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Restless Legs Syndrome (RLS) and Periodic Limb Movement Disorder (PLMS)

Restless legs syndrome (RLS) and period limb movement during sleep (PLMS) are neurologic disorders that can be uncomfortable and frustrating. RLS can make it difficult to fall asleep.

People with RLS often suggest the condition makes them feel like something is crawling on their legs, causing tingling, prickly, creeping, tugging sensations. In some cases, RLS can be painful. RLS symptoms tend to be worse when lying down, sitting, or resting for long periods. The symptoms usually improve when walking or moving. RLS symptoms tend to be worse at night. They often cause an overwhelming urge to move or walk, and they can appear as small movement in the legs, feet, and toes.

Although most RLS symptoms occur in the legs (calves) and feet, they also can occur in the arms and hands.

Three types of RLS are:

  • Primary or familial, which runs in a family
  • Secondary, which results from a condition such as pregnancy, low iron (anemia), or chronic disease
  • Idiopathic, which has no known cause

Risk for RLS includes:

  • Being female (more women than men have RLS)
  • Being middle aged
  • Being elderly
  • Caffeine, alcohol, and tobacco use
  • Certain medications, including tricyclic antidepressants, anti-nausea drugs, anti-seizure drugs, selective serotonin reuptake inhibitors (SSRIs), lithium, and cold and allergic medications
  • Chronic diseases, including diabetes, kidney disease, Parkinson’s disease, and rheumatoid arthritis (RA)
  • Neurologic lesions such as spinal cord injury, peripheral nerve lesions
  • Pregnancy, especially during the last trimester. RLS often resolves after pregnancy
  • Iron deficiency (anemia)

Diagnosing RLS

Because there are no laboratory tests for the condition, RLS can be difficult to diagnose. For this reason, experts evaluate a patient’s personal and family history and symptoms to diagnose RLS.

Criteria for diagnosing RLS include:

  • Urge to move the limbs, especially when it is accompanied with the sensation of pins and needles
  • Symptoms that are worse

Treatment for RLS includes:

  • Iron supplements to increase blood levels of iron
  • Behavioral therapy and lifestyle changes such as avoiding caffeine, walking, stretching, yoga, massage, hot or cold baths, and relaxation techniques to treat mild-to-moderate and secondary RLS
  • Drug therapy, including medications such as dopaminergics, benzodiazepines, opioids, and anticonvulsants to help calm the central nervous system in people with severe RLS
  • Home remedies, including hot baths, leg massage, heating pads, ice packs, aspiring or other over-the-counter medications to treat pain. Some people find that taking vitamin E, vitamin B12, vitamin C, and calcium supplements also can help reduce RLS symptoms
  • Transcutaneous electric nerve stimulation (TENS), which involves stimulating an area of the feet or legs 15 to 30 minutes before bedtime to reduce nighttime jerking in people who have severe RLS

Periodic Limb Movement in Sleep (PLMS)

Many people with RLS also experience periodic limb movements, including jerking, leg bending, small shudders of the ankles and toes, kicking, and flailing the arms and legs while sleeping. Some people with PLMS also have oral, nasal, and abdominal movements. In addition to waking the sleeper, PLMS can disturb a partner’s sleep. PLMS can be mildly bothersome to painful.

Although people with PLMS usually do not realize they are moving during sleep, they often wake feeling tired or as if they had restless sleep.  

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