Understanding Restless Legs Syndrome: Causes, Triggers and Management

Understanding Restless Legs Syndrome and What Triggers It

Restless legs syndrome (RLS) is a common condition affecting the nervous system. It causes uncomfortable sensations in the legs accompanied by an irresistible urge to move them. The symptoms of RLS tend to follow a distinct daily pattern, disrupting sleep and reducing quality of life.

While there is no definitive cure for restless legs syndrome, treatments can provide relief. Understanding what triggers RLS flare-ups is key to managing symptoms. Let's take a closer look at this perplexing condition, what causes it, and how to ease the restless legs it brings.

Defining Restless Legs Syndrome

RLS is classified as a neurological sensory and motor disorder by the National Institute of Neurological Disorders and Stroke (NINDS). The hallmark symptom is unpleasant sensations deep within the legs when they are at rest, along with an uncontrollable urge to move them.

Common sensations described include throbbing, crawling, creeping, tingling, pulling, itching, burning, aching, and feeling like something is crawling inside the legs. These sensations, often referred to as "creeps" and "crawls," usually affect both legs but can be unilateral. They are felt between the thighs and ankles.

RLS sensations range from mildly uncomfortable to painful enough to significantly disrupt sleep and everyday activities. Symptoms worsen during periods of inactivity and at night. Moving the legs brings temporary relief until sensations return once legs are still again.

Who Gets Restless Legs Syndrome?

RLS affects approximately 7-10% of the U.S. population to some degree. Women are twice as likely as men to develop restless legs syndrome. RLS can affect people of any age, but symptoms usually first appear in middle age.

Having a close family member with RLS increases your risk. Researchers have identified over a dozen gene variants associated with RLS development. There also appears to be a connection between RLS and attention deficit hyperactivity disorder (ADHD).

Primary vs. Secondary Restless Legs Syndrome

Restless legs syndrome is classified as either primary or secondary based on the underlying cause:

• Primary RLS - This idiopathic form has no known cause and accounts for the majority of RLS cases. Genetics likely play a significant role.
• Secondary RLS - This type occurs as a side effect of an underlying medical condition, like iron deficiency, pregnancy, kidney disease, or peripheral neuropathy.

Symptoms of primary and secondary RLS manifest similarly. Identifying and properly managing any underlying condition can improve secondary RLS in some cases.

5 Common Restless Legs Syndrome Triggers

While researchers don't fully understand what causes primary RLS, certain triggers can set off or worsen symptoms:

1. Sedentary Activities

Lack of movement is perhaps the most common RLS trigger. Sitting still for extended periods can bring on sensations within as little as 15-20 minutes for some sufferers. Activities like flying, attending the theater, long drives, desk work, and even watching TV often aggravate RLS.

2. Sleep Disruptions

RLS sensations are usually worst at night and in the evenings. Trying to sleep with crawling, tingling legs makes falling and staying asleep very difficult. The resulting sleep loss then exacerbates RLS symptoms, creating a vicious cycle.

3. Medications

Certain prescription drugs may trigger or worsen RLS as a side effect. These include antidepressants, antihistamines, antinausea medications, and antipsychotics. Withdrawing from benzodiazepines, opioids, and antidepressants can also trigger rebound RLS symptoms.

4. Medical Conditions

Underlying disorders linked to secondary RLS include:

• Iron deficiency or anemia
• Kidney disease and renal failure
• Diabetes, thyroid issues, and autoimmune disorders
• Peripheral neuropathy, Parkinson's disease, and spinal cord disorders
• Pregnancy, especially in the third trimester

Treating connected medical issues may help relieve associated RLS symptoms.

5. Caffeine, Alcohol, and Nicotine

Consumption of nicotine, caffeine, and alcohol can provoke RLS symptoms in some individuals. While reasons are unclear, these substances appear to alter the neurochemical balance in the brain that influences legs sensations.

Cutting back on caffeinated coffee, soda, energy drinks, tobacco, and alcoholic beverages may provide RLS relief for some people.

Dealing With Restless Legs Syndrome

While there is no RLS cure, treatment focuses on managing symptoms for better sleep and daily functioning. Here are some helpful tips for finding relief from restless legs:

Establish Good Sleep Hygiene

Lack of quality sleep exacerbates RLS. Practicing good sleep hygiene helps ensure you are optimizing sleep time. Key tips include:

• Maintain a regular sleep-wake schedule, even on weekends
• Make sure your bedroom is cool, quiet, and dark
• Avoid electronics and large meals before bedtime
• Reduce caffeine, nicotine, and alcohol, especially later in the day
• Wind down with a pre-bedtime ritual like reading

Take RLS Medications

Prescription medications specifically for RLS can reduce symptoms and improve sleep quality. Options include:

• Dopamine agonists like ropinirole or pramipexole
• Benzodiazepines like clonazepam for intermittent relief
• Opioids like oxycodone-naloxone for severe RLS
• Anticonvulsants like gabapentin to calm nerve activity

Over-the-counter pain relievers like ibuprofen may also help mild symptoms. Always consult your doctor regarding medication interactions and side effects.

Try Home Remedies

Some natural therapies help relax the nervous system and limbs, providing temporary respite. Options to try include:

• Massaging legs
• Stretching and yoga poses
• Hot or cold baths
• Relaxation techniques like deep breathing
• Distractions like reading or puzzles

Utilize Compression Stockings

Wearing fitted compression stockings helps improve blood flow in the legs during sedentary tasks. This can reduce or delay RLS sensations. Compression stockings are especially helpful for long car rides and flights.

Exercise Regularly

Getting daily physical activity enhances circulation and mobility in the legs. Aim for at least 30 minutes per day of moderate exercise like walking, cycling, swimming, or strength training.

Exercising in the mid-afternoon rather than evening may also help avoid late-day RLS flare-ups.

Manage Underlying Conditions

For secondary RLS, properly managing any underlying medical issues can sometimes alleviate symptoms. This may include supplementing iron and folic acid for deficiency, kidney dialysis, correcting thyroid dysfunction, or adjusting problematic medications.

Pregnancy-related RLS usually resolves after delivery. Discuss any persistent RLS after pregnancy with your doctor.

Seek Further Treatment if Needed

Severely restless legs interfering with sleep and daily function may require more intensive treatments like:

• Prescription strength medication adjustments
• Iron infusions for deficiency
• Pneumatic compression devices
• Transcutaneous electrical nerve stimulation (TENS)
• Deep brain stimulation in extreme refractory cases

A sleep specialist can also help uncover any underlying sleep disorders worsening your RLS.

Achieving RLS Relief

Coping with RLS requires some trial and error to find the right treatments and lifestyle adjustments for your needs. Keep notes on triggers to avoid and remedies that provide relief. See your doctor to develop an effective treatment plan.

While restless legs can be aggravating, a combination of medical care, home remedies, routine exercise, proper sleep habits, and trigger management can significantly minimize disruptive symptoms.

Implementing a few simple lifestyle changes and RLS management strategies helps most people control symptoms and improve restfulness both day and night.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.