Pregnant with restless legs

Treating RLS While Pregnant

If your symptoms are severe enough to interrupt your sleep night after night, you’ll probably want to see your doctor to get RLS treated. That can be challenging during pregnancy.

Most drugs typically used to treat restless legs syndrome, such as Requip (ropinirole) and Mirapex (pramipexole), have not been studied extensively in pregnant women. So there is not enough data to determine all potential risks for a developing fetus.

Before you take any medicine for restless legs syndrome, your doctor should check your iron levels. If you’re low, you can take an iron supplement. In many cases where the supply of iron in the body is low a supplement will be enough to correct RLS.

If your RLS symptoms still don’t go away after an iron deficiency has been found and treated, some doctors prescribe opioid (narcotic) medication. Because of a risk of withdrawal symptoms in a newborn, opioids are typically given for a short period of time.

Also, the FDA has approved a device for treating RLS. Relaxis is the name of the vibrating pad placed under the legs while you’re in bed. It is available only by prescription.

FOR IMMEDIATE RELEASE ON December 06, 2010

ST. PAUL, Minn. – Women with transient restless legs syndrome (RLS) during pregnancy appear to be at a higher risk of developing a chronic form of RLS later in life or have the same symptoms during future pregnancies, according to new research published in the December 7, 2010, print issue of Neurology®, the medical journal of the American Academy of Neurology. RLS is a sleep-related motor disorder that causes an unpleasant feeling in the legs. The condition generally worsens during rest at night and improves with movement. Symptoms tend to progress with age. “This is the first long-term study to look at a possible connection between restless legs syndrome in pregnancy and repeat occurrences in later years or future pregnancies,” said study author Mauro Manconi, MD, PhD, with Vita-Salute University in Milan, Italy. “Most of the time, when a woman experiences RLS in pregnancy, it disappears after the baby is born. However, our results show that having the condition during pregnancy is a significant risk factor for a future chronic form or the short-term form in other pregnancies down the road.” The study involved 74 women who experienced restless legs syndrome during pregnancy and 133 who did not. After six and half years, the women were interviewed about RLS symptoms, further pregnancy, occurrences of other diseases and any medications they used. A total of 18 of the women who had RLS during pregnancy, or 24 percent, also had the disorder at the end of the study, compared to 10 of the women who did not have RLS during pregnancy, or 8 percent. Thus, women who experienced RLS in their pregnancy were four times more likely to have the condition again than those who did not experience pregnancy-related RLS. They were also three times more likely to have the chronic form compared to women who did not experience pregnancy-related RLS. About 60 percent of the women who experienced RLS during pregnancy reported the symptoms again in a future pregnancy, compared to 3 percent of the women who did not have RLS during a first pregnancy but developed it during a future pregnancy, a relative risk of 19.4. “Women who experience RLS should still be reassured that symptoms will probably disappear after delivery but may reappear later on,” said Manconi.

The American Academy of Neurology, an association of more than 22,500 neurologists and neuroscience professionals, is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as epilepsy, Alzheimer’s disease, stroke, migraine, multiple sclerosis, brain injury and Parkinson’s disease. For more information about the American Academy of Neurology, visit http://www.aan.com.

Restless leg syndrome (pregnancy sleep)

Why do I have this urge to keep moving my legs?

You may have restless legs syndrome (RLS), which is common in pregnancy. RLS affects about one in five mums-to-be (CKS 2015a, NHS 2015b).
The need to move your legs is caused by crawling, creeping or tingling sensations. You may have these feelings inside your foot, calf or upper leg.
Sometimes you may feel cramping aching or a fidgety feeling, but above all an overpowering urge to move your legs. It’s usually worse at night (CKS 2015a), and can be a real nuisance when you’re trying to wind down and sleep.
You may also find that your limbs move and jerk around during the night. This is known as periodic limb movements of sleep, and happens in 85 per cent of people with RLS (CKS 2015a, NHS 2015b).
RLS is a recognised medical condition. It can happen for no reason, but it can also run in families (CKS 2015a, NHS 2015b). Sometimes it’s related to another health condition, such as iron deficiency anaemia (CKS 2015a, NHS 2015b, BAP Wilson et al 2010).
Pregnancy itself can also bring on RLS (CKS 2015a). Pregnancy-induced RLS is thought to be caused by your changing hormones, and usually starts in the third trimester (CKS 2015a).

What can I do about my restless legs?

You may find that stretching, bending or rubbing your legs helps. Walking around the room may ease the discomfort, too (CKS 2015a, NHS 2015b). Unfortunately, these tactics tend to give only temporary relief. As soon as you sit or lie down, the RLS may return. It usually gets worse in the afternoon or evening and at night (CKS 2015a, NHS 2015b). Try these tips to help you cope:
Take regular exercise
Daily exercise may help to relieve RLS(CKS 2015a). Walking, swimming and yoga are all great choices during pregnancy (NHS 2017).
Try to avoid vigorous exercise in the evening though, as it could make it harder for you to sleep (CKS 2015b). If RLS strikes, try gentle stretches or a slow stroll to relieve the symptoms (CKS 2015a, NHS 2015b). The best pregnancy exercises Getting moving will help you to have a healthier pregnancy. Discover the best exercises to do when you’re expecting.More pregnancy videos Cut down on caffeine
While you’re pregnant, try not to have more than 200mg of caffeine a day, which is about two mugs of tea or one mug of filter coffee (NHS 2015a). Caffeine can make RLS worse and keep you awake (CKS 2015a, NHS 2015b, Wilson et al 2010). So cut down on tea (including green tea), coffee, cola and chocolate, especially in late afternoon and evening (CKS 2015b).
Ask your midwife about supplements
In some cases, leg cramps can happen as a result of an iron deficiency, in which case iron supplements may help (CKS 2015a, Wilson et al 2010). Always speak to your GP, midwife or pharmacist for advice before taking any supplements in pregnancy though, as they may not be safe for your baby.
Get into a sleep routine
Frustratingly, while restless legs can make it hard to sleep, not getting enough shut-eye can actually make the symptoms worse (Bozorg 2017). Going to bed and getting up at the same time every day will help to regulate your body clock and may make it easier for you to sleep (CKS 2015a).
Use temperature changes
If you have an attack of RLS, try bathing your legs in warm or cool water (Bozorg 2017, CKS 2015a), or using a hot or cold compress (NHS 2015b). The physical sensation can help to soothe and relax the discomfort in your legs.
Massage your legs
Massaging your legs may help to stop the restless feeling during an attack (Wilson et al 2010, CKS 2015, NHS 2015b). A willing partner may be able to massage your legs for you. If you want to use essential oils as part of your massage, find out which ones are safe in pregnancy.

Will my restless legs go away when my baby is born?

If you have pregnancy-induced RLS, it should go away within a few weeks of giving birth (CKS 2015a, NHS 2015b).
Restless legs making you sleep-deprived? Check out these ways to get more rest:

  • See our expert tips for a better night’s sleep
  • Get solutions for third trimester night-time niggles
  • Find out if it’s safe to take sleeping pills
  • Tried and tested: real-life tips for coping with tiredness

Last reviewed: August 2017
Bozorg AM. 2017. Restless legs syndrome treatment & management. emedicine.medscape.com
CKS. 2015a. Restless legs syndrome. Clinical Knowledge Summaries. cks.nice.org.uk
CKS. 2015b. Insomnia.Clinical Knowledge Summaries. cks.nice.org.uk
NHS. 2015a. Should I limit caffeine during pregnancy? NHS Choices, Common health questions. www.nhs.uk
NHS. 2015b. Restless legs syndrome. NHS Choices, Health A-Z. www.nhs.uk
NHS. 2017. Exercise in pregnancy. NHS Choices, Health A-Z. www.nhs.uk
Wilson SJ, Nutt DJ, Alford C. 2010. British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders. J Psychopharmacol 24(11): 1577-1600. www.bap.org.uk

What it is

If you feel an uncontrollable urge to move your legs to relieve crawling, tingling, or burning sensations, you probably have restless legs syndrome (RLS).

You’re not alone. One study of more than 600 pregnant women found that over 16 percent reported symptoms of RLS.

At the end of your rope? Need sleep? Find practical ideas that might work for you here: Coping with restless legs syndrome: Pregnancy advice from moms-to-be.

Symptoms usually show up when you’re at rest, especially right before you fall asleep or when you’ve been sitting still for long periods, such as at the movies or during a long car ride. Most of the time, you’ll feel the symptoms of RLS in your lower legs, but some women feel it in their feet, thighs, arms, or hands, too.

Moving your limbs brings immediate relief, but the sensations return when you stop moving. Needless to say, this can be very uncomfortable and frustrating, especially when you’re trying to sleep. If RLS keeps you from sleeping night after night, you could end up seriously fatigued.

Fortunately for women who develop RLS during pregnancy, it’s temporary. The symptoms typically peak when you’re 7 or 8 months pregnant and disappear altogether by the time you deliver your baby or within a month afterward.

What causes restless legs syndrome
No single cause has been identified, but research is ongoing. In addition to affecting a good number of pregnant women, RLS affects men, children, and women who aren’t pregnant. And it seems to run in families. For women who already have RLS, it usually gets worse during pregnancy.

No one knows why women who’ve never had RLS develop it during pregnancy, but there are a number of theories. Iron deficiency, folate deficiency, hormonal changes (specifically a rise in estrogen), and circulatory changes are all possible culprits.

What you can do about restless legs syndrome

Things to avoid

  • Most drugs used to treat RLS are not recommended during pregnancy.
  • Quinine (found in tonic water) is sometimes used to relieve RLS symptoms, but don’t take it without talking with your healthcare provider first. Its safety during pregnancy hasn’t been established.
  • Even a small amount of caffeine can make RLS symptoms worse. If RLS symptoms are bothering you, you might try eliminating caffeine from your diet completely, if you haven’t already.
  • Some medications, such as the antihistamines in cold and allergy remedies, make the symptoms worse for some people. (So while Benadryl tends to make people sleepy, for example, it may actually intensify your RLS symptoms and make it harder for you to sleep.)
  • Lying in bed reading or watching television before you go to sleep can make things worse. The longer you lie still, the more likely RLS will occur. Instead, get in bed only when you’re actually ready to go to sleep.

Things that might help

  • Ask your doctor or midwife about trying supplements such as iron, magnesium, vitamin B12, or folate. Depending on the quantities in your prenatal vitamin, your practitioner may or may not want you to take more.
  • Some women find it helpful to stretch their legs, get a massage, use hot or cold packs, take warm baths, or practice relaxation techniques. Maybe your significant other will massage or rub your legs until you fall asleep. For lots more tips from moms-to-be, read our article about coping with restless legs syndrome.

The Other Kind of Kicking: RLS in Pregnancy

What special considerations should neurologists take when treating RLS/Transient Willis-Ekbom disease in pregnant women?

“It is interesting how common there are situations where the patient does not complain specifically of , but only of a bad sleep, or sometimes they do not even complain of bad sleep, as women think this is normal in the pregnant state,” says Jose Pereira, MD, Emeritus Professor of Pediatrics, Jundiai Medical school, São Paulo, Brazil and Head (retired), Sleep Sector, Department of Pediatrics, Jundiaí Medical School.

“In the majority of the cases, the symptoms stop around delivery, so usually it is not necessary to start with a pharmacological treatment,” said Mauro Manconi, MD of the Sleep and Epilepsy Centre, Neurocenter (EOC) of Southern Switzerland. “Sometimes symptoms are severe and women ask for a treatment. All of the drugs used for idiopathic RLS belong to the category C, which means no indication during pregnancy for safety reasons. In case of ferritin deficit I suggest IV iron, which can help,” he said. He also recomends that patients stop caffeine and maintain good sleep hygiene. “Dopamine agonists have been used without major complications, however they can theoretically interfere with lactation. In women already affected by RLS before pregnancy the symptoms might worsen a lot during pregnancy and these are the women more severely affected,” he said. Opioids and small doses of clonazepam might be considered for these individuals.

“For all women affected, we educate about the natural course of RLS during pregnancy and suggest non-pharmacologic interventions such as exercise and avoiding aggravating factors,” said Daniel Picchietti MD, a neurologist in Urbana, IL.

Dr. Pereira says some non-pharmacological measures may be useful. “The pregnant woman should be warned about gaining too much weight; that could place on the sensory receptors, an incremented tissue pressure that could enhance their signaling condition. That is, more inputs to cortex that may be felt as symptoms. As the same varicose veins should be addressed, they also put more pressure on the somatosensory receptors in the calf.” He adds that logical reasoning points to the periphery as the site where RLS symptoms originate. “Massage may be of great value, and some women may find it useful to wear tight socks.”

Poor sleep hygiene habits must be addressed, he says, agreeing with Dr. Manconi. Sleep deprivation (SD) mightily increases RLS symptomatology, as the thyroid axis increases during SD. “Any hindrance to a good night sleep should be addressed and removed if possible; and, importantly, abstinence from caffeine must be total. Also, grape fruit juice must be entirely avoided. Caffeine and grapefruit are inhibitors of CYP3A4 isoform, where part of the thyroid hormone is metabolized. If CYP3A4 is inhibited, thyroid hormones increase.” Many drugs have the ability to inhibit CYP3A4, so, if possible, the clinician should avoid prescribing them, or, perhaps, should change them to others with minor CYP3A4 inhibiting profile.

“Pregnancy is a time when iron stores can be very low. Low iron can aggravate RLS symptoms. We check the serum ferritin level (a sensitive iron test) for women who are symptomatic with RLS and recommend oral iron if the ferritin level is below 50 mcg/L,” Dr. Picchietti says.

Why might RLS worsen during pregnancy?
“We know for sure that pregnancy is a strong risk factor for RLS and that symptoms reach a peak during the third trimester,” Dr. Manconi said. “We know that probably pregnancy itself lowers the symptomatic threshold for RLS. We do not know why it happens. Factors implicated might be hormones, iron deficiency, or dopaminergic alterations.”

The cause behind the increase of RLS rates in pregnant women is indeed frustrating to researchers, and research has cast more doubt than it is has solved problems. In a 2011 study, researchers distributed a questionnaire to postpartum patients and saw “no correlation between pregnancy-related restless legs syndrome and low hemoglobin levels in the first trimester.” The incidence of restless legs syndrome was not affected by use of iron supplementation. Further, improvement after delivery is not associated with the number of previous pregnancies, the RLS severity and iron intake during pregnancy, peridural anesthesia, caesarean section, delivery complications, newborn weight, breastfeeding, dopaminergic agent intake after delivery, and with the absence of RLS before pregnancy.

What should neurologists take away from recent research?
For his study, Dr. Manconi and researchers conducted a long-term follow-up study, planned as an extension of a previous survey on restless legs syndrome during pregnancy. After a mean interval of 6.5 years, 207 parous women were contacted again to compare the incidence of RLS among subjects who never experienced the symptoms with those who reported RLS during the previously investigated pregnancy.

“The main finding of my study was that women who suffered of RLS during pregnancy compared to those who did not suffer have a four-fold increased risk to develop a standard idiopathic RLS in the following eight years,” he said. “This means that behind pregnancy-related RLS there is a genetic background that predispose to RLS and pregnancy is only a transient precipitating factor which needs a genetic predisposition. The next step is to scan RLS genes in pregnant women with RLS.”

In summation, Dr. Pereira said, “as Dr. Karl A. Ekbom stated long ago, there will not be any doctor, of any specialty, that will not have to face some patient with .” “But, as to neurologists, they are ‘owners’ of this disease as it is, in my opinion, a functional peripheral neuropathy. Perhaps they share its property with endocrinologists, as its main derangement is an imbalance between two hormones, a classical one, the thyroid hormone, and a neuroendocrine one, dopamine. Neurologists and endocrinologists, perhaps, may be in a good to observe RLS, to treat it, and to unravel more of it that is still hidden.”

Poor Pregnancy Sleep Quality Linked to Untreated RLS

A good night’s sleep can be elusive during pregnancy. But women — and their physicians — shouldn’t dismiss the symptoms of poor sleep as typical pregnancy complaints. Nor should they assume the problem can’t be fixed just because many medications are off-limits during pregnancy.

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That’s according to Michigan Medicine’s Galit Dunietz, Ph.D., MPH, a T32 postdoctoral research fellow in neurology and the lead author on a new study in the Journal of Clinical Sleep Medicine. The research confirms a higher burden of restless leg syndrome among pregnant women. Dunietz reports that more than a quarter of pregnant women with RLS had severe RLS symptoms, which are strongly related to poor sleep quality.

“A lot of the time when women report or experience sleep issues, they attribute those symptoms to the pregnancy,” says Dunietz, who works with U-M’s Sleep Disorders Center. “However, we report RLS may be an additional contributor to these symptoms. With RLS as a predictor, we may be able to alleviate some of the sleep disturbances by treating RLS.”

RLS, a neurological condition with symptoms including uncomfortable or unpleasant tickling or twitching in the legs, is also associated with excessive daytime sleepiness and poor daytime function.

“The more severe the RLS is, the more likely you are to have sleep disturbances during pregnancy,” Dunietz says. “The observed positive dose-response relationship between frequency of RLS symptoms and sleep disturbances is a unique feature of this study.”

This sheds a light on a topic to address in prenatal care, Dunietz says.

How to Handle Restless Leg Syndrome During Pregnancy

Pregnancy can be full of joyful moments, but the sleep challenges expectant moms face in the third trimester are anything but pleasant. During the last few months before childbirth, nighttime disruptions can include frequent urination, kicking from the baby, and heartburn. But perhaps the most annoying, uncomfortable sensation comes from restless leg syndrome, an uncontrollable, twitchy feeling in the lower limbs that forces sufferers to get up and move (or else lie there in spasm). Restless leg syndrome affects plenty of expectant mothers as well: Up to 15 percent of pregnant women develop the condition in the third trimester. Although there is no hard and fast fix for restless leg syndrome, there are some ways you can lower your risk for it or ease the sensation if it occurs.

Check Your Diet

Some women who develop restless leg syndrome in pregnancy may have low levels of iron and/or folic acid. Iron insufficiency is believed to affect dopamine production, a brain chemical responsible for motor control. Ask your doctor whether taking an iron or folic acid supplement might help.

Turn Left

Sleeping on your left side during pregnancy can help improve blood circulation for both you and your baby, which might help with cramping legs. This position has also been shown to enhance blood flow to your organs. If you are not normally a side sleeper, make it more comfortable by placing a pillow between your knees, behind your back, or under your belly to provide additional support.

Point and Flex

When leg spasms hit, gently point and flex your foot, which provides a subtle stretch for your legs. You can also try stretching your legs before you tuck in, which might help prevent a case of restless leg syndrome as you sleep.

Get Out of Bed

Still can’t find relief? Don’t try to force yourself to sleep through the sensation—it won’t work. Movement is often one of the easiest ways to relieve the uncomfortable feeling, so get up and find a calm, quiet activity that involves activating your leg muscles. You could slowly stroll the hallway, walk up and down stairs, organize a cabinet, or gently kick your legs in a warm bath.

Restless Legs Syndrome Fact Sheet

What is restless legs syndrome?

Restless legs syndrome (RLS), also called Willis-Ekbom Disease, causes unpleasant or uncomfortable sensations in the legs and an irresistible urge to move them. Symptoms commonly occur in the late afternoon or evening hours, and are often most severe at night when a person is resting, such as sitting or lying in bed. They also may occur when someone is inactive and sitting for extended periods (for example, when taking a trip by plane or watching a movie). Since symptoms can increase in severity during the night, it could become difficult to fall asleep or return to sleep after waking up. Moving the legs or walking typically relieves the discomfort but the sensations often recur once the movement stops. RLS is classified as a sleep disorder since the symptoms are triggered by resting and attempting to sleep, and as a movement disorder, since people are forced to move their legs in order to relieve symptoms. It is, however, best characterized as a neurological sensory disorder with symptoms that are produced from within the brain itself.

RLS is one of several disorders that can cause exhaustion and daytime sleepiness, which can strongly affect mood, concentration, job and school performance, and personal relationships. Many people with RLS report they are often unable to concentrate, have impaired memory, or fail to accomplish daily tasks. Untreated moderate to severe RLS can lead to about a 20 percent decrease in work productivity and can contribute to depression and anxiety. It also can make traveling difficult.

It is estimated that up to 7-10 percent of the U.S. population may have RLS. RLS occurs in both men and women, although women are more likely to have it than men. It may begin at any age. Many individuals who are severely affected are middle-aged or older, and the symptoms typically become more frequent and last longer with age.

More than 80 percent of people with RLS also experience periodic limb movement of sleep (PLMS). PLMS is characterized by involuntary leg (and sometimes arm) twitching or jerking movements during sleep that typically occur every 15 to 40 seconds, sometimes throughout the night. Although many individuals with RLS also develop PLMS, most people with PLMS do not experience RLS.

Fortunately, most cases of RLS can be treated with non-drug therapies and if necessary, medications.

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What are common signs and symptoms of restless legs?

People with RLS feel the irresistible urge to move, which is accompanied by uncomfortable sensations in their lower limbs that are unlike normal sensations experienced by people without the disorder. The sensations in their legs are often difficult to define but may be described as aching throbbing, pulling, itching, crawling, or creeping. These sensations less commonly affect the arms, and rarely the chest or head. Although the sensations can occur on just one side of the body, they most often affect both sides. They can also alternate between sides. The sensations range in severity from uncomfortable to irritating to painful.

Because moving the legs (or other affected parts of the body) relieves the discomfort, people with RLS often keep their legs in motion to minimize or prevent the sensations. They may pace the floor, constantly move their legs while sitting, and toss and turn in bed.

A classic feature of RLS is that the symptoms are worse at night with a distinct symptom-free period in the early morning, allowing for more refreshing sleep at that time. Some people with RLS have difficulty falling asleep and staying asleep. They may also note a worsening of symptoms if their sleep is further reduced by events or activity.

RLS symptoms may vary from day to day, in severity and frequency, and from person to person. In moderately severe cases, symptoms occur only once or twice a week but often result in significant delay of sleep onset, with some disruption of daytime function. In severe cases of RLS, the symptoms occur more than twice a week and result in burdensome interruption of sleep and impairment of daytime function.

People with RLS can sometimes experience remissions—spontaneous improvement over a period of weeks or months before symptoms reappear—usually during the early stages of the disorder. In general, however, symptoms become more severe over time.

People who have both RLS and an associated medical condition tend to develop more severe symptoms rapidly. In contrast, those who have RLS that is not related to any other condition show a very slow progression of the disorder, particularly if they experience onset at an early age; many years may pass before symptoms occur regularly.

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What causes restless legs syndrome?

In most cases, the cause of RLS is unknown (called primary RLS). However, RLS has a genetic component and can be found in families where the onset of symptoms is before age 40. Specific gene variants have been associated with RLS. Evidence indicates that low levels of iron in the brain also may be responsible for RLS.

Considerable evidence also suggests that RLS is related to a dysfunction in one of the sections of the brain that control movement (called the basal ganglia) that use the brain chemical dopamine. Dopamine is needed to produce smooth, purposeful muscle activity and movement. Disruption of these pathways frequently results in involuntary movements. Individuals with Parkinson’s disease, another disorder of the basal ganglia’s dopamine pathways, have increased chance of developing RLS.

RLS also appears to be related to or accompany the following factors or underlying conditions:

  • end-stage renal disease and hemodialysis
  • iron deficiency
  • certain medications that may aggravate RLS symptoms, such as antinausea drugs (e.g. prochlorperazine or metoclopramide), antipsychotic drugs (e.g., haloperidol or phenothiazine derivatives), antidepressants that increase serotonin (e.g., fluoxetine or sertraline), and some cold and allergy medications that contain older antihistamines (e.g., diphenhydramine)
  • use of alcohol, nicotine, and caffeine
  • pregnancy, especially in the last trimester; in most cases, symptoms usually disappear within 4 weeks after delivery
  • neuropathy (nerve damage).

Sleep deprivation and other sleep conditions like sleep apnea also may aggravate or trigger symptoms in some people. Reducing or completely eliminating these factors may relieve symptoms.

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How is restless legs syndrome diagnosed?

Since there is no specific test for RLS, the condition is diagnosed by a doctor’s evaluation. The five basic criteria for clinically diagnosing the disorder are:

  • A strong and often overwhelming need or urge to move the legs that is often associated with abnormal, unpleasant, or uncomfortable sensations.
  • The urge to move the legs starts or get worse during rest or inactivity.
  • The urge to move the legs is at least temporarily and partially or totally relieved by movements.
  • The urge to move the legs starts or is aggravated in the evening or night.
  • The above four features are not due to any other medical or behavioral condition.

A physician will focus largely on the individual’s descriptions of symptoms, their triggers and relieving factors, as well as the presence or absence of symptoms throughout the day. A neurological and physical exam, plus information from the person’s medical and family history and list of current medications, may be helpful. Individuals may be asked about frequency, duration, and intensity of symptoms; if movement helps to relieve symptoms; how much time it takes to fall asleep; any pain related to symptoms; and any tendency toward daytime sleep patterns and sleepiness, disturbance of sleep, or daytime function. Laboratory tests may rule out other conditions such as kidney failure, iron deficiency anemia (which is a separate condition related to iron deficiency), or pregnancy that may be causing symptoms of RLS. Blood tests can identify iron deficiencies as well as other medical disorders associated with RLS. In some cases, sleep studies such as polysomnography (a test that records the individual’s brain waves, heartbeat, breathing, and leg movements during an entire night) may identify the presence of other causes of sleep disruption (e.g., sleep apnea), which may impact management of the disorder. Periodic limb movement of sleep during a sleep study can support the diagnosis of RLS but, again, is not exclusively seen in individuals with RLS.

Diagnosing RLS in children may be especially difficult, since it may be hard for children to describe what they are experiencing, when and how often the symptoms occur, and how long symptoms last. Pediatric RLS can sometimes be misdiagnosed as “growing pains” or attention deficit disorder.

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How is restless legs syndrome treated?

RLS can be treated, with care directed toward relieving symptoms. Moving the affected limb(s) may provide temporary relief. Sometimes RLS symptoms can be controlled by finding and treating an associated medical condition, such as peripheral neuropathy, diabetes, or iron deficiency anemia.

Iron supplementation or medications are usually helpful but no single medication effectively manages RLS for all individuals. Trials of different drugs may be necessary. In addition, medications taken regularly may lose their effect over time or even make the condition worse, making it necessary to change medications.

Treatment options for RLS include:

Lifestyle changes. Certain lifestyle changes and activities may provide some relief in persons with mild to moderate symptoms of RLS. These steps include avoiding or decreasing the use of alcohol and tobacco, changing or maintaining a regular sleep pattern, a program of moderate exercise, and massaging the legs, taking a warm bath, or using a heating pad or ice pack. There are new medical devices that have been cleared by the U.S. Food & Drug Administration (FDA), including a foot wrap that puts pressure underneath the foot and another that is a pad that delivers vibration to the back of the legs. Aerobic and leg-stretching exercises of moderate intensity also may provide some relief from mild symptoms.

Iron. For individuals with low or low-normal blood tests called ferritin and transferrin saturation, a trial of iron supplements is recommended as the first treatment. Iron supplements are available over-the-counter. A common side effect is upset stomach, which may improve with use of a different type of iron supplement. Because iron is not well-absorbed into the body by the gut, it may cause constipation that can be treated with a stool softeners such as polyethylene glycol. In some people, iron supplementation does not improve a person’s iron levels. Others may require iron given through an IV line in order to boost the iron levels and relieve symptoms.

Anti-seizure drugs. Anti-seizure drugs are becoming the first-line prescription drugs for those with RLS. The FDA has approved gabapentin enacarbil for the treatment of moderate to severe RLS, This drug appears to be as effective as dopaminergic treatment (discussed below) and, at least to date, there have been no reports of problems with a progressive worsening of symptoms due to medication (called augmentation). Other medications may be prescribed “off-label” to relieve some of the symptoms of the disorder.

Other anti-seizure drugs such as the standard form of gabapentin and pregabalin can decrease such sensory disturbances as creeping and crawling as well as nerve pain. Dizziness, fatigue, and sleepiness are among the possible side effects. Recent studies have shown that pregabalin is as effective for RLS treatment as the dopaminergic drug pramipexole, suggesting this class of drug offers equivalent benefits.

Dopaminergic agents. These drugs, which increase dopamine effect, are largely used to treat Parkinson’s disease. They have been shown to reduce symptoms of RLS when they are taken at nighttime. The FDA has approved ropinirole, pramipexole, and rotigotine to treat moderate to severe RLS. These drugs are generally well tolerated but can cause nausea, dizziness, or other short-term side effects. Levodopa plus carbidopa may be effective when used intermittently, but not daily.

Although dopamine-related medications are effective in managing RLS symptoms, long-term use can lead to worsening of the symptoms in many individuals. With chronic use, a person may begin to experience symptoms earlier in the evening or even earlier until the symptoms are present around the clock. Over time, the initial evening or bedtime dose can become less effective, the symptoms at night become more intense, and symptoms could begin to affect the arms or trunk. Fortunately, this apparent progression can be reversed by removing the person from all dopamine-related medications.

Another important adverse effect of dopamine medications that occurs in some people is the development of impulsive or obsessive behaviors such as obsessive gambling or shopping. Should they occur, these behaviors can be improved or reversed by stopping the medication.

Opioids. Drugs such as methadone, codeine, hydrocodone, or oxycodone are sometimes prescribed to treat individuals with more severe symptoms of RLS who did not respond well to other medications. Side effects include constipation, dizziness, nausea, exacerbation of sleep apnea, and the risk of addiction; however, very low doses are often effective in controlling symptoms of RLS.

Benzodiazepines. These drugs can help individuals obtain a more restful sleep. However, even if taken only at bedtime they can sometimes cause daytime sleepiness, reduce energy, and affect concentration. Benzodiazepines such as clonazepam and lorazepam are generally prescribed to treat anxiety, muscle spasms, and insomnia. Because these drugs also may induce or aggravate sleep apnea in some cases, they should not be used in people with this condition. These are last-line drugs due to their side effects.

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What is the prognosis for people with restless legs syndrome?

RLS is generally a lifelong condition for which there is no cure. However, current therapies can control the disorder, minimize symptoms, and increase periods of restful sleep. Symptoms may gradually worsen with age, although the decline may be somewhat faster for individuals who also suffer from an associated medical condition. A diagnosis of RLS does not indicate the onset of another neurological disease, such as Parkinson’s disease. In addition, some individuals have remissions—periods in which symptoms decrease or disappear for days, weeks, months, or years—although symptoms often eventually reappear. If RLS symptoms are mild, do not produce significant daytime discomfort, or do not affect an individual’s ability to fall asleep, the condition does not have to be treated.

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What research is being done?

The mission of the National Institute of Neurological Disorders and Stroke (NINDS) is to seek fundamental knowledge about the brain and nervous system and to use that knowledge to reduce the burden of neurological disease. The NINDS is a component of the National Institutes of Health (NIH), the leading supporter of biomedical research in the world.

While the direct cause of RLS is often unknown, changes in the brain’s signaling pathways are likely to contribute to the disease. In particular, researchers suspect that impaired transmission of dopamine signals in the brain’s basal ganglia may play a role. There is a relationship between genetics and RLS. However, currently there is no genetic testing. NINDS-supported research is ongoing to help discover genetic relationships and to better understand what causes the disease.

The NINDS also supports research on why the use of dopamine agents to treat RLS, Parkinson’s disease, and other movement disorders can lead to impulse control disorders, with aims to develop new or improved treatments that avoid this adverse effect.

The brain arousal systems appear to be overactive in RLS and may produce both the need to move when trying to rest and the inability to maintain sleep. NINDS-funded researchers are using advanced magnetic resonance imaging (MRI) to measure brain chemical changes in individuals with RLS and evaluate their relation to the disorder’s symptoms in hopes of developing new research models and ways to correct the overactive arousal process. Since scientists currently don’t fully understand the mechanisms by which iron gets into the brain and how those mechanisms are regulated, NINDS-funded researchers are studying the role of endothelial cells—part of the protective lining called the blood-brain barrier that separates circulating blood from the fluid surrounding brain tissue—in the regulation of cerebral iron metabolism. Results may offer new insights to treating the cognitive and movement symptoms associated with these disorders.

More information about research on RLS supported by NINDS or other components of the NIH is available through the NIH RePORTER (http://projectreporter.nih.gov/reporter.cfm), a searchable database of current and previously funded research, as well as research results such as publications.

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Where can I get more information?

For more information on neurological disorders or research programs funded by the National Institute of Neurological Disorders and Stroke, contact the Institute’s Brain Resources and Information Network (BRAIN) at:

BRAIN
P.O. Box 5801
Bethesda, MD 20824
800-352-9424

Information also is available from the following organizations:

Restless Legs Syndrome Foundation
3006 Bee Caves Road, Suite D206
Austin, Texas 78746
512-366-9109

National Organization for Rare Disorders (NORD)
55 Kenosia Avenue
Danbury, CT 06810
203-744-0100
Voice Mail 800-999-NORD (6673)

National Sleep Foundation
1010 N. Glebe Road, Suite 310
Arlington, VA 22201
703-243-1697

American Sleep Association
1002 Lititz Pike #229
Lititz, PA 17543

National Heart, Lung, and Blood Institute (NHLBI)
National Institutes of Health, DHHS
31 Center Drive, Room 4A21
Bethesda, MD 20892-2480
301-592-8573

“Restless Legs Syndrome Fact Sheet”, NINDS, Publication date May 2017.

NIH Publication No. 17-4847

Back to Restless Legs Syndrome Information Page

See a list of all NINDS disorders

Publicaciones en Español

Síndrome de las Piernas Inquietas

Prepared by:
Office of Communications and Public Liaison
National Institute of Neurological Disorders and Stroke
National Institutes of Health
Bethesda, MD 20892

NINDS health-related material is provided for information purposes only and does not necessarily represent endorsement by or an official position of the National Institute of Neurological Disorders and Stroke or any other Federal agency. Advice on the treatment or care of an individual patient should be obtained through consultation with a physician who has examined that patient or is familiar with that patient’s medical history.

All NINDS-prepared information is in the public domain and may be freely copied. Credit to the NINDS or the NIH is appreciated.

Treatment


Restless legs syndrome

Dopamine agonists

Dopamine agonists may be recommended if you’re experiencing frequent symptoms of restless legs syndrome.

They work by increasing dopamine levels, which are often low.

Dopamine agonists that may be recommended include:

  • ropinirole
  • pramipexole
  • rotigotine skin patch

These medications can occasionally make you feel sleepy, so you should be cautious when driving or using tools or machinery after taking them.

Other possible side effects can include nausea, dizziness and headaches.

If you experience nausea while taking a dopamine agonist, you may be given medication to help with this (antiemitic medication).

Impulse control disorder (ICD) is a less common side effect sometimes associated with dopamine agonists.

People with ICD are unable to resist the urge to do something harmful to themselves or others.

For example, this could be an addiction to alcohol, drugs, gambling, shopping or sex (hypersexuality).

But the urges associated with ICD will subside once treatment with the dopamine agonist is stopped.

Painkillers

A mild opiate-based painkiller, such as codeine, may be prescribed to relieve pain associated with restless legs syndrome.

Gabapentin and pregabalin are also sometimes prescribed to help relieve painful symptoms of restless legs syndrome.

Side effects of these medications include dizziness, tiredness and headaches.

Aiding sleep

If restless legs syndrome is disrupting your sleep, a short-term course of medication may be recommended to help you sleep.

These types of medication are known as hypnotics, and include temazepam and loprazolam.

Hypnotics are usually only recommended for short-term use (typically no longer than a week).

You may find you still feel sleepy or “hungover” the morning after taking your medication.

Restless Legs Syndrome (RLS) During Pregnancy

Between heartburn, that urgent need to use the loo every two hours, leg cramps and an insistent case of pregnancy insomnia, you’re already having a tough time getting quality shut-eye. And now, in your third trimester of pregnancy, yet another pregnancy symptom is keeping you up all night: restless legs syndrome (RLS).

If you’re one of the 15 percent of expecting moms who experience it, you’ll notice an uncomfortable and disconcerting tingling, creeping and crawling in your feet and legs accompanied by an urge to move them — especially as you’re trying to get to sleep. Your legs seem to take on a life of their own, kind of like they’re plugged into an electrical socket and getting all juiced up.

When Does Restless Legs Syndrome Start During Pregnancy?

Although you might notice RLS more at night, it can strike any time when you’re lying or sitting down. Most of the time you won’t experience it until later in your pregnancy, during the third trimester. Unfortunately, the usual treatments for leg cramps — flexing and stretching — don’t work, and prescription medications that might relieve the restlessness are off-limits during pregnancy.

What Causes Restless Legs Syndrome During Pregnancy?

Experts aren’t sure, although genetics are probably a factor. Other possible culprits include hormones, especially estradiol and progesterone, which surge during the third trimester and fall right after birth, following the same pattern as RLS.

Environmental and dietary factors like iron deficiency and/or sensitivity to certain types of foods may also be risks. That growing baby doing the samba in utero and pressing down on the nerves around your sacrum definitely doesn’t help matters. Neither does fatigue or low mood. Lack of sleep, anxiety, depression and stress — common during pregnancy — can all take a toll and may even trigger RLS. So take care of yourself and try to get plenty of rest.

What Can I Do About Restless Legs Syndrome During Pregnancy?

Though this is one pregnancy symptom you kind of have to wait out if you experience it, there are some ways to get relief:

  • Get some ZZZs. Even though RLS is notorious for keeping expectant moms up at night, fatigue will make your symptoms worse.

  • Distract yourself. When your feet starting jumping on their own, grab a crossword puzzle, immerse yourself in your favorite rom com, start knitting…anything to distract yourself from the annoying symptoms of RLS.

  • Keep a food journal. Note what you’ve eaten before you experience bouts of RLS. Some women find that certain foods (such as carbs eaten late in the day) can trigger restless legs, and you may be able to figure out what foods make your symptoms improve or worsen.

  • Get tested. Ask your practitioner about being tested for iron-deficiency anemia, which some experts think is linked to RLS. In the meantime, it never hurts to fill up on iron-rich, heart-healthy foods like spinach, beans, chickpeas and dried fruit.

  • Heat it up. Sometimes a warm (not hot) bath or a heating pad or ice pack can bring relief.

  • Try acupuncture. With your practitioner’s green light, going under the needle may help for some women, as can yoga, meditation, or other relaxation techniques.

Can I Prevent Restless Legs Syndrome During Pregnancy?

Unfortunately, this might be one of those symptoms you’ll have to learn to live with until your baby is born. But don’t worry — it’s temporary.

When Can I Expect My Restless Legs Syndrome to End?

Symptoms should go away within four weeks of delivery, although one study found 97 percent of women with RLS found complete relief a few days after giving birth.

MORE ON PREGNANCY SYMPTOMS

  • Bloating During Pregnancy
  • Back Pain During Pregnancy
  • Round Ligament Pain (Stomach Pain) During Pregnancy

Restless leg syndrome affects about one in five women during pregnancy. RSL is the feeling of needing to move the legs while at rest, and the feeling is relieved by the movement. It is often worse in the last trimester of pregnancy and improves after delivery. For some women it is only a minor discomfort but for other women it can be very disruptive.

Most women will experience RLS for the first time in pregnancy, although women who have had it prior to pregnancy are more likely to have it during pregnancy. The cause of RLS is not clear. Low iron levels is also said to predispose to RLS. It may also be more common in some families.

RLS is one of the most common reason of sleep disturbance during pregnancy (after needing to urinate and positional discomfort). It can affect getting to sleep and also staying asleep. Poor sleep quality may lead daytime sleepiness and poor daytime function, and mood disorders.

RLS usually increases in frequency and severity as pregnancy progresses, peaking about 30-36 weeks gestation. For most women, it will resolve completely or mostly immediately after delivery.

A pregnancy woman with RLS will give a typical story of

  • an urge to move her legs, sometimes with an uncomfortable feeling in the legs
  • the urge is worse with rest
  • it increases at night
  • it is relieved by activity or movement

If these features are described no further tests are required to make the diagnosis, although iron studies may be made to exclude underlying anaemia as a cause.

RLS should be differentiated form other causes of leg discomfort :

Positional leg discomfort is easily relieved by simple position change while RLS is the need to keep moving the legs.

Nocturnal leg cramps which are sudden, painful tightness and palpable hardening of the muscle. These are common during pregnancy and usually made worse by movement, particularly extension of the foot.

Leg swelling and sore muscles, which are characterised by pain or discomfort but not a need to move the legs.

Numbness of the limb can occur with poor blood supply or nerve compression. Numbness is not found with RLS.

Most pregnant women will require only reassurance that the condition is not associated with any risks to their pregnancy and will resolve after delivery. Stretching exercises may be helpful and other causes of leg discomfort should be excluded. Exercise has been shown to increase deep sleep, RLS symptoms, and benefit mental health, especially depression Brisk walking, water aerobics, ballroom dancing, and general gardening are examples of moderate-intensity exercise.

Women should avoids factors that may make RSL worse, including insufficient sleep, irregular sleep, caffeine, and nicotine. Some medications, including sedating antihistamines, and some drugs used to treat nausea and vomiting of pregnancy (eg, doxylamine and metoclopramide). Ondansetron, however, does not appear to trigger RLS symptoms. Yoga, massage and leg compression stocking may also be helpful. Women should be checked for iron deficiency and iron supplementation prescribed if needed.

For a few women with severe symptoms, not improved with education, non-drug interventions and iron supplementation, medication may be required. This should be assessed on an individual basis by their doctor.

Depression occurs in approximately 1 in 10 to 12 pregnant and women after delivery, and the risk may be higher among women who have experienced restless legs syndrome. Treatment of RLS may improve depressive and anxiety symptoms but specific treatment for depression is usually needed if mood symptoms are significant.

In summary, Restless Leg Syndrome is a common problem during pregnancy, particularly lat pregnancy. It is the sensation of having to move the legs , often worse at night and relived by moving. These typical features will differentiate RLS from other causes of leg discomfort in pregnancy. For most women it is one the many minor discomforts of pregnancy and will be relieved by reassurance that it does not pose a risk to the pregnancy and it will cease when they have delivered their baby. It can be associated with iron deficiency which should be checked and treated as required. Depression may be more common in women with RLS. A very few women will have refractory symptoms that require most specific medical treatment.

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