Is Restless Legs Syndrome a Real Illness?


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The name may sound like a punchline in search of a joke. But there’s nothing funny about a disorder that disturbs your sleep, disrupts your life, and causes considerable misery. People with restless legs syndrome (RLS) know all too well that it’s a serious problem. Yet family and friends who have never experienced it for themselves are often skeptical.

“When other people look at your legs, they appear normal,” says Richard Bogan, M.D., a sleep medicine physician and RLS researcher in Columbia, S.C. “You may also have trouble describing exactly what you’re feeling.”

Along with an urgent need to move when sitting or lying down, you may experience strange sensations. For example, it might feel as if ants are crawling on your legs or ropes are tying around them—but try explaining that when there are no ants or ropes anywhere in sight.

Five Reasons RLS Is the Real Deal

RLS is not an imaginary ailment. And contrary to what the jokes would have you believe, it’s also not just a case of wiggly toes or the antidote to a snoring spouse. It’s a real disorder with the weight of science behind it. When you need to set the record straight, Dr. Bogan suggests these talking points.

It’s a well-defined disease.

RLS isn’t a diagnosis that’s given to every fidgety sitter or fitful sleeper. To be diagnosed with the disorder, you must meet four criteria:

  • You have a strong, sometimes irresistible, urge to move your legs. This urge is often accompanied by unpleasant sensations, such as creepy-crawly, achy, itchy, tugging, tingling, burning, or painful feelings.

  • The symptoms start or get worse when you’re at rest.

  • The symptoms get better when you move your legs.

  • The symptoms are worse in the evening, particularly when you’re lying down.

It has a physiological basis.

RLS is not all in your head, but it is in your brain. “We think there is a problem with how the brain relaxes the body, particularly the legs, when it’s time for sleep at night,” says Dr. Bogan. Specifically, there appears to be a malfunction in the brain’s motor control areas. In many cases, this malfunction seems to be rooted in a lack of iron or faulty use of iron by the brain.

Iron is needed to make dopamine, a brain chemical that plays a key role in controlling movement. Several medical conditions—including kidney failure, Parkinson’s disease, rheumatoid arthritis, and pregnancy—affect how much iron is in the brain or how well it’s used. And it’s no coincidence that these conditions also increase the risk of developing RLS.

It has a genetic component.

One form of the disorder, called familial RLS, runs in families. “Familial RLS typically starts early in life—in young adulthood or even childhood,” says Dr. Bogan. In 2007, scientists announced the discovery of a gene variant that seems to be the largest contributor to this disorder. In individuals born with one copy of the variant, the risk of getting RLS is doubled. In those with two copies, the risk is four times higher, and the symptoms tend to be more severe.

It has serious consequences.

RLS feels unpleasant. Plus, it often interferes with sleep. “People may have trouble falling asleep because their legs are bothering them, or they may have to get out of bed and move around or massage their legs during the night,” says Dr. Bogan. The next day, they’re tired and sleepy. And that, in turn, affects their ability to function at home, work, or school. Many people with RLS also have trouble sitting still for activities such as movies, lectures, concerts, and plane travel, and that limits what they’re able to do.

It can be treated with medicine.

“There are now three FDA-approved drugs for treating RLS on the market in the U.S.,” says Dr. Bogan. These medications are Requip (ropinirole), Mirapex (pramipexole), and Horizant (gabapentin enacarbil). “There is no perfect drug that works for everyone,” Dr. Bogan says. “But the majority of patients tell us that the sensory component of RLS improves when they take one of these medications. As a result, many report some improvement in their ability to sleep and their level of next-day fatigue.”

The scientific verdict is in: RLS is very real—and it’s finally starting to get the real respect it deserves.

Medical Reviewers: Marcellin, Lindsey, MD, MPH Last Review Date: May 8, 2013

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