Restless legs syndrome is one of the most common movement disorders in the country and one of the most quietly missed. The National Institutes of Health estimates that 5 to 10 percent of adults and 2 to 4 percent of children in the United States are affected, with women more often than men. A clinical review published on the NCBI Bookshelf puts the range as high as 15 percent and counts more than 3 million US cases each year.
The condition, also known as Willis-Ekbom disease, produces a set of very specific sensations. When they show up mostly at night, they are easy to file away as insomnia, cramps or plain fatigue. Below are seven signs clinicians actually look for.
What the diagnosis actually looks like
Doctors diagnose restless legs syndrome (RLS) from a short list of features that must appear together. Any one of them in isolation is common. The pattern is what matters.
1. An irresistible urge to move the legs. NIH describes RLS as a neurological condition that produces an irresistible urge to move the legs. It is not the same as fidgeting. The urge feels involuntary and hard to override.
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2. Crawling, pulling or itching sensations deep in the legs. The urge is triggered by uncomfortable feelings often described as crawling, pulling, or itching, deep within both legs. Some people report aching, tingling or a burning quality. In severe cases the sensations can spread to the arms or other parts of the body.
3. Symptoms appear at rest. The feelings usually surface while the person is sitting or lying down. Long car trips, plane flights and movies are typical triggers. So is settling into bed.
4. Symptoms worsen in the evening and at night. In the clinical criteria, the urge to move progressively worsens in the evenings and at night. Symptoms that are just as bad at 10 a.m. as at 10 p.m. point somewhere else.
5. Movement brings relief. Kicking, stretching, rubbing or pacing make the discomfort go away, at least temporarily. This relief is a defining feature and one reason many people end up walking around the bedroom at night.
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6. Falling and staying asleep becomes hard. The unpleasant feelings and the need to move often make it difficult to fall asleep or stay asleep. Daytime consequences include difficulty concentrating, mood swings and depression.
7. The legs kick or jerk during sleep. About 80 percent of patients with RLS also have periodic limb movements of sleep, brief involuntary flexions of the foot that repeat every 20 to 40 seconds. A bed partner often notices them first.
Iron, pregnancy and other triggers
The suspected mechanism is a shortage of iron in certain parts of the brain, which appears to disrupt dopamine signaling that helps control movement, according to NIH's MedlinePlus Genetics. Anemia and pregnancy raise the risk, and symptoms often improve once iron levels rise or after the woman gives birth.
Restless legs syndrome frequently overlaps with other sleep problems. Systematic reviews report that 10 to 30 percent of people with obstructive sleep apnea also meet criteria for RLS, and the two conditions together tend to produce worse insomnia and daytime sleepiness than either alone.
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Medications can also trigger the condition, including some drugs for nausea, depression, colds, allergies, heart problems and high blood pressure. Caffeine, nicotine and alcohol tend to make symptoms worse.
When to talk to a doctor
Clinical guidance is to check ferritin, a marker of iron stores, in anyone with RLS symptoms. A ferritin below 50 ng/mL is generally treated with iron replacement. When lifestyle changes and iron are not enough, first-line prescription options include alpha-2 delta calcium channel ligands such as gabapentin and pregabalin, or dopamine receptor agonists such as pramipexole, ropinirole and rotigotine.
Anyone whose sleep is regularly disrupted by leg discomfort, or whose bed partner notices nighttime kicking, should raise it with a physician rather than write it off as poor sleep.
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This article is made and published by Jesper Bengtson, who may have used AI in the preparation.