If you've ever felt an overwhelming urge to move your legs, especially when you're trying to relax or sleep, you might be dealing with restless legs syndrome (RLS). This neurological condition affects millions of people, yet it's often misunderstood or dismissed as just "fidgeting."

RLS is a real medical condition that can significantly impact your quality of life, sleep, and daily functioning.

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What restless legs syndrome feels like

People describe RLS sensations differently, but they share common characteristics that make the condition unmistakable once you know what to look for.

• The sensations typically occur deep inside your legs (in the calves, thighs, or sometimes the entire leg).
• Most people experience it in both legs, although it can be more pronounced on one side.
• The feelings are difficult to describe but often include sensations such as crawling, creeping, pulling, throbbing, aching, itching, or tingling.

What makes RLS distinct is the overwhelming urge to move your legs to relieve these uncomfortable feelings. Moving temporarily helps, but the sensations return when you stop. This creates a cycle where you need to keep moving to find relief.

The symptoms typically worsen when you're at rest, especially when lying down or sitting still for extended periods. Evening and nighttime are typically the worst times, which is why RLS often disrupts sleep.

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How RLS affects your life

Sleep disruption is one of the most significant problems, as the urge to move your legs can make it difficult to fall asleep or stay asleep. You might find yourself walking around at night or constantly moving your legs in bed.

This sleep loss creates a cascade of other issues. Daytime fatigue becomes common, affecting your concentration, mood, and ability to function at work or school. Many people with RLS develop anxiety or depression, partly from the chronic sleep deprivation and partly from the frustration of dealing with an unpredictable condition.

Social situations can become challenging when you need to sit still for extended periods, such as during movies, flights, meetings, or dinner parties. The constant need to move can be embarrassing and disruptive.

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What causes restless legs syndrome

RLS appears to involve challenges with how your brain processes dopamine, a neurotransmitter that helps control movement and mood. In many cases, the exact cause isn't clear (idiopathic), but several factors can contribute to or trigger the condition.

• Iron deficiency and other nutritional deficiencies (Vitamin D, B12, folate, etc.)
• Genetics (about 40-60% of people with RLS have family members with the condition).
• Pregnancy commonly triggers or worsens RLS, especially in the third trimester.
• Chronic kidney disease (likely due to the buildup of waste products that would normally be filtered by healthy kidneys).
• Certain medications can trigger or worsen RLS, including some antidepressants, antihistamines, anti-nausea medications, and antipsychotics.
• Other medical conditions (diabetes, rheumatoid arthritis, and peripheral neuropathy).

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Getting the right diagnosis

There's no specific test for RLS. The diagnosis is based on your symptoms and medical history. Your doctor will ask about the sensations you experience, when they occur, and how they affect your sleep and daily life.

The key diagnostic criteria include the urge to move your legs accompanied by uncomfortable sensations, symptoms that worsen with rest and improve with movement, and symptoms that are worse in the evening or at night.

Your doctor will likely check for underlying conditions that can cause or worsen RLS. Blood tests typically include iron studies (ferritin, iron, total iron-binding capacity), vitamin B12 and folate levels, and kidney function tests.

Sleep studies aren't usually necessary for diagnosing RLS, but they might be helpful if your sleep problems are severe or if your doctor suspects other sleep disorders, particularly sleep apnea which tends to worsen RLS outcomes.

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Treatment approaches that work

Treatment for RLS focuses on managing symptoms and addressing underlying causes when possible. The approach depends on the severity of your symptoms and their impact on your life.

• Iron supplementation is often the first step, especially if your ferritin level is below 75 ng/mL. Even people with "normal" iron levels according to standard ranges may benefit from iron supplementation. This treatment can take several months to show full effects.
• Lifestyle modifications can help many people manage mild to moderate symptoms:
• Good sleep hygiene includes maintaining regular sleep and wake times, creating a comfortable sleep environment, and avoiding caffeine and alcohol, especially in the evening.
• Regular moderate exercise can be beneficial, but intense exercise close to bedtime may exacerbate symptoms. Walking, swimming, or gentle stretching are often beneficial.
• Leg massages, warm baths, heating pads, or ice packs may provide temporary relief. Some people find that compression stockings help.
• Avoiding triggers like OTC antihistamines (e.g. Benadryl or Unisom), caffeine, alcohol, and nicotine can reduce symptom severity.
• Medications may be necessary for moderate to severe RLS that doesn't respond to lifestyle changes and iron supplementation.
• Dopamine agonists like pramipexole (Mirapex) and ropinirole (Requip) are often effective but can cause side effects, including nausea, dizziness, and sometimes compulsive behaviors.
• Alpha-2-delta calcium channel ligands like gabapentin (Neurontin) and pregabalin (Lyrica) are increasingly used as first-line treatments because they have fewer long-term complications.
• Opioids may be used for severe, refractory cases, but they carry risks of dependence and tolerance.
• Treating known sleep apnea helps improve RLS symptoms.

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Managing expectations and avoiding complications

Some RLS medications can cause a phenomenon called augmentation, where symptoms become worse over time, start earlier in the day, or spread to other body parts. This is more common with dopamine agonists and is one reason doctors are increasingly cautious about their long-term use.

RLS is typically a chronic condition that requires ongoing management rather than a cure. Symptoms may fluctuate over time - sometimes improving for months or years, then returning or worsening. Understanding this pattern can help you maintain realistic expectations about treatment.

Working with your doctor to find the right treatment approach may take time. What works for one person may not work for another, and you might need to try several approaches before finding what helps you most.

Support groups and online communities can offer valuable practical tips and emotional support from others who understand what you're going through. RLS can be isolating, and connecting with others who have the condition can be helpful.

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When to seek specialized care

Many people successfully manage their RLS symptoms with appropriate treatment. The key is working with healthcare providers who understand the condition and are willing to work with you to find effective approaches.

Consider seeing a neurologist or sleep specialist if your symptoms are severe, significantly impacting your sleep or daily life, or not responding to initial treatments. Specialists have more experience with the full range of RLS treatments and can help with complex cases. You should also seek specialized care if you experience concerning side effects from medications or if your symptoms change significantly in pattern or severity.

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Book a visit with a Neura Health sleep specialist to discuss your symptoms and explore treatment options that can help improve your sleep and quality of life.

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