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Restless Leg Syndrome

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Restless legs syndrome causes burning, itching, crawling sensations in the legs and the victim feels a need to move the limbs to seek relief.
Alternative names:  Nocturnal myoclonus; RLS

Definition:  Restless leg syndrome is a sleep disorder characterized by leg discomfort during sleep, which is only relieved by frequent movements of the legs.

Causes, incidence, and risk factors:  Restless leg syndrome (RLS) is often diagnosed and treated beginning in middle-aged adults when it is worsened by stress, and they seek their ARNP/Doctor for relief. The cause is not known.

The disorder consists of sensations in the lower legs that make the person uncomfortable unless the legs are moved. The sensations usually occur shortly after going to bed but may also occur during the daytime.

The abnormal sensations occasionally occur in the upper leg, the feet or the arms in addition to the lower leg. In some cases, no other medical or neurological condition is identified. However, restless leg syndrome may occur in patients with peripheral neuropathy or other neurological disorders.

There is an irresistible urge to walk or move the legs to relieve the discomfort, resulting in periodic episodes of leg movements during early sleep stages. The symptoms may last for 1 hour or longer.

Restless leg syndrome can result in a decreased quality of sleep (insomnia) with subsequent daytime sleepiness, anxiety or depression, and confusion or slowed thought processes from lack of sleep.

Symptom Review
· Sleeping difficulty
· Persistent leg movements during sleep hours
· Irresistible urge to move the legs
· Abnormal sensation in the legs (occasionally, feet, thighs, arms)
· Creeping sensations or discomfort (not pain, not cramps) relieved by movement of the legs
· May occur during the day
· Worse when lying down

Note: Symptoms may be worse during stress or emotional upset, or suffering from affective/mood disorders that are undiagnosed, untreated or undertreated.

Are your legs keeping you up at night? Do you dread long business meetings, going to the movies, or traveling on an airplane because you know your restless legs won't let you sit still? You just know you'll have to get up to relieve the discomfort in your restless legs, disturbing your work colleagues, other moviegoers, and fellow passengers.

If this sounds familiar, you may have Restless Legs Syndrome (RLS), which includes mild, moderate, and severe symptoms and affects approximately 1 in 10 adults in the U.S. RLS is a common medical condition characterized by an uncontrollable urge to move the legs when sitting or lying down.

Other Associated Signs and tests
There is no specific examination for restless leg syndrome. No structural or other abnormalities are usually discovered unless peripheral nerve disease is also present. Your Psychiatric ARNP may order a blood test to be done to rule out anemia, which rarely has been associated with restless leg syndrome... Symptoms of RLS such as tingling sensations in the leg can be similar to symptoms of other disorders, so only your ARNP/doctor can diagnose RLS. There are no specific tests to diagnose RLS. Diagnosis of Restless Legs Syndrome is based on your symptoms, your medical history, and a medical examination. Blood tests may be done to rule out other conditions that may cause similar symptoms, especially disorders associated with claudication (or intermittent claudication; Vaso-occlusive disease of the legs; Arterial insufficiency of the legs; Recurrent leg pain and cramping; Calf pain with exercise) of the legs, which is defined as poor circulation and blockage of blood in the leg arteries produces an aching, tired, and sometimes burning pain/sensation in the legs that is brought on by exercise, and relieved by rest. The limping that occurs from leg cramps is called claudication of the legs.

If you think you're experiencing the symptoms of Restless Legs Syndrome (RLS), such as restless leg sensations, see your Psychiatric ARNP. Warm baths, gentle stretching exercises, massage or similar techniques may promote muscle relaxation.  If sleep is severely disrupted, medications such as Sinemet (an anti-Parkinson's medication) or tranquilizers such as clonazepam may be helpful to some people, but they may worsen daytime sleepiness in others. Low doses of Pramipexole, a dopamine agonist, has been found to be very effective in controlling symptoms in some people.

Sometimes low doses of narcotics will relieve symptoms of restless leg syndrome as well, in addition to Requip, a prescription medication, the first and only medication approved by the FDA for the treatment of moderate-to-severe primary Restless Legs Syndrome.

Expectations (prognosis): Primary Restless Legs Syndrome is a chronic condition that can worsen over time, so your doctor may want to evaluate you and consider adjusting your dose of Requip and/or other appropriate medication.

Complications: Insomnia may occur.
Calling your psychiatric ARNP: Call for an appointment with your health care provider if symptoms of restless leg syndrome are present and sleep is disrupted.

Prevention: Techniques to promote muscle relaxation and stress reduction may reduce the incidence of restless leg syndrome in people prone to the condition.  See your psychiatric nurse practitioner frequently for routine mental healthcare maintenance.



Contact Rainier Professional Psychiatry