When sleeplessness starts in the legs

Uncomfortable nighttime leg sensations can spoil your sleep, but you can take steps to relieve it.

Is restless legs syndrome (RLS) the cause of your restless sleep? This exasperating condition triggers abnormal sensations in the legs and an irresistible urge to move them. It can wreak havoc with sleep, leading to daytime fatigue.

As striking as RLS sounds, it sometimes goes unrecognized. "People come in describing insomnia, but they don't put two and two together," says Dr. John Winkelman, an RLS specialist at Harvard-affiliated Massachusetts General Hospital. "You have to make that connection and then address the restless legs, and that helps people to sleep better."

What is RLS?

Up to 10% of adults may experience restless legs to some degree. About 3% of all adults have truly bothersome RLS, with moderate to severe symptoms at least twice a week.

RLS is more than just garden-variety muscle cramps or aches. The sensations seem to come from deep in the legs, often described as a tingling, aching, pulling, itching, or cramping feeling, or the "creepy-crawlies." This triggers an irresistible urge to move the legs. The symptoms typically start or get worse at night.

RLS and sleep

The leg sensations caused by RLS make it harder to fall asleep or to return to sleep after being awakened by the leg sensations. "People are kind of up and down and up and down during the night," Dr. Winkelman says.

Sleeping partners can also suffer, since most people with RLS also experience involuntary muscle movements called periodic leg movements of sleep (PLMS). These typically occur in the foot, ankle, or knee every 15 to 30 seconds, lasting for about two seconds (and sometimes longer). People without RLS can also experience PLMS. Unfortunately, there is no specific treatment for it.

Diagnosing RLS

There is no simple test for RLS, but with a few questions your doctor can make the diagnosis. Your doctor will do a blood test to measure how much iron is stored in your body. Taking a daily iron supplement sometimes relieves RLS symptoms.

Your doctor will review the medications you take, since some can cause or worsen restless legs. These include certain kinds of antihistamines, antidepressants, and anti-nausea drugs.

Treating RLS

There are now five FDA-approved medications for people with severe and frequent symptoms of RLS. On the other hand, if your symptoms are infrequent or only moderately bothersome, you might be able to get by with these self-help strategies:

• Avoid caffeine, nicotine, and alcohol, especially within several hours of bedtime.

• Before going to bed, massage your leg muscles, do gentle stretches, take a warm bath, or apply heating pads.

• Get some daily exercise, which may help to dampen RLS symptoms. It's unclear what kind of exercise is best, or when to do it—morning, afternoon, or evening. Just do what works for you.

• Schedule activities that require prolonged sitting or reclining—like car and plane travel and medical appointments—in the morning rather than the afternoon.