Everyday Health: What are the primary symptoms of RLS?

Robert Doekel Jr., MD: RLS is characterized by an urge to move the legs, usually accompanied by or caused by uncomfortable and unpleasant sensations in the legs, which begin or worsen during periods of rest or inactivity such as when you're lying down or sitting.

The urge to move the legs and the accompanying unpleasant sensations are partially or totally relieved by movement, such as walking and stretching, at least as long as the activity continues. The symptoms are worse in the evening and at night than during the day, or may only occur in the evening or at night.

In addition, the symptoms are not solely accounted for by another condition, such as leg cramps, positional discomfort, leg swelling, or arthritis.

Helene Emsellem, MD, FAASM: Creepy-crawly feelings in the legs associated with the urge to move. The arms can also be affected in some people.

Markus Schmidt, MD, PhD, and Asim Roy, MD: RLS is characterized by an irresistible urge to move the legs in the evening or prior to falling asleep and is sometimes associated with a creepy or crawly sensation or aching in the legs. Symptoms are typically relieved by movement, are worse during rest, and are typically worse in the evening hours.

David B. Rye, MD, PhD: Primary symptoms are well described - I can't add much to what's been written. There's a compulsion to move the legs, it's sort of like an itch.

Is RLS Inherited?

Robert Doekel Jr., MD: RLS often runs in families.

Helene Emsellem, MD, FAASM: Some individuals have a positive family history of RLS. Sometimes the onset can be in childhood or adolescence.

Markus Schmidt, MD, PhD, and Asim Roy, MD: RLS affects about 10 percent of the U.S. population. It tends to run in families, with as many as 50 percent of cases being accounted for by genetically inherited RLS. Other causes include iron deficiency, kidney disease, pregnancy, and contributing medications, such as tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), antihistamines, decongestants, and antinausea meds.

David B. Rye, MD, PhD: There's a large hereditary component in an (unfortunately) nonpredictable pattern. Risk alleles in genes have been identified and have a large influence on the expression of symptoms.

Does RLS Ever Go Away On Its Own?

Robert Doekel Jr., MD: Up to 25 percent of women develop RLS during pregnancy, but the symptoms often disappear after they give birth.

Helene Emsellem, MD, FAASM: Usually not. If there is an underlying cause of the RLS - such as iron deficiency - and it's corrected, then the RLS can clear up. RLS happens more frequently during pregnancy and may abate at the end of the pregnancy

Markus Schmidt, MD, PhD, and Asim Roy, MD: Although walking, moving, and stretching the legs can help alleviate the symptoms, RLS typically does not go away on its own. People with RLS that's been triggered by iron deficiency or another underlying condition may see their symptoms resolved once their medical condition is treated.

David B. Rye, MD, PhD: Rarely - but that's based on clinical samples. Who knows what happens in the real world?

What Are the Best Ways to Live Well With RLS?

Robert Doekel Jr., MD: In 2006 a small study found that a combination of moderate aerobic exercise and lower-body resistance training three days a week reduced symptom severity by about 50 percent. The study found that it took six weeks to see maximum benefit from the exercise program. Generally, people with RLS have reported that moderate exercise seems helpful and that strenuous exercise may worsen their symptoms.

If an underlying iron or vitamin deficiency is found to be the cause of restless legs, supplementing with iron, vitamin B, or folate (as indicated) may alleviate the symptoms or even clear them up.

Products, including chocolate, that contain caffeine should be avoided. Alcohol increases the duration or intensity of symptoms for most individuals. Avoid medications that can worsen symptoms, such as antihistamines, antinausea medications, and certain antidepressants and other psychiatric drugs.

Helene Emsellem, MD, FAASM: Maintain a regular sleep-wake schedule. A regular exercise program is often helpful. Identify and avoid triggers in your habits and activities.

Markus Schmidt, MD, PhD, and Asim Roy, MD: Symptoms can be greatly relieved by maintaining a consistent sleep-wake schedule, exercising regularly, and minimizing caffeinated beverages, tobacco, and alcohol.

David B. Rye, MD, PhD: A regular sleep-wake schedule. Physical activity - not too little or too much. Avoid other aggravators, such as red wine and alcohol in general. Avoid sleep deprivation.

Can RLS Lead to Something Worse?

Robert Doekel Jr., MD: No.

Helene Emsellem, MD, FAASM: Usually not. Although it can sometimes be a sign of an underlying problem, such as iron deficiency.

Markus Schmidt, MD, PhD, and Asim Roy, MD: RLS symptoms can worsen with age. More than 80 percent of individuals with RLS will also develop periodic limb movements during sleep - these are involuntary brief movements involving dorsiflexion, or movement upward, of the foot, knee, or hip These limb movements can disrupt sleep.

David B. Rye, MD, PhD: Other than really bad RLS, no; although data increasingly suggest that RLS confers "risk" for cardiovascular disease by way of mechanisms that remain ill-defined.

Are Medications Necessary to Treat RLS?

Robert Doekel Jr., MD: Supplements such as iron and vitamin B may work if there is an underlying deficiency (see my answer to question number 4). If there's no deficiency, vitamin E or magnesium supplementation may help relieve mild symptoms; if not, then prescription medication is usually required. Some patients with RLS have symptoms intermittently and can be treated only when the symptoms arise. Others require daily treatment.

An evaluation by a knowledgeable physician is the most helpful in determining the appropriate treatment.

Helene Emsellem, MD, FAASM: Identifying lifestyle changes that relieve symptoms is a reasonable form of intervention. When this is not sufficient, then medication may be necessary. We don't always have to treat everybody every day. For instance, some people need a medication when they are in a very confined situation - on a plane, in a car, or at the movies - but don't need treatment in other situations. Medication intervention depends on other medications that an individual is taking and whether treatment is going to be used on daily or intermittently. Drugs that increase brain dopamine may be helpful in relieving symptoms, as might be some anticonvulsants and some opioids. It is very important to look for underlying causes that could be treated before beginning a specific medication.

Markus Schmidt, MD, PhD, and Asim Roy, MD: A physician or an RLS specialist can prescribe dopaminergic agonist medications such as ropinirole or pramipexole, initially used to treat tremor and other symptoms in patients with Parkinson’s disease. Other medications - such as gabapentin enacarbil and narcotic analgesics, including methadone or oxycodone - can also help. If iron levels are low, iron replacement can be an effective treatment.

David B. Rye, MD, PhD: You'd treat iron deficiency if present. There are a number of medications, and this is really a question of lifestyle/personal choice between the doctor and the patient.

What Kind of Movement or Exercise Helps Relieve RLS Symptoms?

Robert Doekel Jr., MD: As I referenced in question number 4, moderate aerobic exercise and lower-body resistance training three days a week has been proven to reduced symptom severity by about 50 percent. Incorporate moderate exercise to see helpful results and stay away from strenuous exercise may worsen symptoms.

Helene Emsellem, MD, FAASM: Stretching exercises, massaging, and walking are some strategies. Some people like to lie down on their back with their legs flexed at the hip, their feet propped up on a wall, which can be helpful in relieving symptoms. Daily exercise programs are often helpful.

Markus Schmidt, MD, PhD, and Asim Roy, MD: Walking, moving, and massaging the legs can help alleviate the symptoms. Applying a hot or cold pack, taking a warm bath, and practicing relaxation techniques such as stretching and yoga may also help.

David B. Rye, MD, PhD: There are no known exercises to alleviate RLS. In fact, there is more a suggestion that people choose a profession as a sort of self-medication. For example, a lot of my patients are on their feet at their jobs (a disproportionate number are hairstylists, etc.). What's the chicken, then, and what's the egg?

What Other Lifestyle Changes Can Help People With RLS?

Robert Doekel Jr., MD: Live a healthy lifestyle, eliminate symptom-producing substances, take vitamin and mineral supplements if necessary, engage in activities that help take their minds off RLS, and avoid foods and medicines that aggravate symptoms.

Helene Emsellem, MD, FAASM: Avoid long car rides, plane trips, etc. - specifically, if you live close to work and don't have a 45-minute commute each way, that will make your life better.

Markus Schmidt, MD, PhD, and Asim Roy, MD: RLS is typically worsened by sleep deprivation. So maximizing sleep at night and practicing good sleep hygiene, such as maintaining a strict sleep-wake schedule, can help minimize symptoms.

David B. Rye, MD, PhD: Again, the effects of lifestyle changes have not been well studied.

What Are Two Tips That Can Help Prevent RLS During Travel?

Robert Doekel Jr., MD: Being able to move the legs gives temporary relief. If this is not possible, then additional medication may be required during periods of prolonged sitting - for example, during automobile or plane travel.

Helene Emsellem, MD, FAASM: This is very difficult. Many of our patients do use treatment just for travel. If you don't have any treatment and you are taking a long car ride, making short stops and walking around a little can be helpful.

Markus Schmidt, MD, PhD, and Asim Roy, MD: Sitting in a tight seat in an airplane or a car can exacerbate RLS symptoms. Stretching the legs or getting up briefly to walk when traveling can minimize symptoms. Some patients may benefit from taking their RLS medication prior to getting on a plane. If you're driving, be extra cautious because such medications can cause sleepiness.

David B. Rye, MD, PhD: Try not to travel sleep deprived, and get an aisle seat!