also get an uncomfortable or tingling sensation such as 'pins and needles', prickling, pulling or crawling.
• These feelings begin about 15 minutes after you lie down to sleep or to relax or when you have not moved for long periods, such as when travelling in a car or airplane.
• Moving will usually make you feel better, at least for a short time. 

Most of the time RLS can be diagnosed by your GP or neurologist without any special tests. However, blood tests may be required to look for possible triggers.

If you have a medical condition causing or aggravating RLS, such as iron deficiency, treating it may resolve your symptoms. A change of medication may be advised if a side effect from a medicine is thought to be responsible.

Lifestyle changes

Sometimes a few lifestyle changes may be enough to control your symptoms such as:

• stopping smoking
• limiting or avoiding alcohol and caffeine
• keep your bedroom cool, quiet and comfortable, and using it only for sleeping, not for watching TV or scrolling through social media
• getting regular exercise – try walking before bedtime or doing gentle leg stretches for 5 minutes before you sleep
• eating a healthy diet
• massaging or soaking the affected leg or arm
• using heat or ice packs on the affected leg or arm
• doing distracting activities such as reading to reduce awareness of symptoms.

Medication

When symptoms are more severe, medicines may help control the urge to move and help you sleep. Different types of medicine may help, such as pramipexole, ropinirole, carbamazepine, gabapentin and pregabalin. You may have to try a few to find the one that works best for you. They each have their own risks and benefits.