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Restless legs syndrome and related disorders

Description

An in-depth report on the causes, diagnosis, treatment, and prevention of RLS.

Alternative Names

Ekbom's syndrome; Nocturnal leg cramps; Periodic limb movement disorder

Complications

Restless legs syndrome rarely results in any serious consequences. But in some cases, severe and persistent symptoms can cause considerable mental distress, chronic insomnia, and daytime sleepiness.

Sleep Deprivation

Sleep deprivation, and the daytime sleepiness that follows, is increasingly recognized as a cause of mood disruption and a contributor to industrial errors and motor vehicle crashes.

Effect on Daily Performance and Activities. Studies suggest that sleeplessness worsens many waking behaviors. These include:

• Avoidance of passive activities. Since RLS is worse when resting, people with severe RLS may avoid activities that involve long periods of sitting, such as going to movies or traveling long distances.
• Reduced concentration. Some experts report that deep sleep deprivation impairs the brain's ability to process information.
• Impaired task performance. Missing several hours of nightly sleep over the course of a week can negatively affect performance levels and mood. In fact, sleep deprivation can cause impaired performance levels comparable to those of intoxicated people.
• Effect on learning. Whether sleeplessness significantly impairs learning is unclear. Some studies have reported problems in memorization, although others have found no differences in test scores between people with temporary sleep loss and those with full sleep.

Psychiatric Effects

Some experts believe that many cases of RLS are due to underlying anxiety or depression. Other experts think it more likely that emotional issues stem from RLS rather than the other way around.

Studies in Swedish working-aged men and women reported that those with RLS were more apt to be socially isolated, to have frequent daytime headaches or depression, and to complain of reduced libido or problems related to sleepiness. Similarly, research presented at the 2005 meeting of the American College of Chest Physicians indicated that adults at risk of RLS were more likely than healthy peers to have psychiatric conditions such as depression and anxiety. They were also more likely to be overweight, unemployed, chronic smokers, and have trouble with work attendance and performance.

RLS can contribute to insomnia. Insomnia itself can increase the activity of hormones and pathways in the brain that produce emotional problems. Even modest alterations in waking and sleeping patterns can have significant effects on a person's mood. Persistent insomnia may even predict the future development of mood disorders in some cases.

It is not clear if RLS is responsible for negative mood states or if anxiety or depression contributes to RLS. Anxiety can cause agitation and leg restlessness that resemble RLS, and depression and RLS symptoms also overlap. In addition, certain types of antidepressant drugs -- such as serotonin reuptake inhibitors (SSRIs) -- can increase periodic limb movements during sleep.

• Review Date: 10/18/2006
• Reviewed By: Harvey Simon, M.D., Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital

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