Are your legs always restless? (Restless Legs Syndrome) - Let's talk about this!

Do you also feel something strange in your legs, like they are just crawling, or like they are struggling, when you try to sleep at night, or while watching TV? Do you feel like you can't help but move your legs? When that happens, do you feel relief when you move your legs a little, or walk? Then this is something that may be important to you too. We call this Restless Legs Syndrome (RLS) . In Sinhala , it means something like "restless legs syndrome" .

What exactly is restless legs syndrome (RLS)?

Simply put, it's a condition that involves our brain, nervous system , and sleep . The main thing is that there is a strong, uncontrollable urge to move our legs. This urge is accompanied by discomfort in the legs. Some people may feel it as if it's being pulled, pulled from the inside, or something is burning. It's a very disturbing feeling.

The most important thing is that this discomfort and the urge to move the legs are worse when you are at rest, especially in the evening and at night . It is often felt most when you go to bed and try to sleep. It may be relieved by moving the legs a little, walking, or getting a massage . But it can reappear when you are at rest.

Sometimes your doctor may also call this Willis-Ekbom disease , which is another name for the same condition.

Are there main types of RLS?

Yes, there are mainly two types:

• Early-onset RLS: This is usually diagnosed before the age of 45. It often runs in the family, meaning it can be hereditary . In this type, symptoms develop gradually.
• Late-onset RLS: This is diagnosed after the age of 45. In this type, symptoms can worsen quickly .

How common is this condition called RLS?

In the United States, it is estimated that between 7% and 10% of the population has RLS. It is more common among whites and women. The risk of developing this condition increases with age. There are many people in Sri Lanka who suffer from this condition, but some people may not recognize it as a disease.

What are the symptoms of RLS? How is it diagnosed?

A person with RLS may experience symptoms like:

• Leg cramps are a feeling of discomfort in the legs that makes you want to move your legs . This discomfort can feel different. Some people may feel like something is moving inside their legs, like worms are crawling, like they are crawling, or just like they are being pulled and grabbed.
• This discomfort increases when resting (when trying to sleep, when sitting) .
• The discomfort is somewhat reduced when you move your legs, walk, or stretch them.
• Frequent twitching or involuntary movement of the legs in the evening and at night. Sometimes this can happen even during sleep.

These symptoms can disrupt your sleep , which can lead to other problems. For example:

• Not being able to sleep, waking up from sleep, not being able to sleep continuously.
• The urge to get out of bed at night, stretch your legs, and walk.
• Feeling extremely tired and sleepy during the day.
• Behavioral and mood changes (irritability, agitation).
• Difficulty concentrating, remembering things, and concentrating.
• Some people may even experience conditions like depression or anxiety .

Imagine, you went to bed at night to get a good night's sleep. After a while, you feel a strange burning sensation and numbness in your legs. You can't stand it. You just want to move your legs. You get up and walk around. When you go back to bed, it starts again after a while. If you don't sleep well until dawn like this, how can you get anything done the next day? You're tired and angry, right?

How do your legs feel with RLS?

The discomfort in these legs varies from person to person. Most often, it is felt in both legs. Sometimes, the arms can also feel this discomfort, and rarely, the whole body. You may experience these feelings:

• It looks like something is crawling .
• Itching .
• Aching .
• Like burning .
• Throbbing .
• Like pulling inward (Pulling) .
• Like tugging .

What causes RLS?

The exact cause of RLS is not yet known , but scientists believe it is related to the activity of the basal ganglia, a part of the brain that controls movement. This part of the brain uses a chemical called dopamine to control our body's movements. So if this part of the brain doesn't get enough dopamine, it can't control our movements properly. That may be one reason for the symptoms of RLS.

Research has found that these things can contribute to RLS:

• Genetics: RLS can be inherited. If one of your parents has the condition, it is likely to be passed on to your children through a genetic trait called autosomal dominant .
• Iron deficiency : Even if the blood iron levels are normal, the brain iron levels may be low. This is considered a major cause of RLS.
• Other underlying medical conditions: Some medical conditions can also cause RLS. This is called secondary RLS .
• Certain medications: Certain medications, such as antihistamines , antidepressants , and antinausea medications, can cause RLS or worsen symptoms.

What other medical conditions cause RLS?

People with these conditions are at higher risk of developing RLS:

• Iron deficiency .
• Anemia .
• Pregnancy.
• Diabetes .
• Kidney disease .
• Peripheral neuropathy .
• Substance use disorders .

What aggravates RLS symptoms? (Triggers)

There are certain things that can make a person with RLS more likely to experience symptoms. These are called triggers . They can vary from person to person. In general, these things can be a trigger:

• Alcohol.
• Caffeine - found in coffee, tea, and some soft drinks.
• Nicotine - Smoking.
• Some medications.
• Stress.

If you use these things before you relax or go to bed, you are more likely to have worse symptoms. Also, sleep deprivation can make RLS symptoms worse . That is, your symptoms can lead to sleep deprivation, and sleep deprivation can lead to worse symptoms. It's like a vicious cycle. If you're having trouble figuring out what your triggers are, it's a good idea to talk to a doctor.

What age groups does RLS affect?

RLS can affect people of any age. It can affect children, young adults, and adults. However, it is most common after the age of 50. Symptoms can get worse as you get older.

How is RLS diagnosed? (Diagnosis)

A doctor will diagnose RLS by carefully listening to your symptoms and examining you. At that time, they will also ask about your complete medical history and whether anyone in your family has had similar conditions.

There is no specific test to diagnose RLS, but a doctor mayA neurological exam and blood tests may be done to rule out other conditions and to find the cause of your symptoms. Sometimes an overnight sleep study may also be ordered to look for other sleep problems. However, RLS is a clinical diagnosis , meaning it is primarily diagnosed based on symptoms.

To confirm the presence of RLS, a doctor will consider the following:

• Do you have a strong urge to move your legs, and are there any uncomfortable sensations (such as cramps, pulling) that accompany it?
• Do symptoms start or worsen when you are at rest or with less activity?
• Does stretching, walking, or exercising provide relief (completely or temporarily) to the affected muscles?
• Are the symptoms worse in the evening or at night, or do they only occur at those times?
• It means that these symptoms are not caused by another medical condition.

Is RLS difficult to diagnose in children?

Yes, sometimes it can be difficult for doctors to diagnose RLS in children. This is because a child may not be able to describe their symptoms accurately . RLS in children can sometimes look like attention deficit hyperactivity disorder (ADHD) or "growing pains" that occur when the body is developing.

How is RLS treated?

RLS can be treated with medications, home remedies, or lifestyle changes to help reduce symptoms. For some people, RLS symptoms can be reduced when other underlying health conditions are controlled. You and your doctor should discuss the best treatment for you, including possible side effects.

Medication for RLS

There are some medications that can help control RLS symptoms. A doctor may prescribe medications like these:

• Iron supplements are better absorbed by the body when taken with vitamin C.
• Some antiseizure medications - e.g. Gabapentin , Pregabalin .
• Dopamine agonists - e.g. Pramipexole , Ropinirole .
• Drugs that convert to dopamine or help produce dopamine (Dopamine precursors) - e.g. (Levodopa) .

However, long-term use of dopamine-enhancing drugs such as Levodopa can cause RLS symptoms to worsen (augmentation) in some people. Therefore, you should be under the close supervision of a doctor when using these drugs.

In very severe cases, when all other treatments have failed, Benzodiazepines (e.g. Clonazepam) ,Medications such as (Hypnotics) (e.g. (Zolpidem) ) or (Opioids) (e.g. (Methadone) , (Buprenorphine) ) can also be used. However, the side effects of these medications can be severe , and there is a risk of addiction to them.

There are many types of iron pills. A blood test can help determine which type is best for you. For people with severe RLS symptoms who suspect they have very low iron levels in the brain, an iron infusion may sometimes help.

At-home therapies for RLS

If you have mild RLS symptoms, your doctor may recommend some things you can do at home, such as these. These may help you feel a little more relaxed and sleep better with RLS:

• Regular exercise : For example , aerobics , cycling (even a stationary bike) or walking. But avoid strenuous exercise a few hours before bedtime.
• Practice good sleep habits : Avoid things like reading books, watching TV, and using your phone while sitting in bed. Not getting enough sleep can make RLS symptoms worse .
• Soaking your feet in warm water , applying a heating pad , or applying a cold compress to your feet can provide temporary relief from discomfort.
• Reducing your overall stress . You can seek help from a mental health counselor for this.
• Avoid drinking caffeine (like coffee and tea) before bed.

How to quickly reduce restless legs?

Shaking your legs, walking, getting a massage, or stretching your legs may provide temporary relief , but symptoms may return as soon as you stop moving.

Is RLS a serious condition?

RLS won't affect your lifespan, meaning it won't shorten your life . But it can have a big impact on your overall wellness . Symptoms can range from mild to severe. Even mild symptoms can be very disruptive to your daily life, especially sleep. Depending on how you define "severe," your symptoms may fall into that category.

Is there a permanent cure for RLS?

Unfortunately, there is currently no cure for RLS. However, with treatment, symptoms can be well controlled and people can live a normal life.

Can RLS be prevented?

There is currently no specific way to prevent RLS, but treating underlying health conditions and avoiding triggers such as caffeine and alcohol can help reduce the severity of symptoms.

When should I see a doctor?

If you have RLS symptoms, be sure to see a doctor if:

• If home treatment does not help .
• If symptoms get worse .
• If it has a big impact on your sleep .

What questions should I ask my doctor?

When you go to see the doctor, you can ask questions like:

• What is causing these symptoms?
• What treatment do you recommend?
• Are there any side effects of the treatment?
• How can I sleep well with RLS?
• How should I change my nighttime habits to reduce RLS symptoms?

Finally, take-home message

Living with Restless Legs Syndrome (RLS) can be very annoying at times. It can disrupt your sleep and keep you from sleeping properly. You may wake up in the morning wishing you had gotten more sleep. Drinking coffee (caffeine) to help you feel sleepy in the morning can make your symptoms worse at night.

Although there is currently no permanent cure for RLS, the symptoms can be well controlled with proper treatment and lifestyle changes . So if you have these symptoms, don't be shy or afraid to see a doctor and get advice. Then you too can get relief and spend the day with a good night's sleep.

Remember, you are not alone. There are many people who suffer from this condition. With the right guidance and treatment, you can live with it successfully.

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