Restless legs syndrome is a pathology in which the patient experiences discomfort in the lower extremities. The syndrome occurs at rest, usually at bedtime. To alleviate his condition, a person has to make constant movements with his legs, which is why he cannot sleep normally, as a result, chronic insomnia occurs.

Restless legs syndrome affects people of all ages, but more often than others, it occurs in people of middle and retirement age, as well as pregnant women in the second and third trimester. Studies have found that up to 10% of the world’s population suffers from RLS of varying severity.

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There are two types of disease:

1. Primary (idiopathic).
2. Symptomatic.

Idiopathic restless legs syndrome is the most common type of pathology. It is characterized by early manifestation (in childhood). There are family cases of the problem. According to various sources, the frequency of such cases can reach 30-90%. Geneticists have found a connection between the formation of pathology and abnormalities in the structure of certain chromosomes. Scientists have come to the conclusion that the idiopathic form is a pathology that occurs under the influence of many negative factors in the presence of a genetic predisposition.  

The symptomatic form manifests itself no earlier than in adulthood (after 45 years) and is a consequence of concomitant pathologies of the body – metabolic disorders, diseases of the nervous system and blood vessels of the lower extremities. Secondary restless legs syndrome quite often occurs in pregnant women in the second, third trimester, but after childbirth the symptoms disappear. 

Causes of restless legs syndrome

To prescribe a competent and successful treatment, it is important to establish the correct cause of the development of pathology:

• Genetics. In the idiopathic form without concomitant pathologies of the nervous system and other diseases of the body, the cause is always bad heredity. With proper diagnosis, primary restless legs syndrome is detected early enough – before the age of 30. 
   
• Concomitant pathologies. The cause of RLS may lie in dysfunction of the nervous system, in which dopamine metabolism in the central nervous system decreases. Factors causing such disorders include renal failure, diabetes mellitus, and brain injury. The syndrome can also develop with diseases such as multiple sclerosis, Parkinson’s disease, pathology of the cardiovascular system. When establishing these causes of RLS, there is no point in fighting the symptoms; proper therapy for the underlying disease is needed. 
   
• Pregnancy. According to statistics, the symptoms of restless legs syndrome occur during gestation in 15-20% of cases. The reason for this is the provoking factors that accompany pregnancy – hormonal changes in the body, an increase in the load on the lower limbs due to weight gain, neurological disorders due to increased nervousness and worries about the unborn baby. 
   
• Addictions. Both primary and secondary forms of RLS can occur with alcohol abuse, smoking, drinking in excess of drinks with a high caffeine content (energy drinks, coffee, strong black tea). Any bad habits affect the entire body as a whole, to a large extent, this effect also affects the work of the nervous system. 
   
• Medications. The development of RLS can be a side effect after taking a number of medications. These drugs primarily include those that contain caffeine (analgesics), as well as antidepressants, antipsychotics, antiallergic drugs, antiemetic drugs. 

Doctors note that in recent years, restless legs syndrome has become an increasingly common pathology among all segments of the population. The reason lies in the very way of life of people – increased stress, constant tension, work associated with both a long sitting position and increased physical exertion.

If symptoms of RLS are found, action should be taken immediately. The pathology will not go away on its own, it requires the establishment of provoking factors, their elimination and further treatment of the disease.

RLS symptoms

Restless legs syndrome is characterized by the following symptoms:

• The appearance of painful sensations in the lower extremities, expressed in the form of itching in the legs, twitching of nerve endings, pain. Patients cannot accurately describe the pain factor: someone complains of aching pain, someone spontaneously arises in different parts of the legs. The sensations are smooth, they are not concentrated all the time at one point and change localization, flowing from one place to another.
   
• RLS is characterized by symptoms only when the legs are at rest, most often when the patient falls asleep. Due to the constant desire to change the position of the body, the brain cannot go to sleep and turn off the nervous system, which is why chronic insomnia occurs . Such symptomatology (selective by the time of onset) is called circadian – arising with a certain rhythm. In the morning and afternoon hours, the symptoms do not bother the patient, he may take a nap, but he still does not have enough sleep.
   
• Unpleasant sensations pass with the movement of the lower extremities, hence the name of the pathology. To get rid of the irritating factor, patients begin to jerk their legs, change their position, with obsessive pain, a person can get up and start walking around the room, but as soon as he goes back to bed, the symptoms return.
   
• Involuntary movements of the lower extremities sometimes occur even in a state of full sleep. If the patient managed to fall asleep and go into the phase of slow sleep, he may continue to unconsciously jerk his limbs. Such movements can occur only a few times, and can last throughout the night, depending on the severity of the disease.

From the above, it is clear that restless legs syndrome is expressed in one vivid symptom – unpleasant sensations in the limbs in a state of complete rest. But these sensations are subjective, no doctor will give a typical picture of their manifestation. During neurological examination of patients with RLS symptoms, physicians most often do not detect a specific focal pathology, impaired sensitivity, or distorted reflexes. This means that the pathology itself does not manifest itself in any way at the time of examination, this complicates its diagnosis.

Diagnosis of the disease

It should be noted that with all its prevalence, the diagnosis of “restless legs syndrome” (the causes and treatment are described in the article) is not given to every patient with characteristic symptoms. The problem lies in the difficulty of diagnosing the disease. The correct conclusion is made only in 8-10%, in other cases, patients are treated for neurological pathologies. If you experience insomnia due to discomfort in your legs before going to bed, it is important to consult a narrowly qualified specialist – a somnologist . Somnology studies exactly sleep disorders, so the doctor will be able not only to establish the root cause of insomnia, but also to prescribe concomitant examinations from other specialists, which is not always done, for example, by a neurologist.

It is important to collect a family history before making a diagnosis. When a factor of chronic insomnia is identified among close relatives of a patient, there is a high probability of an idiopathic form of the disease caused by a hereditary predisposition. In this case, a geneticist will be involved in the diagnosis.

Women with characteristic symptoms take a pregnancy test, since hormonal changes in the body are often the cause of the problem.

Patients are prescribed blood tests to detect a lack of minerals and vitamins, to identify diabetes mellitus, iron deficiency anemia. The doctor may also order tests to detect spinal cord tumors, problems with the heart, kidneys and lungs, and the functioning of the thyroid gland.

After the results obtained, special examinations are carried out:

• an electroencephalogram can detect neurological disorders. For example, seizure syndrome is often confused with RLS;
• electroneuromyography provides an opportunity to assess the quality of the conduction of nerve endings;
• polysomnography helps to identify pathology in its uncharacteristic course, detects limb movements in any phase of sleep, and not only when the patient falls asleep and when he is simply at rest. The same technique allows you to determine the severity of the disease. No more than 20 movements per hour speaks of a mild form of pathology, over 60 – of its severe course.

To make an accurate diagnosis, the doctor may prescribe special dopaminergic medications. If, after drinking a course of such drugs, the patient speaks of the disappearance of symptoms, then it was the restless legs syndrome that worried him. This diagnosis is based on the study of RLS and establishing a direct connection between this pathology and the number of dopamine receptors involved in the transmission of nerve impulses.

Drug treatment

Therapy is highly individual for each patient, but general principles of how to treat restless legs syndrome still exist:

• Dopaminergic drugs. The main effect of this group of drugs is directed to the peripheral nervous system. Most often, Levodopa is prescribed as a drug for the treatment of Willis disease. Taking medication is sometimes accompanied by muscle spasms, nausea, and dizziness.
   
• Benzodeazepines – Diazepam , Mirapex and others. Medicines, the main action of which is hypnotic and sedative effect. The drugs do not treat restless legs syndrome itself, but they significantly improve the quality of sleep and reduce anxiety. Medications are highly addictive, even after recovering from the disease, patients cannot sleep normally all night without taking the drug. Other side effects include daytime sleepiness and decreased concentration and alertness.
   
• Vitamins – multivitamin complexes containing folic acid, magnesium, iron, vitamins C, E, group B are recommended for patients with mild pathology, pregnant women and the elderly, since discomfort in the lower extremities sometimes provokes a banal lack of nutrients in the body.
   
• Anticonvulsants are prescribed individually for severe disease, when the main therapy does not give a positive result.

Medication can be prescribed only by the attending physician! Uncontrolled intake of drugs can lead to depletion of the nervous and cardiovascular systems, mental disorders, and impaired psychomotor functions.

Home treatment

Treatment of restless legs syndrome can be started before prescribing drug therapy with folk remedies that temporarily relieve symptoms and relieve sleepless nights:

• Soothing decoctions and tinctures of motherwort, valerian, lemon balm, linden. These folk remedies in moderation allow you to get rid of stress, relieve fatigue, eliminate spasms and cramps of the lower extremities, and improve the quality of sleep. Broths are taken before bedtime for half a glass, and tinctures – 20-25 drops.
   
• Laurel oil helps to relax the muscles of the limbs, relieves spasms, and has a warming effect. Chopped bay leaves should be placed in a dark glass container and covered with vegetable oil. The container is removed in a dark, cool place for 5 days. The oil is rubbed into the legs with light massage movements before going to bed.
   
• Lemon juice and vinegar. Rubbing vinegar or lemon juice on your feet before bed will help get rid of the discomfort. This must be done carefully so as not to burn the skin.
   
• Hot water foot baths can help relieve restless legs syndrome and soothe muscles, especially if the work involves staying on your feet for a long time during the day. You can add a decoction of chamomile, calendula, nettle, sage to the bath. The water temperature should be tolerable for the feet, not too hot. The duration of the procedure is 10-15 minutes before bedtime.

These folk remedies give a temporary effect, when the symptoms of the disease are often exacerbated due to increased fatigue and tension in the legs, but medical help is required to fully treat the disease.

General recommendations

If restless legs syndrome is mild, simple preventive measures will help get rid of discomfort before bedtime:

• Establishing a specific mode of night sleep. If a person finds that discomfort occurs in the late evening before going to bed, you can try changing the daily schedule so that you can get more sleep in the morning. A comfortable pillow, a proper orthopedic mattress, exclusion of external annoying sounds, and a cool room contribute to good sleep.
   
• Moderate physical activity. Hiking in the evening, swimming, yoga can help recuperate and calm the nerves.
   
• Quitting bad habits and drinking caffeine. Suffering from RLS, you will have to exclude from the diet not only coffee and black tea, but also any other products containing caffeine, it can be energy drinks, chocolate, cola. Alcohol and nicotine also increase symptoms.
   
• Foot massage. Regularly rubbing the lower limbs with oils before bedtime, you can get rid of discomfort, make it easier to fall asleep.
   
• Avoiding medications, one of the side effects of which is the development of RLS.

What is restless legs syndrome? This is a serious pathology, which is impossible to get rid of on your own. An integrated approach to solving the problem is required. Only the correct diagnosis, medical support, controlled intake of prescribed drugs will allow you to cure the disease and forget about sleepless nights forever.