Restless Leg Syndrome (RLS) is a complex and poorly understood medical condition. Ask ten people about their triggers, experience, and treatments and you'll get eleven different answers.
Before going down the rabbit hole of treatment options, it is first important to understand what Restless Leg Syndrome (RLS) is and the different types of RLS.
What is Restless Leg Syndrome (RLS)?
Restless Leg Syndrome (also known as Willis-Ekbom Disease) is a constellation of symptoms that fall within a particular pattern. The International Restless Leg Syndrome Study Group (IRLSSG.org) developed a robust list of diagnostic criteria for Restless Leg Syndrome:
- A strong, often irresistible urge to move your legs, often accompanied by uncomfortable sensations
- Symptoms tend to appear or worsen when you are at rest (such as in bed, on a plane, or on a long car ride)
- Your symptoms are partially and/or temporarily relieved by movement, massage, or stretching
- Symptoms worsen at night
- Symptoms cannot be solely attributed to another medical condition
Restless Leg Syndrome (RLS) is recognized by the National Sleep Foundation as a sleep disorder that can cause mild to severe sleep disturbances. As with most sleep related condition, impacts can include exhaustion, fatigue, irritability, anxiety, depression, decreased cognitive function, and decreased productivity. For many, RLS symptoms are most prominent around bed time and while trying to sleep, which can make this condition especially troublesome for those that suffer from it. Unlike many other sleep conditions which allow the patient to sleep, albiet interrupted, RLS can completely prevent those that suffer from the condition from sleeping at all during a flare up.
Restless Leg Syndrome (RLS) affects both men and women but is more common in women than men - by about 2.5x. Restless Leg Syndrome (RLS) also tends to increase in prevalence and severity with age. Approximately 7-10% of the US population is impacted by Restless Leg Syndrome (RLS) with prevalence higher in older populations. While older populations are the predominant set of confirmed cases, children as young as two years old also exhibit RLS symptoms and represent a not-insignificant portion of confirmed cases.
Troublingly, Restless Leg Syndrome is only accurately diagnosed in roughly 6-7% of cases which can make finding effective treatment all the more difficult.
Some conditions, such as Periodic Limb Movement Disorder (PLMD), are highly comorbid with Restless Leg Syndrome (RLS). Approximately 80% of confirmed RLS cases present with PLMD, while only a small percentage of confirmed PLMD cases present with RLS.
Additional information can be found in our resources blog as well as with the Mayo Clinic, IRLSSG, NIH, and others.
Two Types of Restless Leg Syndrome
There are two types of Restless Leg Syndrome. In order to properly manage and advocate for one's condition, it is important to understand the forms RLS can take, consult a doctor, and determine what type of RLS one is experiencing. The information below is available from the National Institute of Health.
Primary RLS is a form of Restless Leg Syndrome that has no known cause. Generally considered to be due to genetics, this form of RLS is more common and generally appears earlier in life than Secondary RLS. Some gene variants are associated with Restless Leg Syndrome and some emerging evidence suggests that in some cases it may be associated with low levels of iron in the brain. Evidence also exists to indicate that RLS may be associated with dysfunction in one of the sections of the brain that control movement due to dopaminergic malfunction. As dopaminergic function is impeded, involuntary movements can occur. Parkinson's Disease is an example of this type of dopaminergic malfunction and Parkinson's patients have an increased likelihood of developing Restless Leg Syndrome.
Secondary RLS is a form of Restless Leg Syndrome that may occur due to an underlying condition. Those conditions and triggers can include, but are not limited to:
- Iron deficiency
- End-stage renal disease and hemodialysis
- Medication that may aggravate RLS symptoms such as: anti-nausea drugs, antipsychotic drugs, antidepressants that increase serotonin, antihistamines
- Alcohol, Nicotine, and Caffeine
Additionally, other sleep conditions such as sleep apnea, may cause or worsen RLS symptoms. By reducing or eliminating these factors, some people may experience various degrees of relief.
While there is no cure for Restless Leg Syndrome (RLS), a number of treatment options exist with various degrees of reported relief. No single treatment has been proven safe and effective for all confirmed cases of Restless Leg Syndrome. As there is no test for RLS, diagnosis is made by a doctor's evaluation against the criteria mentioned above.
Occasionally, RLS symptoms may be reduced by treating the underlying condition such as iron deficiency, neuropathy, or diabetes.
Iron supplementation may be effective for those whose condition is caused by iron deficiency.
Always speak to your doctor before starting or stoping any medication as drugs may have series side effects or interactions.
Anti-Seizure drugs show promising results in some patients. The FDA has approved gabapentin enacarbil for the treatment of moderate to severe RLS. There appears to be no or limited risk of augmentation with this regimen. Other anti-seizure drugs can decrease sensory disturbances such as creeping or crawling sensations as well as nerve pain. Side effects may include dizziness, fatigue, and sleepiness.
Dopaminergic agents are largely used to treat Parkinson's Disease but also show some positive results for RLS patients, as they can increase the dopamine effect. The FDA has approved ropinirole, pramipexole, and rotigotine to treat moderate to severe RLS. Side effects may include nausea, dizziness, impulsive or obsessive behavior, and other short-term side effects. While generally effective in the short term, long term use can lead to worsening symptoms and lower effectiveness of the prescriptions (also known as "augmentation"). In addition, symptoms may begin to appear earlier in the evening or even present around the clock. This progression can be reverse by removing all dopaminergic drugs from the patient's regimen.
Opioids are another class of drugs that show some promise for RLS relief. Methadone, codeine, hydrocodone, or oxycodone are sometimes prescribed to treat more individuals with more severe cases of RLS that did not respond to other drug classes. Side effects may include constipation, dizziness, addiction, exacerbation of sleep apnea, and nausea.
Benzodiazepines can help individuals obtain more restful sleep. Drugs such as clonazepam and lorazepam are generally prescribed to treat anxiety, muscle spasms, and insomnia. Side effects may include severe drowsiness, daytime sleepiness, reduced energy, and can affect concentration. These drugs may also induce or aggravate sleep apnea and should not be used in patients with this condition. These are generally considered last-line drugs due to their side effects.
Foot wraps for Restless Leg Syndrome are an emerging area of research that, so far, has shown mixed results. While a low risk treatment category, foot wraps tend to provide relief only while applied to the feet or legs and can be clunky or uncomfortable to wear in bed. For most RLS patients, RLS symptoms are most pronounced when laying in bed and trying to sleep and this can inhibit the help that foot wraps attempt to provide
Topical products are an interesting area of RLS relief. Another low risk category, topicals pose an opportunity for relief if they have the right ingredients. When searching for a topical product for RLS relief, it is important to identify products with a known mechanism of action. Many products on the market claim to "promote calm" through the use of ingredients like lanolin or chamomile. These types of products tend to produce more of a placebo effect rather than meaningful and lasting relief. As they are low risk, if your budget allows for testing multiple products, this may be a good avenue for some.
At Full Eight, our topicals utilize a known mechanism of action called Gate Control Theory. We have an entire page dedicated to Gate Control so we won't be too redundant here, but the basic concept is that you use one sensation to block another. By using safe, natural, and effective ingredients, Full Eight can deliver where other products fail. We are proud to carry an FDA monograph so that our customers can Rest Better knowing that our active ingredient is safe and effective as a topical analgesic.
Where can I get more information?
P.O. Box 5801
Bethesda, MD 20824
Information also is available from the following organizations:
Restless Legs Syndrome Foundation
3006 Bee Caves Road, Suite D206
Austin, Texas 78746
National Organization for Rare Disorders (NORD)
55 Kenosia Avenue
Danbury, CT 06810
Voice Mail 800-999-NORD (6673)
National Sleep Foundation
1010 N. Glebe Road, Suite 310
Arlington, VA 22201
American Sleep Association
1002 Lititz Pike #229
Lititz, PA 17543
National Heart, Lung, and Blood Institute (NHLBI)
National Institutes of Health, DHHS
31 Center Drive, Room 4A21
Bethesda, MD 20892-2480