The Restless Legs Syndrome

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Author:

Richard Allen, Ph.D.

Medically Reviewed On: March 31, 2006

General Description

The Restless Legs Syndrome (RLS) is a fairly common sleep-related neurological disorder affecting, in some form, about five percent of the adult population. It is one of the older recognized sleep disturbances, first described over 300 years ago. Frequently seen with greater frequency in particular families, it is often reported to be a genetic disorder, although this has yet to be confirmed. RLS causes disturbing sensations and it leads to a need for excessive amounts of movement. When the strange sensations, or sensory symptoms, are clearly present, the diagnosis is fairly easy. The RLS patients describe peculiar, very disturbing sensations localized in the limbs, usually the legs. The abnormal sensations are often hard for patients to describe since they have no reference in normal life experience. They are commonly described as: "Pepsi in the veins." "worms under the skin," "crawly feelings in the legs," "electricity running through the legs," etc. The sensations are painful for about 30% of the RLS patients, but they are almost always compelling. There is a wide variation in severity. Some patients experience the sensations only occasionally at night, while others have intense feelings every day leaving them almost frantic to find relief even when they are not associated with pain. It is the compulsion to remove the feelings that leads to excessive movements, since the best form of relief is walking or any large body movement. Sometimes the compulsion to remove the sensation becomes the dominant feeling and the patient reports primarily this irresistible urge to move the legs. The feelings generally wax and wane occurring about once every 5 to 20 seconds. When the patient gets up and walks around these feelings generally go away, but they quickly return when the patient stops walking. Fortunately some reasonable treatments are now available for RLS.


Daily Cycle of Symptoms and the Relation to Sleep

The symptoms have a marked circadian (daily) pattern becoming much worse in the evening to early morning and often completely abating in the later morning. When severe, the symptoms will start in the afternoon or even shortly before noon. In some very extreme cases the symptoms occur 24 hours a day, but even then are generally less severe in the morning. In almost all cases, however, there is a relative sparing of the early morning hours from about 7-10 AM, when there are virtually no symptoms. Patients nonetheless live in dread of the next bedtime when they will again be struggling with these feelings. Nighttime brings not rest but suffering.


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