RLS is a common neurological sleep disorder affecting 5-15% of the  population. Although popularly known as Restless Legs Syndrome, more than half of affected individuals have symptoms affecting the arms as well as their legs. Majority of those with RLS-WED have mild or moderate symptoms that do not usually require medical treatment. However, approximately 10% of patients with RLS-WED have significant symptoms that would require medical intervention.  A quarter of these patients have severe symptoms.

The characteristic symptom is an “urge” to move the legs. Associated with this there may be various abnormal sensations in the affected areas. These can be creepy-crawly sensations, pain, burning, itching throbbing or others.  Symptoms mostly occur in the evenings/night although occasionally it can occur in the afternoons but rarely before midday. The urge is relieved by movement. As soon as movement stops the symptoms start again. This makes patients feel “fidgety” or restless. Many patients get up and walk to alleviate the symptoms. It can continue into the night and the legs may continue to move periodically during sleep.

The leg discomfort often delays sleep onset, and wakes the individual at night disrupting continuity of sleep leading to insomnia. Patients do not feel refreshed upon waking up and feel tired and sleepy in the day. Many patients have profound fatigue/tiredness even when the leg symptoms are mild.

Diagnosis:

Restless Legs Syndrome is a clinical diagnosis, and there are no diagnostic tests.  The following will help in making a diagnosis:

• The characteristic symptom is the Urge to move the legs.
• Symptoms begin or worsen at Rest.
• Symptoms improve when one Gets active.
• The begin or worsen in the Evenings.
• The symptoms are not solely caused by other problems such as arthritis, ‘poor circulation’ etc.

Management:

RLS is often worsened by caffeine, alcohol, and tobacco.  Avoiding these may make a significant difference in the symptoms.

Physical activity improves RLS symptoms.

Physical measures such as warm or cool baths, massage, stretching can improve RLS symptoms.

Many drugs can worsen RLS.  Examples include antihistamines, drugs used to treat vomiting, antidepressants, amitriptyline, mirtazepine and others.  Antihistamines are widely used for treating allergic disorders and are present in many over-the-counter sleep aids.  Ask your doctor to review your medications and wherever possible discontinue  drugs that can worsen RLS.

Testing for iron deficiency and treatment with iron supplements improves RLS in a significant proportion of patients.

Many patients have associated Obstructive Sleep Apnoea, treatment of which can improve RLS. Therefore, testing for OSA is important.

Drug treatment is used if the above measures are not sufficient to control symptoms.  Dopamine agonists (e.g., pramipexole, rotigotine) or drugs such as gabapentin and pregabalin are very effective.  The aim of treatment will be to use the lowest effective dose that controls the symptoms.