How to Sleep with Restless Leg Syndrome

Learn how Restless Leg Syndrome can ruin your sleep and what you can do about it

By Andrea Pisani Babich

Restless Leg Syndrome (RLS), also called Willis-Ekbom disease, comes on in the night just as you are relaxing and beginning to fall asleep. Like an itch that must be scratched, the sensation is an irresistible urge to move your legs. No matter how much you try to ignore it, you are compelled to move by a force greater than yourself. You may think your muscles are just twitchy and will eventually relax, but if you experience this sensation night after night and it affects your ability to fall asleep, you may have this neurological sensory and sleep disorder.

Most people with RLS describe the sensation as a creeping, crawly, pulling or throbbing sensation that forces you to move your legs. The severity of the sensation can range from mildly uncomfortable to painful. Symptoms usually occur late in the day and are more pronounced at night while people are in bed.

RLS affects about 5-10% of the general population and about 80% of them also suffer from Periodic Limb Movement Disorder (PLMD), which causes frequent twitching in your limbs while you sleep. While PLMD plagues people during their sleep, RLS symptoms occur while you are still awake but are relaxing or trying to fall asleep. RLS can also be triggered by long periods of inactivity like car or airplane travel or sitting in a movie theater. Both Restless Leg Syndrome and Periodic Limb Movement Disorder can cause insomnia and sleep deprivation, leading to anxiety and depression.

What Causes Restless Leg Syndrome?

The exact mechanism that causes every case of RLS is not known, there appear to be several conditions that are related to or accompany the disorder. When the onset of RLS occurs before age 40 (known as primary RLS), the disorder has a genetic component and runs in the family. Evidence suggests that a deficiency of iron in the brain at least contributes to RLS. A large body of evidence suggests RLS is related to a disruption in the brain’s use of dopamine, a chemical needed to produce smooth and purposeful muscle movements. Use of alcohol, nicotine, and caffeine can also trigger or exacerbate RLS symptoms.

Other medical conditions that appear to be related to RLS include:

  • Parkinson’s disease
  • Kidney failure and its treatment with dialysis
  • Pregnancy, especially in the last trimester
  • Nerve damage
  • Rheumatoid arthritis
  • Hereditary peripheral neuropathy, a disorder of the nerves that carry messages to and from the brain and spinal cord
  • Cancer patients receiving chemotherapy
  • Sjogren’s syndrome
  • Sleep deprivation
  • Sleep apnea

RLS symptoms can also be caused or aggravated by certain medications such as:

  • Anti-nausea drugs such as prochlorperazine or metoclopramide
  • Anti-psychotic drugs such as haloperidol or phenothiazine derivatives
  • Selective Serotonin Reuptake Inhibitors (SSRIs) such as fluoxetine or sertraline, used to treat depression
  • Tricyclic antidepressants
  • Older antihistamines like diphenhydramine, found in some cold and allergy medications

How to Relieve Symptoms of RLS

Primary RLS is a lifelong condition for which there is no cure. But there are several ways to manage symptoms and keep RLS from keeping you from getting the rest you need.

While getting out of bed and walking around or stretching can relieve your RLS symptoms, the relief is often temporary or insufficient to allow you to sleep. In those cases, a more systematic approach to relief may be necessary.

Home remedies

Secondary RLS that is caused by a temporary medical condition or lifestyle choices may be resolved along with the resolution or treatment for the condition. Other behavioral changes that can help you manage RLS symptoms or resolve it completely include:

  • Regular moderate exercise. Intense exercise may actually increase symptoms, so be consistent, but take it easy.
  • Stress reduction or relaxation techniques such as yoga, meditation, stretching, soaking in a hot bath
  • Quitting smoking and reducing or eliminating caffeine and alcohol from your diet
  • Massaging your legs

Some over-the-counter supplements may help treat your RLS when it appears to be caused by certain deficiencies. Always consult with your doctor before starting any treatment regimen to determine if your RLS is caused by a deficiency and to target that deficiency properly.  

  • Iron supplements when the patient has iron deficiency anemia
  • Vitamin D when the patient demonstrates a Vitamin D deficiency
  • Vitamins C and E for patients on dialysis
  • Magnesium – especially when a magnesium deficiency is believed to contribute to the condition. Magnesium is believed to help regulate nerves and muscles. When magnesium levels are low, calcium can activate nerves and trigger muscle contractions. 

Drug-free remedies

Several devices and practices have been shown to provide relief for RLS symptoms and may help you avoid having to take prescription medications.

  • A foot wrap called restiffic applies pressure to certain points on the bottom of your feet. The pressure points send signals to the brain to relax the affect leg muscles.
  • Pneumatic compression sleeves fit over your legs, inflating and deflating to provide gentle pressure and release on restless muscles.
  • Near-infrared spectroscopy (NIRS) uses long wavelength light beams to penetrate the skin and increase circulation to help relieve RLS symptoms.
  • Acupuncture has been shown to reduce the symptoms of RLS significantly.

Prescription Medication for RLS

When behavioral adaptations and other drug-free remedies fail to relieve symptoms of your RLS, you may need prescription medication.

  • The first-line treatment for RLS is often the dopaminergic drugs pramipexole, ropinirole, and rotigotine, which promote the release of dopamine to your brain. Dopamine is involved in purposeful muscle movements, and some RLS patients experience symptoms as a result of a dopamine deficiency. Since long-term use of dopaminergic drugs has been shown to make symptoms worse or onset earlier in day, doctors will often prescribe the lowest dose possible. However, even at low doses, sometimes these drugs lose their efficacy.
  • The antiseizure medicine gabapentin has been approved by the FDA to treat RLS, although it is not entirely understood how it works to relieve symptoms.
  • Opioids are used judiciously when other first-line treatments are ineffective or make symptoms worse. Because of the risk of addiction, doctors will prescribe low doses and monitor usage carefully.

New research demonstrates that Restless Leg Syndrome is not just related to disorders in the central nervous system as previously thought, but also involves the specific nerve cells that supply the legs. Increased excitability of these nerve cells increases the number of signals sent between nerve cells, overstimulating the leg muscles. Further research on treatments targeting these nerve cells could lead to more effective treatments. Stay tuned, Mattress Advisor will be on it!

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