How to fix restless legs syndrome

Neurological Disorders

Info

RLS, also known as Willis-Ekbom Disease, is a neurological and sleep-related condition that produces an irresistible impulse to move the legs and painful sensations like crawling, itching, throbbing, or pulling.

Restless legs syndrome.

Symptoms

• Start or worsen while sitting or lying down,
• Are momentarily eased by walking or stretching,
• Nighttime intensity increases.
• It can interrupt sleep and cause daytime weariness, mood swings, and concentration issues.

RLS can affect everyone; however, it appears more in women and worsens with age. Primary RLS can occur alone or in conjunction with iron deficiency, kidney illness, or pregnancy.

No cure, however, lifestyle modifications, addressing causes, and symptom-management drugs are available.

Restless Legs Syndrome types

Based on the onset of symptoms and the identification of a specific cause, we categorize Restless Legs Syndrome (RLS) into two primary forms:

Idiopathic RLS

• It typically occurs before the age of 45.
• The cause of idiopathic RLS is unknown, but it often runs in families, indicating a genetic component.
• Slow progression: Symptoms may intensify over time.

Secondary RLS

• It typically manifests after the age of 45.
• Iron deficiency, kidney illness, diabetes, Parkinson's disease, and pregnancy can cause it.
• Treatment for the underlying cause may lead to unexpected symptom onset and improvement.

Some publications also identify two subtypes of RLS: early-onset and late-onset.

• Early-onset: Genetic and modestly progressing.
• Late-onset: Secondary and faster-progressing.

RLS Signs and Symptoms

RLS causes sensory and motor problems that interrupt sleep and rest. The hallmark symptoms are

Main Symptoms

• The urge to move the legs usually causes discomfort.
• Sitting or lying down worsens symptoms.
• Walking, stretching, or jiggling the legs provides temporary alleviation.
• During the night, it becomes more difficult to fall asleep.

Sensation descriptions

The sensations are often described as

• To crawl
• Tugging
• Burning or itching
• Aching or throbbing
• Buzzing or electric emotions

These sensations frequently occur deep in the legs on both sides. Sometimes the arms are involved.

Sleep-Related Issues

• Trouble falling or staying asleep
• Twitching or jerking legs at night (frequently associated with PMD)
• Poor sleep causes daytime weariness, irritation, and concentration issues.

Cognitive and emotional effects

• Depressive or anxious moods
• Trouble focusing or remembering
• Lower productivity and living quality
• Symptom strength and duration vary. 
• Some people have remissions, especially early on.

Also, read https://rls.bio/.

Restless Legs Syndrome Causes and Risks

Restless Legs Syndrome (RLS) has genetic, neurological, and systemic causes. Below is a list of key causes and risk factors.

The main causes

• Families often experience RLS, particularly when symptoms first manifest before the age of 40. Multiple gene variations are associated with the disorder.
• Dopamine Dysfunction: Like Parkinson's disease, brain dopamine circuits can alter muscle control and cause RLS symptoms.
• Iron deficiency in the brain, such as in the substantia nigra, can decrease dopamine production and cause RLS even with normal blood iron levels.

Secondary causes (underlying conditions)

• Iron loss, inflammation, and metabolic abnormalities cause RLS in chronic kidney disease (CKD) patients, especially dialysis patients.
• Changes in hormones, especially in the third trimester, might cause transient RLS symptoms.
• Diabetes and other diseases can damage peripheral nerves, increasing RLS risk.
• Others: RLS is linked to Parkinson's, rheumatoid arthritis, and fibromyalgia.

Risk factors

• Risk increases with age, especially after 45.
• Females are more likely to have RLS, probably due to hormones.
• Low Iron Stores: Low ferritin or transferrin saturation causes worry even without anemia.
• Antihistamines, antidepressants, and antipsychotics may aggravate symptoms.
• Lifestyle factors: Nighttime caffeine, alcohol, and tobacco usage might worsen RLS.

Diagnostics of Restless Legs Syndrome

Clinical diagnosis of Restless Legs Syndrome (RLS) relies on symptoms and medical history. Healthcare providers usually approach it:

Diagnostic Criteria (International RLS Study Group)

To certify a diagnosis of RLS, all of the following criteria must be present:

The patient must experience an uncomfortable urge to move their legs.

• Resting causes or worsens symptoms.
• Relaxation by walking or stretching.
• Nighttime deterioration.
• Arthritis or leg cramps do not cause the symptoms.

Tests to support

• No lab test can prove RLS; however, doctors may prescribe
• Doctors recommend blood tests due to the correlation between RLS and low brain iron (ferritin).
• Neurological exam: To rule out neuropathy.
• Polysomnography: Although it is rarely necessary, doctors may perform it if they suspect sleep apnea.

A Differential Diagnosis

• Doctors will also evaluate and rule out:
• Neuropathy peripheral
• Leg cramps at night
• Arthritis
• Movement or anxiety problems

Restless Legs Syndrome Treatment and Medication

Treatment for Restless Legs Syndrome (RLS) involves lifestyle changes, addressing its causes, and using medications. The overview follows a structured format:

Home remedies and lifestyle

The video about natural treatment for RLS.

These are usually the first steps for mild symptoms:

• Exercise regularly (but not before bed)
• Pre-bedtime massage or stretching
• Heated baths or pads
• Avoiding caffeine, alcohol, and nicotine at night
• Good sleep hygiene: regular bedtime, cool/dark room, no screens.

Medication

For moderate-to-severe symptoms or sleep disturbances, doctors may prescribe:

1. First-line Calcium Channel Alpha-2-Delta Ligands

• Pregabalin, Gabapentin enacarbil,
• Reduce nerve pain
• Side effects: dizziness, fatigue, weight gain.

2. Dopamine agonists

• Pramipexole, Ropinirole, Rotigotine patch
• Reduce symptoms by mimicking dopamine
• Risk: symptom worsening, impulse control issues

3. Iron Supplement

• To people with low ferritin or iron stores, even without anemia
• Ferric carboxymaltose can be taken orally or intravenously.

4. Other Choices

• Opioids, such as tramadol and oxycodone, are prescribed for patients with severe symptoms who do not respond to other treatments.
• Clonazepam may aid sleep, but not fundamental symptoms.

Treatment of underlying conditions

Addressing the etiology of RLS, such as iron deficiency, kidney disease, or pregnancy, can improve symptoms.

Alternative and Complementary Medicine

Several alternative and complementary therapies have shown potential in treating Restless Legs Syndrome (RLS) and increasing sleep quality:

Physical and Sensory Therapies

• Acupuncture: Stimulating body points may lessen leg pain and nighttime movements.
• Massage works well before bedtime to improve circulation, relax muscles, and release dopamine.
• Near-infrared light treatment (NIR): Low-energy light may relieve nerve pain in neuropathy patients.
• Warm baths and cold packs help relieve leg pain and flare-ups.

Approaches based on nutrition and supplements

Iron supplementation: Essential for low ferritin levels, even without anemia. Never supplement without testing.

• Natural muscle relaxant magnesium may reduce twitching and promote sleep.
• Some people with B12 and D deficiencies have worsening symptoms.
• Folic acid may relieve symptoms, although data is limited.
• Use Mind-Body Techniques
• Yoga and stretching: Gentle exercises reduce muscle stress and improve sleep.
• Meditation and deep breathing alleviate stress, a proven RLS trigger.
• Progressive muscular relaxation: A guided method to quiet the nervous system and relax muscles.

Other emerging options

• Electrical stimulation or vibration therapy, such as foot and leg stimulators, may be beneficial when used before bedtime.
• Foot wraps and pneumatic compression devices may help some people.
• In mild situations, these therapies can serve as a supplement to traditional treatments or stand alone.

Restless Legs Syndrome Prevention

Restless Legs Syndrome (RLS) prevention involves reducing risk factors and adopting nerve- and brain-healthy routines. Although genetic RLS cannot be prevented, several methods may help lessen its symptoms:

Take care of root causes.

• Low ferritin is a primary cause. Treatment of iron deficiency early can prevent symptoms.
• Controlling chronic illnesses like diabetes, renal disease, and peripheral neuropathy can prevent subsequent RLS.
• Medication review. Antihistamines, antidepressants, and antipsychotics may aggravate RLS. If a new drug causes symptoms, consult your doctor.

Adjustments to lifestyle

• Stay active: Moderate exercise boosts circulation and lowers symptoms. Avoid hard workouts before bed.
• Maintain a healthy weight: RLS risk increases with obesity. Even small weight loss helps.
• In the evening, limit caffeine, alcohol, and nicotine, which can worsen symptoms and interrupt sleep.

💤 Sleep hygiene

• Maintain a sleep schedule: Consistent bedtime and waketime support the circadian rhythm.
• Relax with warm baths, mild stretching, or reading before bed.
• Maintain a cool, dark, and quiet bedroom for better sleep.

Reduced stress

• Reduce nervous system overactivity by meditation, deep breathing, or progressive muscle relaxation.
• Treat anxiety and depression: They might aggravate RLS and sleep. 

These strategies can help if you're at higher risk owing to family history or pregnancy. 

Restless Legs Syndrome lifestyle changes

When symptoms are mild to moderate, lifestyle adjustments might help manage Restless Legs Syndrome (RLS).

• Physical activity and movement
• Regular activity like walking, yoga, or swimming might lessen discomfort. Avoid strenuous workouts before bedtime.
• Try calf, hamstring, or ankle stretches before bed to relieve nighttime pain.
• Massage therapy: Regular leg rubs or massage guns can relax muscles and mask pain.

💤 Sleep hygiene

• Daily sleep schedule: Go to bed and wake up at the same time.
• Set a nightly routine: Warm baths, reading, or mild stretching will help you relax.
• Optimize sleep: Keep your bedroom cold, dark, and quiet. A weighted blanket may help you feel grounded.

• Diet and supplements

• Caffeine and alcohol, especially at night, might aggravate symptoms and interrupt sleep.
• If ferritin levels are low, consume spinach, lentils, and lean meats, and take supplements.
• Consult your doctor before adding magnesium and B vitamins for nerve health.

Be aware of stress and medication.

• Relax the nervous system using meditation, deep breathing, or progressive muscle relaxation.
• Medication review. Antihistamines, antidepressants, and antipsychotics can worsen RLS. Consult your doctor for options.

Restless Legs Syndrome complications

• Restless Legs Syndrome (RLS) may seem harmless, but, untreated, especially in moderate to severe cases, it can cause various physical and emotional issues:

Sleep disturbance

• One of the most prevalent effects is chronic sleeplessness. Leg movement can make it difficult to fall or remain asleep.
• This causes daytime weariness, low attentiveness, and poor attention.

🧠 Mental and emotional impacts

Chronic sleep loss can cause:

• Memory issues
• Trouble focusing
• Depressive and anxiety disorders
• Work performance, relationships, and quality of life might suffer over time.
• A worsening of underlying conditions

Secondary RLS symptoms, if untreated, can worsen:

• Chronic Kidney Disease (CKD) is particularly prevalent among dialysis patients, who often experience Restless Legs Syndrome (RLS) and are frequently associated with iron deficiency.
• Diabetic peripheral neuropathy can increase nerve pain.

🔁 Supplement

Dopamine agonist medication can cause amplification when symptoms start earlier, intensify, or spread to additional body areas.

• This can complicate long-term management.
• Impairment in social and functional areas
• Due to sitting pain, severe RLS sufferers may avoid extended flights, movies, and meetings.
• The condition might cause social isolation and decreased daily activity.
• Early diagnosis and customized therapy can prevent many consequences. You can choose to do so.

Exercise Optimization for Restless Legs Syndrome: 8 Tips

Exercise helps manage RLS, so here's how to do it safely and successfully.

1. Maintain Routine

2. Avoid strenuous exercise before bed.

3. While exercising, wear compression stockings

4. Select Moderate Exercises

5. Use Lower-Body Stretches in Exercise

6. Do Exercise Daily

7. Listen to Your Body

8. Get Massaged

Conclusion

Effective management combines Physical activity, sleep hygiene, caffeine/alcohol avoidance, and fixing concerns like low iron. Pharmaceuticals or alternative therapies such as massage, yoga, or acupuncture can be used when necessary. RLS can cause insomnia, emotional difficulties, and social disengagement if untreated. However, with the appropriate techniques, most individuals can experience significant relief.