Restless Legs Syndrome

Restless Legs Syndrome, or RLS, is a very common disorder that often occurs in families due to inherited problems with a neuro­chemical called dopamine. RLS also may result from other conditions such as diabetes, kidney disease, neuropathy, anemia and even nervous system trauma. The symptoms include an uncomfortable feeling in the legs or arms and/or an irresistible urge to move the extremities while at rest. These difficult to describe symptoms occur more often in the evening or night and may be temporarily relieved by rubbing, movement or message. People with RLS are noted by bed partners to kick during the night and to have periodic leg movements during wake which can seem like a “nervous habit”. RLS affects children, adolescents, adults and the elderly, and is more common in women.

Those suffering from untreated RLS report difficulty falling asleep or staying asleep because of the unpleasant feelings in the legs or arms, and the twitching and kicking that often disrupts sleep.

Excessive daytime sleepiness, hypertension, depression, attention deficit/hyperactivity disorder (ADHD) and substance abuse have all been associated with RLS and may be the result of untreated RLS.

How is RLS Diagnosed?

RLS is a syndrome that can be caused by dopamine dysfunction in the central nervous system. Dopamine is a neuro-chemical that regulates sensation and movement through the spinal cord. When this system is disrupted whether due to trauma or an inherited dopamine deficiency, the results are the same; (1) an urge to move the legs with or without an uncomfortable sensation that gets (2) worse in the evening and (3) with rest, and that is (4) temporarily relieved by movement or rubbing.

Diagnosis is made by a full sleep history including medications and foods that can exacerbate RLS, as well as diagnostic testing such as ambulatory leg monitoring, serum testing and detailed neurological examination. When RLS occurs without an associated condition, such as diabetes, the cause is often genetic and passed down from generation to generation. Up to 10% of people may have the genes for RLS, and ongoing studies between researchers at Fusion Sleep, Emory University and collaborators in Iceland are uncovering these links.

Signs and Symptoms of RLS

Associated Conditions

Studies of patients with RLS have demonstrated a clear link between RLS and hypertension. The cause for this may be related to the recurrent periodic leg movements that usually accompany RLS during sleep and which often result in arousals that inappropriately activate the “fight or flight” response during sleep.

Children with ADHD are much more likely to have RLS, at a rate of up to 40% in some studies. Research indicates that alterations in dopamine systems in the central nervous system are the root cause for RLS, and these systems are implicated in the expression of ADHD. Treatment studies of children with RLS and ADHD have illustrated a clear link between these disorders since dopamine therapy not only results in resolution of RLS symptoms, but also in the symptoms of ADHD.

How is RLS Treated?

Therapy for RLS has made major advances in the quality of life for RLS patients as well as in our understanding of the biology of this disorder. Dopamine medications have been approved by the FDA to treat RLS and are very well tolerated and effective. Therapy also involves diagnosing and treating iron deficiency since this can lead to problems with dopamine production and usage in the central nervous system.

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