Medically reviewed by: Luke Maj, MD
At night, when the rest of your body is ready to slip into sleep, do your legs become decidedly awake? In people with restless leg syndrome (RLS), a deeply uncomfortable sensation in the legs causes an overwhelming urge to move them. Minutes or even seconds after you wriggle, shake or jerk your legs, the achy, creepy-crawly sensation returns.
Because it interferes with a good night’s sleep, RLS can wreak havoc on daytime alertness and even a person’s mood. But the path to finding a restless leg syndrome treatment that works isn’t always straight. Even to experts, the condition is a bit of mystery, with a long list of possible causes.
One proposed cause is an imbalance of dopamine in the brain. This neurotransmitter helps control muscle movements. People who see a neurologist for RLS are often prescribed a drug that increases level of dopamine in the brain, or an anti-seizure medicine called gabapentin. But gabapentin has side effects, and not all people with RLS need it.
“I look at RLS a little bit differently,” said Luke Maj, MD, an interventional radiologist and vein expert at Water’s Edge Dermatology. “The first thing I do when I see patients with RLS is get them off of gabapentin. It’s possible that the drug is masking other causes of the condition that may not need to be treated with medication.”
One of those causes is chronic venous insufficiency (CVI), a common, treatable vein condition.
CVI as a hidden cause of restless leg syndrome
In chronic venous insufficiency, faulty valves in the veins allow blood to pool in the legs. The pooled blood can cause pain, swelling and leg cramps. Moving the legs helps.
“Moving the ankles in particular can ease symptoms because it constricts the calf muscles, which squeezes the veins, sending blood back to the heart,” said Dr. Maj. This explains why some people have a habit of jiggling their feet during the day — it makes their legs feel better.
To confirm a diagnosis of CVI, Dr. Maj orders an ultrasound during a patient’s first visit. This imaging test shows the structure of the leg veins, including the valves, and any problems with blood flow. He also advises patients with CVI symptoms to wear compression socks or stockings to see if they improve the RLS. They often do.
“During follow-up visits, many patients tell me that the restlessness has gone away. They often ask, ‘What are these magical socks?’” said Dr. Maj. If compression garments help, and the ultrasound indicates CVI, patients have the option of undergoing an in-office treatment to close the abnormal veins and alleviate their RLS permanently.
Other causes of RLS
In addition to dopamine imbalances and CVI, a host of other factors may cause or contribute to RLS, which is why identifying the underlying problem is important. They include:
- Iron deficiency. Lack of iron in the brain may interfere with dopamine’s ability to send signals from the brain to the muscles.
- Genetics. Approximately 40% to 90% of people with RLS say they have at least one first-degree relative (parent, sibling or child) who also has it.
- Certain health problems. Your risk of RLS may be higher if you have diabetes, rheumatoid arthritis, multiple sclerosis, Parkinson’s disease or end-stage kidney disease. Damage to the nerves in the hands and feet (peripheral neuropathy) can also contribute to RLS.
- Certain medications. Drugs thought to increase the risk of RLS include certain antidepressants, antipsychotics, heart medications, anti-nausea drugs and cold and allergy medications.
- Caffeine, alcohol and nicotine. In some people, consuming too much of any of these can cause RLS or worsen symptoms.
- Pregnancy. Pregnant women sometimes develop RLS symptoms, often in the third trimester. The symptoms usually go away within a month after giving birth.
- Sleep deprivation and sleep disorders. Lack of sleep and conditions such as sleep apnea that interfere with sleep may cause episodes of RLS.
If you suspect that a disease you have or a medication you take may be causing your RLS, talk with your primary care doctor or specialist.
When a vein issue isn’t the cause of RLS, Dr. Maj often suggests a simple treatment to try: a compression foot wrap called restiffic, available online. It puts pressure on certain muscles in the foot, which for many people helps relieve the urge to move the legs.
“I’ve had patients come back and say they’ve had a great result,” said Dr. Maj. A small study published in the Journal of the American Osteopathic Association found that people with RLS who used the device for six weeks saw a 69% reduction in the severity of their symptoms.
“The most important piece of advice is to get evaluated by your vein physician, who can identify any treatable causes. Addressing the root cause could resolve your symptoms and let you sleep better at night,” noted Dr Maj.
Written by: Jessica Brown, a health and science writer/editor based in Nanuet, New York. She has written for Riverchase Dermatology, Prevention magazine, jnj.com, BCRF.org, and many other outlets.