How Often Do Symptoms Occur
The frequency of symptoms can vary from person to person. Moderate cases of RLS typically see symptoms occur about once or twice a week, while severe cases may cause symptoms to appear more than two times a week.
Sometimes RLS symptoms may go away for weeks or months at a time before reappearing. This typically happens in the early stages of developing this condition.
Risk Factors For Periodic Limb Movement Disorder
About 6% of the general population has PLMD. However, the prevalence in older adults is much higher, reaching almost 60%. Studies suggest that PLMD may be especially common in older women. As with RLS, there are many conditions that are associated with PLMD. They include sleep apnea, spinal cord injuries, stroke, narcolepsy, and diseases that destroy nerves or the brain over time. Certain drugs, including some antidepressants and anti-seizure medications, may also contribute to PLMD. About a third of people with PLMD also have RLS.
The Association Of Rls With Venous Insufficiency
Those who treat varicose veins have long heard from their patients descriptions of throbbing, buzzing, creepy-crawly pains in the lower extremities symptoms that sound very similar to those of RLS. Restless legs syndrome has long been accepted as a symptom of venous insufficiency by phlebologists. It was McDonagh, et al., in 2007 who published the paper, Restless legs syndrome in patients with chronic venous disorders: an untold story. This case- control study found a significant difference between the cases and controls . The clinical difference found between the two groups was a higher prevalence of cramping symptoms in the group with both RLS and venous insufficiency when compared to the control group that had RLS without venous insufficiency.
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Lifestyle Changes To Ease The Symptoms
Simple lifestyle changes can lessen the symptoms of restless legs syndrome. As caffeine can worsen symptoms, drinking coffee, tea, and soft drinks containing caffeine and eating chocolate should be reduced or stopped altogether. Also, since the consumption of alcohol and the use of tobacco products increase the duration or intensity of symptoms you should also reduce or eliminate them.
Fatigue and drowsiness tend to worsen symptoms. Therefore, having good sleep hygiene is often helpful to feel well rested and, over time, reduce symptoms. Sleep hygiene includes ensuring that the sleeping environment is comfortably cool and quiet, going to bed at the same time every night, and getting up at the same time every morning. For more information about sleep hygiene, read our article about it.
A variety of activities also provide effective, although temporary, relief: walking, stretching, taking a hot bath, massaging the affected limb, and applying hot or cold packs. When movement is impossible or restricted, as when travelling, distracting activities can be helpful, such as reading a gripping novel, performing intricate needlework, or playing video games.
How Is Restless Legs Syndrome Diagnosed
Since there is no specific test for RLS, the condition is diagnosed by a doctors evaluation.; The five basic criteria for clinically diagnosing the disorder are:
- A strong and often overwhelming need or urge to move the legs that is often associated with abnormal, unpleasant, or uncomfortable sensations.
- The urge to move the legs starts or get worse during rest or inactivity.
- The urge to move the legs is at least temporarily and partially or totally relieved by movements.;
- The urge to move the legs starts or is aggravated in the evening or night.
- The above four features are not due to any other medical or behavioral condition.
Diagnosing RLS in children may be especially difficult, since it may be hard for children to describe what they are experiencing, when and how often the symptoms occur, and how long symptoms last.; Pediatric RLS can sometimes be misdiagnosed as “growing pains” or attention deficit disorder.
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Periodic Limb Movement Disorder
Periodic limb movement disorder is also known as nocturnal myoclonus. Characteristics of PLMD include:
- Nighttime episodes that usually peak near midnight .
- Contractions and jerking of the leg muscles every 20 to 40 seconds during sleep. These movements may last less than 1 second, or as long as 10 seconds.
- Movements of PLMD do not wake the person who actually has it, but they are often noticed by their bed partner. This condition is distinct from the brief and sudden movements that occur just as people are falling asleep, which can interrupt sleep.
- Association with RLS: Four out of five people who have RLS also report having PLMD, but only a third of people with PLMD report having RLS.
While treatments for the two conditions are similar, PLMD is a separate syndrome. PLMD is also very common in narcolepsy, a sleep disorder that causes people to fall asleep suddenly and uncontrollably.
What Are The Signs Of Restless Leg Syndrome
Restless legs syndrome is essentially characterized by an unpleasant feeling in the legs that leads to an urge to move them. Characteristically, the unpleasant sensations come on or intensify during resting periods in the evening or at night, as well as during the day, and these unpleasant sensations disappear completely or partially when the legs are moved.
The unpleasant sensations are usually in the form of tingling, prickling, itching, burning, tightness, or a feeling of electric shock, but are sometimes poorly described by the patient. Sometimes legs can be painful too.
These signs may be more pronounced in one leg than the other. In severe cases, they may also affect the arms.
These unpleasant sensations are usually accompanied by involuntary movements during sleep that especially disturbs the person laying next to the patient in bed.
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Replace The Urge To Move
When your legs are tingling, throbbing or hurting, it can be difficult for the brain to focus on anything else. One way to break the cycle is to replace the urge to move with another sensation.
Any kind of counterstimulation, like taking a bath or shower in the evening, can be helpful, Dr. Vensel-Rundo says. Even rubbing or massaging the legs can provide temporary relief.
Light stretching can help, but rigorous exercise before bed isnt a good idea, she says.
Restless Legs Syndrome Triggers
Sitting or resting are common triggers for RLS symptoms. Additionally, some substances can make symptoms worse. These include:
- Medications, including certain drugs used to treat nausea, colds and allergies, and mental health conditions
Incidentally, most of these substances when taken in excess or too close to bedtime can also adversely affect our sleep architecture.
Restless Legs Syndrome And Mental Health
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Restless legs syndrome and mental health have a chicken and egg relationship. People with RLS often have depression, anxiety, and other mental health issues. And, people with mental health issues often have restless legs.
Plenty of evidence exists to prove that restless legs syndrome and mental health are closely tied, including:1-3
- About 4 of every 10 people with RLS also have a psychiatric condition like depression, anxiety, or post-traumatic stress disorder .
- RLS can cause insomnia and insomnia is one of the 9 symptoms used to diagnose major depression.
- The worse the RLS symptoms, the more likely someone is to be diagnosed with a serious mental health issue.
- In most people, their mood disorder appeared after their RLS symptoms began, which means RLS may cause or aggravate depression or anxiety.
Using My Tools For Both Rls And Gad
On those days I try and practice some of the lifestyle and psychological tools Ive been taught. Stretching, listening to music, distractions, going for a walk, cooking, working, talking to a friend, getting out in nature, binge-watching Netflix, doing a workout.
All these things tend to be useful for my restless legs and my anxiety, so I dont have to wonder whats going on. Its kind of cool really. Because the reality is, if I leave the legs to get more restless, my anxiety about the restlessness will increase. If I leave the anxious shaking to get more distressed, the stress can cause the RLS to kick in for me. Then Im super shaky and very distressed and all I really needed was a cup of tea and a dozen pushups.
What Could Be Confused With Restless Leg Syndrome
Nocturnal cramps may be confused with restless legs syndrome, but in this case, there is an obvious contraction of a muscle or muscle group.
Some neurological conditions can resemble restless legs syndrome: This is the case with sciatica. This may also be the case with early polyneuritis, in which there is paresthesia in the areas innervated by the affected nerves.
Venous insufficiency can also cause uncomfortable sensations in the legs that predominate at the end of the day, but these sensations are usually accompanied by swelling of the legs, even varicose veins, and are greatly relieved by lying down and elevating the legs.
Arterial damage in the lower limbs can also cause unpleasant sensations at night, but during the day there are usually painful cramps and a significant decrease in the pulse rate in the lower limbs.
Main Features Of Restless Legs Syndrome
The main feature of restless legs syndrome is the presence of troublesome, but usually not painful, sensations in the legs that produce an irresistible urge to move. It is often difficult to describe these sensations, but terms such as creeping, burning, itching, pulling, aching, or tugging are frequently used. Sometimes people experience sharp “pins and needles” or numb feelings as well. Children often describe symptoms similar to “growing pains.”
The symptoms occur or worsen at rest, typically ease with movement, and yet frequently return again upon resting. Finally, symptoms of this syndrome are worse in the evening and at night, especially when lying down. Symptoms can also come on when you are sitting for a long time such as when travelling by car or plane or when at a movie. Restlessness, fidgeting or nervousness create movements of the toes, feet, or legs when the sitting or lying down.
Because of difficulty sleeping, people with restless legs syndrome may be abnormally tired or even sleepy during waking hours. Chronic sleep deprivation and its effects on alertness, mood and thinking can affect work, relationships, and recreational activities. Unfortunately, the symptoms of RSL usually worsen over time.
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Relaxation Meditation And Mindfulness
Deep, slow breathing is a good place to start if you find yourself tense and unable to sleep. Other relaxation techniques include taking a warm bath or practicing muscle relaxation. Guided meditation is another way to help you release anxiety and stress so that sleep comes more easily. However, learning meditation and relaxation skills takes time. Be patient with yourself as you explore which mindfulness or meditation techniques work for you.
Restless Legs Syndrome Insomnia And Brain Chemistry: A Tangled Mystery Solved
Johns Hopkins researchers believe they may have discovered an explanation for the sleepless nights associated with restless legs syndrome , a symptom that persists even when the disruptive, overwhelming nocturnal urge to move the legs is treated successfully with medication.
Neurologists have long believed RLS is related to a dysfunction in the way the brain uses the neurotransmitter dopamine, a chemical used by brain cells to communicate and produce smooth, purposeful muscle activity and movement. Disruption of these neurochemical signals, characteristic of Parkinsons disease, frequently results in involuntary movements. Drugs that increase dopamine levels are mainstay treatments for RLS, but studies have shown they dont significantly improve sleep. An estimated 5 percent of the U.S. population has RLS.
The small new study, headed by Richard P. Allen, Ph.D., an associate professor of neurology at the Johns Hopkins University School of Medicine, used MRI to image the brain and found glutamate a neurotransmitter involved in arousal in abnormally high levels in people with RLS. The more glutamate the researchers found in the brains of those with RLS, the worse their sleep.
Allen says there are already drugs on the market, such as the anticonvulsive gabapentin enacarbil, that can reduce glutamate levels in the brain, but they have not been given as a first-line treatment for RLS patients.
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What Can Be Done About Restless Leg Syndrome
Simple gestures and a healthy lifestyle are usually enough to alleviate the signs of this disease.
The first step is to identify the elements that can cause or worsen restless legs syndrome, and in particular medication . If this is the case, it will be necessary to try to modify the treatments by changing the drugs, for example.
For good sleep hygiene, it is recommended to go to bed and get up at regular times, limit activities in the bedroom and avoid disruptive activities.
You can also move your legs, try taking a warm bath before going to bed, massage your legs and stretch your lower limbs.
Moderate exercise can also be part of preventive treatment at night.
Reduction of obesity has also been associated with an improvement in the syndrome.
It is also advisable to limit the consumption of alcohol, tobacco, coffee, and tea.
How To Get Rid Of Anxiety
When this symptom is caused by stress, including anxiety-caused stress, some people have found these short-term strategies beneficial:
- Light to moderate exercise before resting or going to sleep
- A short leisure walk before resting or going to sleep
- Deep relaxation
- Quit smoking if you are a smoker
- Avoid alcohol
- Talk with your doctor or pharmacist about your medications
- Don’t engage in stimulating activities before you want to rest or sleep
Overall, eliminating anxiety-caused restless leg syndrome requires reducing and eliminating the bodys hyperstimulation. As the body recovers from the adverse effects of hyperstimulation, it stops exhibiting symptoms, including restless legs.
You can speed up the recovery process by faithfully practicing healthy stress reduction strategies, such as reducing your stress load, practicing relaxed breathing, increasing your rest and relaxation, and not worrying about this symptom. Yes, restless legs can be bothersome, but again, when your body has recovered from the adverse effects of hyperstimulation, this symptom will subside.
If you are having difficulty managing worry, you may want to connect with one of our recommended anxiety disorder therapists. Working with an experienced anxiety disorder therapist is the most effective way to overcome what seems like unmanageable worry and anxiety.
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My Rls And Gad Are Managedmost Days
I have lived with both these conditions my entire life, but RLS wasnt confirmed until about 15 years ago, and anxiety only diagnosed five years ago.
While it is clear to me now theyve both been with me since childhood, unfortunately, most things are only clear in hindsight. But with knowledge comes power. I have the power to manage my restless legs through lifestyle change, supplementary medications, and pharmacological support. I understand and recognise the symptoms and know how to manage them. I have psychological and pharmacological treatments for anxiety and now have the ability to discern whats happening and attempt to respond appropriately.
But there are also days when I find myself oscillating like an ostrich and I have no idea why. I dont have the pain and the creepy-crawly, bug-in-my-legs feeling from RLS. And I dont have the pounding heart and sense of panic of GAD. Im just quivery.
Rls Leading To Anxiety
It’s also possible that restless legs cause anxiety, rather than the other way around.
Support for this theory is based on the idea that RLS leads to poor sleep quality, and poor sleep quality is a known contributor to stress and anxiety.
The belief is not that RLS itself necessarily causes anxiety . Rather, that the main symptoms of RLS constant uncomfortable feelings when the person is getting ready to rest that force them up and about, as well as the inability to get a good night’s rest may contribute to overall anxiousness that could get worse as the disorder continues.
This is the most popular belief in the medical community, but it does seem to disagree with one other known connection with anxiety namely, that the more individuals control their anxiety, the weaker RLS symptoms appear to be. This would contradict the belief that RLS causes anxiety.
Nevertheless, the idea that RLS is the reason for anxiety in most patients remains a popular one.
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How Stress Can Make Restless Leg Syndrome Worse
So, stress has the ability to make things worse, it has the full potential of triggering your RLS.
Stress causes restlessness which is another major symptom of RLS because it will urge certain sensations in your limbs that will make you rub them constantly until the feeling goes away, other than this it will make your body to toss and turn while you are asleep.
Restless Leg Syndrome In Children
Children can experience the same tingling and pulling sensations in their legs as adults with RLS. But they may have a hard time describing it. They might call it a creepy crawly feeling.
Children with RLS also have an overwhelming urge to move their legs. Theyre more likely than adults to have symptoms during the day.
RLS can interfere with sleep, which can affect every aspect of life. A child with RLS may seem inattentive, irritable, or fidgety. They may be labeled disruptive or hyperactive. Diagnosing and treating RLS can help address these problems and improve school performance.
To diagnose RLS in children up to age 12, the adult criteria must be met:
- overwhelming urge to move, usually accompanied by strange sensations
- symptoms worsen at night
- symptoms are triggered when you try to relax or sleep
- symptoms ease up when you move
Additionally, the child must be able to describe the leg sensations in their own words.
Otherwise, two of these must be true:
- Theres a clinical sleep disturbance for age.
- A biological parent or sibling had RLS.
- A sleep study confirms a periodic limb movement index of five or more per hour of sleep.
Any dietary deficiencies must be addressed. Children with RLS should avoid caffeine and develop good bedtime habits.
If necessary, medications that affect dopamine, benzodiazepines, and anticonvulsants may be prescribed.
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