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Guide Health: Restless leg syndrome

Why is this condition under-recognized?

Restless leg syndrome is just what its name suggests, an uncontrollable urge to move your legs, especially at night or late in the day.

Restless leg syndrome can also create unpleasant sensations in the legs, sometimes even deep within the legs.

These symptoms are most noticeable at rest, such as when you are in bed, which is why moving or stretching your legs seems to help.

Also called Willis-Ekbom disease, restless leg syndrome tends to be under-recognized and under-diagnosed, with many people attributing their symptoms to other conditions including generalized tiredness or a pulled muscle.

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More older people are affected, with estimates as high as 15 per cent of the Canadian population having these symptoms. However, this is just a guess because so many people choose to cope with the symptoms on their own and don’t report them.

Women are affected twice as often as men, and in about 75 per cent of cases, there seems to be a family history of the syndrome.

Restless leg syndrome can be associated with other conditions, for example pregnancy, kidney disease, iron deficiency, Parkinson’s disease, diabetes nerve disease, rheumatoid arthritis, and Lyme disease.

It follows that treating the underlying condition is an effective strategy for lessening the symptoms of restless leg syndrome.

Nutrition does seem to have a role as well. In addition to iron deficiency, the lack of other minerals can be problematic, for example vitamin B12, folic acid, and magnesium.

Supplementation, especially with iron, is often a first step. However, good overall health is considered the starting point.

Treatment focuses on non-drug approaches. Because daytime tiredness is the most noticeable symptom, the focus is on getting a good night’s sleep.

Good sleep habits include avoiding caffeine, alcohol and nicotine. A hot or cold bath prior to bed may also be recommended.

Exercise, massage, and whirlpool baths may help reduce symptoms too and may improve your overall sleep.

In some instances a drug side-effect may be the cause of a patient’s restless leg syndrome.

Some anti­depressants like fluoxetine, diphen­hydramine, tricyclic drugs like amitriptyline, lithium, beta blockers, and even several acid reducers like omeprazole can cause symptoms of restless leg syndrome.

Reducing the dose or changing the drug may be possible.

Medications used to treat the symptoms work through the nervous system and include pregabalin, pramipexole, ropinirole, and the carbidopa/levodopa combination.

These drugs are actually indicated for other conditions, but clinicians have noticed that they may be effectve in improving restless leg symptoms.

Success rates vary, however, and once started you may not be able to stop these medications without your symptoms worsening.

Opioids such as acetaminophen with codeine alleviate the discomfort associated with restless leg syndrome. However, they are best used for intermittent or breakthrough symptoms. Constipation, sedation, and dependency are drawbacks with opioids.

Because restless leg syndrome can interfere with sleep and result in daytime drowsiness, it makes sense to get checked if you think you might be affected.

You certainly don’t want to fall asleep while driving or in the middle of a task that requires your full attention!

About the author

Contributor

Marie Berry is a lawyer/pharmacist interested in health and education.

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