Restless Legs Syndrome: The Hidden Enemy Threatening Your Sleep Quality

Restless legs syndrome (RLS) is a neurological condition typically occurring in the evening or at bedtime, characterised by an indescribable feeling of discomfort and an irresistible urge to move the legs. This condition can severely impact your quality of life by making it difficult to fall asleep. Symptoms are usually temporarily relieved by movement but worsen again when resting, preventing you from getting uninterrupted sleep throughout the night.

At a Glance:

• What it is: A neurological sleep disorder that causes uncomfortable sensations and an urge to move the legs.
• Main Symptom: Tingling, numbness, and a pulling sensation in the legs, especially at night.
• Triggers: Resting, sitting for long periods, and evening hours increase the complaints.
• Risk Factors: Iron deficiency, genetic predisposition, and pregnancy are among the most common causes.
• Treatment: Managed with lifestyle changes, iron supplementation, and dopamine agonists.

What is Restless Legs Syndrome?

The clearest answer to what restless legs syndrome is—a condition classified among sleep-related movement disorders—is abnormal sensations felt in the legs due to a malfunction in the nervous system, leading to a constant need to move. Dr. Ayşegül Daldal, Neurology Specialist at BHT CLINIC İstanbul Tema Hastanesi, notes that according to population studies, the prevalence of this condition is between 10% and 15%. Despite being quite common, the diagnostic process can be delayed because patients often struggle to put the strange sensations they experience into words.

At the onset of the disease, symptoms may be unilateral, but over time they can spread to affect both legs. In advanced cases, similar symptoms can even appear in the arms in about half of the patients. Unable to clearly articulate their symptoms, patients may spend years trying various treatments across different medical specialties. The time lost until an accurate diagnosis is made disrupts the person's sleep pattern, leading to daytime fatigue and a loss of productivity.

What Are the Causes and Risk Factors?

Although the exact cause of restless legs syndrome is not always fully understood, an imbalance of the brain chemical dopamine, which controls muscle movements, is considered the primary factor. The disease can occur without an underlying cause (idiopathic) or develop as a result of other health problems (symptomatic).

Genetic predisposition is one of the most significant risk factors. In individuals with a family history of this condition, complaints are more likely to start at an early age. Additionally, the depletion of iron stores in the body or a drop in blood ferritin levels is among the most common triggers of the syndrome. Pregnancy, particularly the last trimester, is a period of highest risk due to hormonal changes and increased iron requirements. In most women, symptoms disappear on their own about a month after giving birth. Chronic kidney failure, diabetic neuropathy (nerve damage due to diabetes), and thyroid dysfunction are also counted among secondary causes. Certain antidepressants, allergy medications, and anti-nausea drugs can also exacerbate existing complaints.

What Are the Symptoms?

While restless legs syndrome symptoms vary from person to person, they generally begin during rest and peak in the evening hours. Patients may find it difficult to describe the discomfort they experience. Many describe it not as pain, but rather as a strange sensation crawling under the skin. The most common complaints voiced by patients include:

• A pulling sensation as if the legs are about to cramp
• Tingling and pins-and-needles in the legs at night
• Deep throbbing, burning, or electrical sensations
• Aching inside the bones or discomfort similar to a toothache
• An unbearable urge to move accompanied by numbness and pain in the legs

These sensations are temporarily relieved by physical activities such as walking, stretching the legs, shaking them, or massaging them. However, when the person returns to bed and remains still, the complaints return shortly. Furthermore, a large majority of patients also experience leg movements during sleep (Periodic Limb Movement Disorder). This manifests as involuntary twitching or kicking of the legs during sleep, disrupting sleep continuity.

How is it Diagnosed at the Hospital?

The diagnosis of restless legs syndrome relies on the physician's detailed clinical evaluation and the patient's medical history rather than complex laboratory tests. Neurology specialists look for the presence of four internationally recognised primary diagnostic criteria:

First, a strong urge to move the legs, accompanied by uncomfortable sensations. Second, these symptoms begin or worsen during periods of rest, such as sitting or lying down. Third, the complaints are partially or completely relieved by movements such as walking or stretching. Fourth, all these signs become more pronounced in the evening or throughout the night.

To confirm the diagnosis and rule out potential underlying causes, certain tests are requested. A complete blood count, iron, ferritin, vitamin B12, folic acid, and kidney function tests are administered as standard. If there is a suspicion of diabetes or nerve damage (neuropathy), an EMG (Electromyography) test, which measures nerve conduction velocity, may be performed. While a sleep test (Polysomnography) is not typically required in standard cases, an evaluation in a sleep laboratory may be requested if leg movements during sleep are severe or if an additional issue like sleep apnea is suspected.

How is it Treated?

Restless legs syndrome treatment is personalised based on the severity of the disease, the patient's age, and underlying causes. Dr. Ayşegül Daldal states that the first step in treatment is identifying and resolving any potential underlying condition. If blood tests reveal low ferritin levels, iron supplementation started under a physician's supervision can largely eliminate the complaints.

Medical Treatment Methods

In idiopathic cases where no clear underlying cause is found, dopamine agonists, which regulate dopamine levels in the brain, are the first-choice drug group. These medications are highly effective in controlling the feeling of restlessness and involuntary movements in the legs. In advanced cases, anticonvulsant drugs that reduce nerve pain may also be added to the treatment plan. Medication therapy may be lifelong, and dosage adjustments can be made by the physician according to periods of flare-ups and relief.

Lifestyle Changes You Can Apply at Home

In addition to medical treatment, simple but effective measures you can take at home will significantly improve your quality of life:

• Regular Exercise: Engaging in moderate-paced walking, swimming, or yoga at least three days a week reduces muscle tension. However, heavy exercise right before bedtime can increase complaints.
• Massage and Heat Application: A light massage on the legs or taking a warm shower before bed helps relax the muscles. Cold or warm compress applications can also relieve the sensation.
• Sleep Hygiene: Going to bed and waking up at the same time every day, keeping the bedroom cool and dark, and avoiding screen lights make it easier to fall asleep.
• Avoiding Triggers: Caffeine, alcohol, and tobacco products stimulate the nervous system and exacerbate symptoms. Consumption of tea, coffee, and chocolate should be limited, especially in the evening.

Complications and Risk Groups

When left untreated, the disease causes the most damage to sleep patterns. Chronic insomnia leads to constant daytime fatigue, difficulty focusing, memory problems, and a decline in work performance. In the long term, sleep deprivation increases the risk of developing psychiatric issues such as depression and anxiety.

The decline in sleep quality and rising stress levels can also negatively affect other systems in the body. The digestive system is frequently impacted by this; for instance, symptoms of functional disorders like Irritable Bowel Syndrome (IBS) can flare up alongside insomnia and stress. The elderly, pregnant women, dialysis patients, and diabetics are the risk groups most vulnerable to the complications of this syndrome.

When to See a Doctor?

If the discomfort in your legs is now preventing you from falling asleep, causing you to wake up frequently during the night, and draining your energy for the next day, it is time to consult a neurology specialist. Furthermore, if your complaints are no longer limited to your legs but are spreading to your arms, or if there is no reduction in symptoms despite the medications you use, seeking medical support is essential.

However, not every sensation in the legs is restless legs syndrome. If you experience sudden, very severe pain in your leg, unilateral swelling, redness, or increased warmth (suspected Deep Vein Thrombosis), or if a sudden loss of strength, numbness, or a paralysis-like condition develops in your leg, you should call 112 emergency services without losing time or go to the nearest emergency room.

Diagnosis and Treatment Process at BHT CLINIC

At the Neurology clinic of BHT CLINIC İstanbul Tema Hastanesi, the diagnosis and treatment of sleep disorders and movement diseases are meticulously carried out using current medical approaches. Detailed neurological examinations of our patients are performed by our specialist physicians, and necessary blood tests and examinations like EMG are quickly finalized in our hospital's fully equipped laboratories.

In unexpected situations or for sudden neurological complaints, you can reach us through our emergency department, which operates 24/7, and our call centre at 0850 811 34 00. With early diagnosis and correct treatment, you can largely bring your complaints under control. To start your process, you can get support from Dr. Ayşegül Daldal and our expert medical staff by selecting the Neurology department via the BHT CLINIC appointment page.

Frequently Asked Questions

Can restless legs syndrome be completely cured?

If the disease is due to an underlying temporary cause such as iron deficiency or pregnancy, it can completely resolve once this condition is eliminated. However, in genetic or idiopathic (unknown cause) cases, the disease is chronic; although it may not completely disappear, symptoms are largely brought under control with the right medication and lifestyle changes.

Which department should I visit for restless legs syndrome?

The diagnosis and treatment of this condition are performed by Neurology specialists. When deemed necessary, they may work in collaboration with sleep disorder centres or Internal Medicine departments depending on the underlying cause.

Does magnesium deficiency cause restless legs syndrome?

Although magnesium deficiency is not considered a direct primary cause of restless legs syndrome, it can exacerbate existing complaints as it leads to muscle cramps and nervous system sensitivity. In some patients, magnesium supplementation helps relax the muscles and improve sleep quality.

Can restless legs syndrome symptoms be experienced during the day?

While the disease typically occurs in the evening and night hours, symptoms can also be felt during the day in advanced cases or when remaining immobile for a long time (for example, during long flights or bus journeys, or while sitting in a cinema).

Is restless legs syndrome seen in children?

Yes, it can also be seen in children. However, because children cannot fully describe the discomfort they feel, it is often confused with 'growing pains' or 'hyperactivity'. If your child constantly moves their legs at night and has difficulty falling asleep, it would be beneficial to consult a specialist.

This article is for informational purposes only; please consult your physician for diagnosis and treatment.