Ask the doctors: Restless leg syndrome leads to more than interrupted sleep

Dear Doctor: I wonder if you could help me with a problem that robs me of sleep, and which lately even persists during the day. I’m referring to restless leg syndrome. What causes it? Are there any new findings about getting relief?

Dear Reader: Restless leg syndrome, which is also known as Willis-Ekbom disease, is a condition in which someone has an uncontrollable need to continually move or flex the muscles in their legs. This is due to unusual and unpleasant sensations such as throbbing, crawling, pulling, tingling or itching, which only subside during movement.

Restless leg syndrome, or RLS, can happen to anyone and at any stage of life. Up to one-third of pregnant women report that they experience RLS symptoms, and the condition occurs in children as well. It’s seen more often in women than in men, and it is most common among older adults. Although it can affect any part of the body, most people experience symptoms in the muscles of their calves or thighs.

RLS symptoms, which become more frequent in the late afternoon and evening, typically begin when someone is at rest. The sensations are so persistent they can’t be ignored. Although flexing the muscles, standing or walking can bring relief, as soon as someone is at rest again, the symptoms return. Like you, the majority of people living with RLS also experience twitching and jerking movements that interfere with sleep. These can occur two or three times per minute throughout the night and often lead not only to sleep deprivation, but also to anxiety and depression.

Although the exact cause of RLS remains unknown at this time, research links it to a disruption in a region of the brain known as the basal ganglia, which is associated with movement. This part of the brain uses dopamine, a brain chemical crucial to smooth and sustained motion. There is also evidence that low levels of iron in the brain may play a role. Drug treatment focuses on opioids, medications to amplify dopamine, antiseizure drugs and certain sleep medications. Each of these comes with potential side effects, so it’s important to discuss the pros and cons with your doctor.

Lifestyle changes such as a moderate exercise program, stretching, massage, warm baths, cutting back on alcohol and tobacco use, and the use of heat or ice packs can ease symptoms. Some people with RSL find relief with a foot wrap, approved by the FDA, which applies pressure to two muscles in the foot. Another device provides pressure and vibration along the backs of the legs. Both of these have been found to help ease RLS symptoms.

A small study by researchers at the Stanford Center for Sleep Sciences and Medicine recently found that people with RLS may have an imbalance in certain kinds of bacteria in their gut. This echoes the gut-brain connection currently being explored in Parkinson’s disease, which also involves a loss of dopamine that affects movement. More research is needed, but this line of inquiry holds promise for new and more effective directions in treatment.