It is thought to affect up to 10% of the UK population but is commonly confused with other conditions with similar symptoms. Here’s how to spot the signs of restless legs syndrome and stop an episode in its tracks

If when in bed or relaxing, you notice an overwhelming urge to move your legs accompanied by a tickling sensation underneath your skin, you may be among the estimated 10% of people in the UK that suffers from restless legs syndrome (RLS).

Although not life threatening, severe cases can cause huge disruption to a person’s day-to-day life, manifesting as involuntary spasms in some, and because symptoms can worsen in the evenings and at night, poor quality sleep and insomnia in others. From its symptoms to its causes and treatments, here’s how to spot the signs and reduce RLS episodes in the short and long-term.

What is restless legs syndrome? 

Restless legs syndrome, otherwise known as Willis-Ekbom disease, is a common neurological condition that causes an irresistible urge to move the legs. It can affect the arms, torso and other parts of the body, too, and have an impact on your quality of sleep.  

There are two recognised types.   

The first is primary or idiopathic RLS. While its exact cause is unknown, there is thought to be a genetic link (say, if one of your family members has RLS). It tends to affect those under 40 and it’s progressive in nature, meaning that it worsens with age. 

The other type is secondary RLS, which is thought to be linked with certain medical conditions such as iron deficiency, and certain drugs and medications. Its symptoms tend to develop and come on quickly. 

What are the symptoms of restless legs syndrome?

Symptoms can range from mild to severe and can vary in frequency. Some may experience them every day, while others may have them occasionally. 

The most common symptoms include:  

• An urge to move the legs or arms, usually caused, accompanied or followed by unpleasant crawling or creeping sensations.

• Itchy legs or a tickling feeling in the muscles, almost like you’ve got a scratch that seems impossible to reach.

• Involuntary jerking of the legs and/or arms also known as periodic limb movements (PLM) during sleep.

These symptoms may be triggered by periods of sitting or lying down and can be relieved to a certain extent by walking or stretching. They can also be worse in the evening and during the night.

If it’s not restless legs syndrome, what else could it be?

As with most conditions, there can be a crossover of symptoms. RLS can be confused with ailments such as nocturnal leg cramps, arthritis and deep vein thrombosis to name a few.   If you’re experiencing any of these symptoms or pain or discomfort in your limbs, book in with your GP for a proper diagnosis. 

What can cause restless legs syndrome?

Usually there isn’t an obvious cause. That being said though, there is a genetic link in cases of primary RLS; while secondary RLS may be associated with underlying health conditions such as kidney or thyroid issues, Parkinson’s disease, rheumatoid arthritis or iron deficiency. Certain drugs can also worsen symptoms (these include some antidepressants and antihistamines) as can lack of movement, stress, being overweight, smoking, caffeine and alcohol.

From a neurological level, there is evidence to suggest a link between RLS and the body’s use of the neurotransmitter, dopamine.   

Why is dopamine important? It plays a key role in helping the brain control and coordinate movement. When nerve cells are damaged though this lowers its levels, which can give rise to involuntary muscle spasms. 

Can certain people be more prone to developing restless leg syndrome?

Yes. While anyone can have RLS (including children), women are twice as likely as men to develop it and it is more common in those over 40.   

Genetics play a role when it comes to primary RLS, while underlying health conditions and certain medications can give rise to secondary RLS.  

RLS is also believed to affect one in five pregnant women, commonly in their third trimester. The reason for this is not fully understood; however it’s usually temporary, disappearing around four weeks after birth.  

What causes restless legs at night in bed?

Many RLS sufferers find that their symptoms can be particularly bad at night, but why is that?  

Symptoms can be worsened by lack of movement. Therefore lying down and relaxing in bed for a period of time can be a trigger for some people. 

Dopamine levels can also be a factor. They naturally decrease at the end of the day, which can have an effect on the brain’s ability to regulate and coordinate movement.  

How can restless legs syndrome be treated? 

If you’re experiencing any of the common symptoms of RLS, it is best to book in with your GP for a formal diagnosis. While once unrecognised, knowledge and awareness about the condition have greatly improved to increase chances of successfully identifying and treating any underlying causes such as iron deficiency (iron supplements may be prescribed in these circumstances) and relieve symptoms.  

Treatments can range from lifestyle tweaks to supplementation and medication for more severe cases. The more severe symptoms are, the greater the likelihood that it could be interfering with your sleep. Some RLS sufferers also have insomnia as a result, which can leave them feeling drained, more anxious and suffering from low mood.

To stop restless legs immediately

Try walking, stretching and massaging the affected area. It can also be helpful to apply heat (using a heat pad) to it or have a hot bath. Mental distraction can be useful too, such as reading, doing relaxation exercises or listening to music.  

For mild cases

If symptoms are not due to an underlying health condition, making a few adjustments to your lifestyle may be all that's needed. Examples include giving up smoking, increasing water intake and doing more exercise. Changing your bedtime habits to increase your chances of a good night’s sleep may also help, such as avoiding caffeine and alcohol consumption late at night, creating a relaxing environment and sticking to a regular sleep schedule. 

For more severe cases

If the symptoms are affecting your day-to-day quality of life, your GP may explore the possibility of a course of medication (with exceptions if you’re pregnant or breastfeeding). These include drugs that help address levels of dopamine in the body, painkillers such as codeine for pain associated with restless legs syndrome and treatments that may help with insomnia.

If symptoms persist after trying the above, you may be referred to a sleep specialist or neurologist for further advice. For more support, visit the Restless Leg Syndrome UK website, a charity that provides resources and information for those with RLS and their family and friends. 

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