Restless Legs Syndrome

Restless legs syndrome (RLS), also known as Willis-Ekbom Disease (WED), is generally a long-term disorder that causes a strong urge to move one’s legs. There is often an unpleasant feeling in the legs that improves somewhat by moving them. Occasionally, arms may also be affected. The feelings generally happen when at rest and therefore can make it hard to sleep. Due to the disturbance in sleep, people with RLS may have daytime sleepiness, low energy, irritability, and a depressed mood. Additionally, many have limb twitching during sleep. RLS is not the same as habitual foot tapping or leg rocking.

Restless legs syndrome Definition

A condition in which a person has a strong urge to move his or her legs in order to stop uncomfortable sensations. These include burning, itching, creeping, tugging, crawling, or pain. These feelings usually happen when a person is lying or sitting down, and are worse at night. They can also occur in other parts of the body.

Risk factors for Restless legs syndrome

Risk factors for RLS include low iron levels, kidney failure, Parkinson’s disease, diabetes mellitus, rheumatoid arthritis, pregnancy, and celiac disease. A number of medications may also trigger the disorder including antidepressants, antipsychotics, antihistamines, and calcium channel blockers.

There are two main types. One is early onset RLS which starts before age 45, runs in families, and worsens over time. The other is late onset RLS which begins after age 45, starts suddenly, and does not worsen. Diagnosis is generally based on a person’s symptoms after ruling out other potential causes.

Females are more commonly affected than males, and it becomes increasingly common with age.

Restless legs syndrome Symptoms

RLS sensations range from pain or aching in the muscles, to “an itch you can’t scratch”, a “buzzing sensation”, an unpleasant “tickle that won’t stop”, a “crawling” feeling, or limbs jerking while awake. The sensations typically begin or intensify during quiet wakefulness, such as when relaxing, reading, studying, or trying to sleep.

The sensations—and the need to move—may return immediately after ceasing movement or at a later time. RLS may start at any age, including childhood, and is a progressive disease for some, while the symptoms may remit in others. In a survey among members of the Restless Legs Syndrome Foundation, it was found that up to 45% of patients had their first symptoms before the age of 20 years.

An urge to move

The sensations are unusual and unlike other common sensations. Those with RLS have a hard time describing them, using words or phrases such as uncomfortable, painful, ‘antsy’, electrical, creeping, itching, pins, and needles, pulling, crawling, buzzing, and numbness. It is sometimes described as similar to a limb ‘falling asleep’ or an exaggerated sense of positional awareness of the affected area. The sensation and the urge can occur in any body part; the most cited location is the legs, followed by the arms. Some people have little or no sensation, yet still, have a strong urge to move.

Motor restlessness

Movement usually brings immediate relief, although temporary and partial. Walking is most common; however, stretching, yoga, biking, or other physical activity may relieve the symptoms. Continuous, fast up-and-down movements of the leg, and/or rapidly moving the legs toward then away from each other, may keep sensations at bay without having to walk. Specific movements may be unique to each person.

Worsening of symptoms

Sitting or lying down (reading, plane ride, watching TV) can trigger the sensations and urge to move. Severity depends on the severity of the person’s RLS, the degree of restfulness, the duration of the inactivity, etc.

Variability

Some experience RLS only at bedtime, while others experience it throughout the day and night. Most people experience the worst symptoms in the evening and the least in the morning.

Restless legs

These symptoms of RLS can make sleeping difficult for many patients and a 2005 National Sleep Foundation poll shows the presence of significant daytime difficulties resulting from this condition. These problems range from being late for work to missing work or events because of drowsiness. Patients with RLS who responded reported driving while drowsy more than patients without RLS. These daytime difficulties can translate into safety and social and economic issues for the patient and for society.

RLS may contribute to higher rates of depression and anxiety disorders in RLS patients.

Category of Restless legs syndrome

RLS is categorized as either primary or secondary:

• Primary RLS is considered idiopathic or with no known cause. Primary RLS usually begins slowly, before approximately 40–45 years of age, and may disappear for months or even years. It is often progressive and gets worse with age. RLS in children is often misdiagnosed as growing pains.
• Secondary RLS often has a sudden onset after age 40 and maybe daily from the beginning. It is most associated with specific medical conditions or the use of certain drugs.

Restless legs syndrome Causes

While the cause is generally unknown, it is believed to be caused by changes in the nerve transmitter dopamine resulting in an abnormal use of iron by the brain. RLS is often due to iron deficiency (low total body iron status). Other associated conditions may include:

• End-stage kidney disease and hemodialysis,
• Folate deficiency,
• Magnesium deficiency,
• Sleep apnea,
• Diabetes,
• Peripheral neuropathy,
• Parkinson’s disease,
• Multiple sclerosis.

RLS can worsen in pregnancy, possibly due to elevated estrogen levels. The use of alcohol, nicotine products, and caffeine may be associated with RLS. A 2014 study from the American Academy of Neurology also found that reduced leg oxygen levels were strongly associated with restless legs Syndrome symptom severity in untreated patients.

ADHD

An association has been observed between attention deficit hyperactivity disorder (ADHD) and RLS or periodic limb movement disorder. Both conditions appear to have links to dysfunctions related to the neurotransmitter dopamine, and common medications for both conditions among other systems, affect dopamine levels in the brain.

A 2005 study suggested that up to 44% of people with ADHD had comorbid (i.e. coexisting) RLS, and up to 26% of people with RLS had confirmed ADHD or symptoms of the condition.

Restless legs syndrome Medications

Certain medications may cause or worsen RLS, or cause it secondarily, including:

• Certain antiemetics (antidopaminergic ones),
• Certain antihistamines (especially the sedating, first-generation H1 antihistamines often in over-the-counter cold medications),
• Many antidepressants (both older TCAs and newer SSRIs),
• Antipsychotics and certain anticonvulsants,
• A rebound effect of sedative-hypnotic drugs such as benzodiazepine withdrawal syndrome from discontinuing benzodiazepine tranquilizers or sleeping pills,
• Alcohol withdrawal can also cause restless legs syndrome and other movement disorders such as akathisia and parkinsonism usually associated with antipsychotics, and
• Opioid withdrawal is associated with causing and worsening RLS.

Both primary and secondary RLS can be worsened by surgery of any kind; however, back surgery or injury can be associated with causing RLS.

The cause vs. effect of certain conditions and behaviors observed in some patients (excess weight, lack of exercise, depression, or other mental illnesses) is not well established. Loss of sleep due to RLS could cause the conditions or medication used to treat a condition could cause RLS.

Genetics

More than 60% of cases of RLS are familial and are inherited in an autosomal dominant fashion with variable penetrance.

Research and brain autopsies have implicated both the dopaminergic system and iron insufficiency in the substantia nigra. Iron is well understood to be an essential cofactor for the formation of L-dopa, the precursor of dopamine.

Genetic loci

Six genetic loci found by linkage are known and listed below. Other than the first one, all of the linkage loci were discovered using an autosomal dominant mode of inheritance:

• The first genetic locus was discovered in one large French Canadian family and maps to chromosome 12q. This locus was discovered using an autosomal recessive inheritance model. Evidence for this locus was also found using a transmission disequilibrium test (TDT) in 12 Bavarian families.
• The second RLS locus maps to chromosome 14q and was discovered in one Italian family. Evidence for this locus was found in one French Canadian family. Also, an association study in a large sample of 159 trios of European descent showed some evidence for this locus.
• This locus maps to chromosome 9p and was discovered in two unrelated American families. Evidence for this locus was also found by the TDT in a large Bavarian family, in which significant linkage to this locus was found.
• Locus maps to chromosome 20p and was discovered in a large French Canadian family with RLS.
• This locus mapped to chromosome 2p and was found in three related families from a population isolated in South Tyrol.
• The sixth locus is located on chromosome 16p12.1 and was discovered by Levchenko et al. in 2008.

Three genes, MEIS1, BTBD9, and MAP2K5, were found to be associated with RLS. Their role in RLS pathogenesis is still unclear. More recently, a fourth gene, PTPRD was found to be associated with RLS.

There is also some evidence that periodic limb movements in sleep (PLMS) are associated with BTBD9 on chromosome 6p21.2, MEIS1, MAP2K5/SKOR1, and PTPRD. The presence of positive family history suggests that there may be a genetic involvement in the etiology of RLS.

Restless legs syndrome Diagnosis

There are no specific tests for RLS, but non-specific laboratory tests are used to rule out other causes such as vitamin deficiencies. Five symptoms are used to confirm the diagnosis:

• A strong urge to move the limbs is usually associated with unpleasant or uncomfortable sensations.
• Starts or worsens during inactivity or rest.
• Improves or disappears (at least temporarily) with activity.
• Worsens in the evening or night.
• These symptoms are not caused by any medical or behavioral condition.

These symptoms are not essential, like the ones above, but occur commonly in RLS patients:

• Genetic component or family history with RLS.
• Good response to dopaminergic therapy.
• Periodic leg movements during the day or sleep.
• Most strongly affected are people who are middle-aged or older.
• Other sleep disturbances are experienced.
• Decreased iron stores can be a risk factor and should be assessed.

According to the International Classification of Sleep Disorders (ICSD-3), the main symptoms have to be associated with a sleep disturbance or impairment in order to support RLS diagnosis.

Differential diagnosis of Restless legs syndrome

The most common conditions that should be differentiated with RLS include:

• Leg cramps,
• Positional discomfort,
• Local leg injury,
• Arthritis,
• Leg edema,
• Venous stasis,
• Peripheral neuropathy,
• Radiculopathy,
• Habitual foot tapping/leg rocking,
• Anxiety,
• Myalgia, and
• Drug-induced akathisia.

Peripheral artery disease and arthritis can also cause leg pain but this usually gets worse with movement.

There are less common differential diagnostic conditions included:

• Myelopathy,
• Myopathy,
• Vascular or neurogenic claudication,
• Hypotensive akathisia,
• Orthostatic tremor,
• Painful legs, and
• Moving toes.

Restless legs syndrome Treatment

If RLS is not linked to an underlying cause, its frequency may be reduced by lifestyle modifications such as adopting improving sleep hygiene, regular exercise, and stopping smoking. Medications used may include dopamine agonists or gabapentin in those with daily restless legs syndrome, and opioids for the treatment of resistant cases.

Treatment of RLS should not be considered until possible medical causes are ruled out. Secondary RLS may be cured if precipitating medical conditions (anemia) are managed effectively.

Physical measures

Stretching the leg muscles can bring temporary relief. Walking and moving the legs, as the name “restless legs” implies, brings temporary relief. In fact, those with RLS often have an almost uncontrollable need to walk and therefore relieve the symptoms while they are moving.

Unfortunately, the symptoms usually return immediately after the moving and walking cease. A vibratory counter-stimulation device has been found to help some people with primary RLS improve their sleep.

Iron

There is some evidence that intravenous iron supplementation moderately improves restlessness for people with RLS.

Medications

For those whose RLS disrupts or prevents sleep or regular daily activities, medication may be useful. Evidence supports the use of dopamine agonists including:

• Pramipexole,
• Ropinirole,
• Rotigotine, and
• Cabergoline.

They reduce symptoms and improve sleep quality and quality of life. Levodopa is also effective. However, pergolide and cabergoline are less recommended due to their association with the increased risk of valvular heart disease. Ropinirole has a faster onset with a shorter duration.

Rotigotine is commonly used as a transdermal patch that continuously provides stable plasma drug concentrations, resulting in its particular therapeutic effect on patients with symptoms throughout the day. One review found pramipexole to be better than ropinirole.

Dopamine agonists

There are, however, issues with the use of dopamine agonists including augmentation. This is a medical condition where the drug itself causes symptoms to increase in severity and/or occur earlier in the day.

Dopamine agonists may also cause rebound when symptoms increase as the drug wears off. In many cases, the longer dopamine agonists have been used the higher the risk of augmentation and rebound as well as the severity of the symptoms. Also, a recent study indicated that dopamine agonists used in restless legs syndrome can lead to an increase in compulsive gambling.

• Gabapentin or pregabalin is a non-dopaminergic treatment for moderate to severe primary RLS.
• Opioids are only indicated in severe cases that do not respond to other measures due to their very high abuse liability and high rate of side effects, which may include constipation, fatigue, and headache.

One possible treatment for RLS is dopamine agonists, unfortunately, patients can develop dopamine dysregulation syndrome, meaning that they can experience an addictive pattern of dopamine replacement therapy. Additionally, they can exhibit some behavioral disturbances such as impulse control disorders like pathologic gambling, compulsive purchasing, and compulsive eating. 

Restless legs syndrome Prognosis

RLS symptoms may gradually worsen with age, although more slowly for those with the idiopathic form of RLS than for people who also have an associated medical condition. Current therapies can control the disorder, minimizing symptoms and increasing periods of restful sleep.

In addition, some people have remissions, periods in which symptoms decrease or disappear for days, weeks, or months, although symptoms usually eventually reappear. Being diagnosed with RLS does not indicate or foreshadow another neurological disease, such as Parkinson’s disease. 

Restless legs syndrome Epidemiology

RLS affects an estimated 2.5–15% of the American population. A minority (around 2.7% of the population) experience daily or severe symptoms. RLS is twice as common in women as in men, and Caucasians are more prone to RLS than people of African descent.

RLS occurs in 3% of individuals from the Mediterranean or Middle Eastern regions, and in 1–5% of those from East Asia, indicating that different genetic or environmental factors, including diet, may play a role in the prevalence of this syndrome. 

Restless legs syndrome Research

Different measurements have been used to evaluate treatments in RLS. Most of them are based on subjective rating scores, such as the IRLS rating scale (IRLS), Clinical Global Impression (CGI), Patient Global Impression (PGI), and Quality of life (QoL).

These questionnaires provide information about the severity and progress of the disease, as well as the person’s quality of life and sleep. Polysomnography (PSG) and actigraphy (both related to sleep parameters) are more objective resources that provide evidence of sleep disturbances associated with RLS symptoms.

Ayurveda for Restless legs syndrome

Treatment is focused on treating the underlying condition that is causing RLS. Once the underlying condition is addressed, there is great relief in the symptoms of RLS. But in the case of RLS without any associated condition, lifestyle modifications are recommended. In case of lifestyle modifications are ineffective, medications are recommended.

The lifestyle modifications

1. Starting a regular exercise program.
2. Eliminating or reducing caffeine, alcohol, and tobacco.
3. Ensuring adequate sleep.
4. Getting leg massages.
5. Ice packs and/or heat packs.
6. Avoid standing or sitting for long periods of time.

Medications

Dopaminergic drugs that help in regulating dopamine, benzodiazepines for sleep regulation, and narcotics for pain relief in case of severe pain may help in alleviating the symptoms of restless legs syndrome, as there is no permanent cure for this condition.

Ayurveda

Ayurveda treatment has proven to be effective in the treatment of RLS. Oil massages, various types of kizhi, and internal medicines have proven to be effective in treating RLS.

Home remedies for Restless legs syndrome

RLS occurs more in women than men. It can happen at any age, but it affects adults more often, according to the National Institutes of Health Trusted Source

The symptoms of RLS can vary in duration and severity for each person. Some people experience mild symptoms intermittently, while others may have more severe symptoms with each episode. No matter what your pain level is, there are some home remedies that you can try to help you manage your condition:

Lifestyle changes

It’s not well understood what causes RLS, but researchers do know there is a connection between your lifestyle and how frequently your symptoms occur. There are some lifestyle changes that you can make to help ease your symptoms.

Diet

Eating a healthy diet can help promote good sleep. Limit how much alcohol and caffeine you consume, and avoid these before bedtime. You can also avoid any foods that you know might keep you awake at night.

Smoking

Smoking can make the body feel jittery and can have an impact on sleep. Try cutting down on smoking or quitting completely.

Medications

Sometimes medications that you take for other conditions can make it difficult for your muscles to relax or can cause insomnia. Make sure to review the medications you are taking with your doctor and see if any of these are contributing to your condition.

Reduce Pain

The symptoms of RLS can range from irritating to very painful. Try alternating hot and cold compresses on your legs to reduce pain. You can also take a hot bath, or massage your muscles to get them to relax.

Siddha remedies for Restless legs syndrome

1. Siddha preventive measures

Everybody must practice Siddha preventive measures, whether a person is affected by restless legs syndrome or not, but preventive measures are the primary steps for switching on to any other Siddha remedies, and hence they are important. It helps in one’s capability, effectiveness, productivity, decision-making power, intellectuality, and removing minor health problems. There are three types of preventive measures:

• Earthing – performed for removing and earthing the negativity of our body
• Field cleaning – cleans the energy field (Aura) of our body
• Siddha brain exercise/Energizing – energizes our brain for proper functionality

Everybody’s tendency is to get attracted to the word ‘free, however, don’t neglect even these Siddha preventive measures are free. Avail of the benefits by practicing them sincerely, and regularly. For ease of understanding of what Siddha preventive measures are, please watch a video for a live demonstration.

2. Siddha Shaktidata Yoga

This unique Siddha Shaktidata Yoga of Siddha Spirituality can solve the problems related to restless legs syndrome with Siddha remedies. There is no compulsion of training in ‘Swami Hardas Life System’ methods. This not only gives benefits to self but also it can be used for other affected persons, whether a person is in the same house, distantly available in the same city, same nation, or might be in any corner of the world, however, both the procedures have been explained here.

3. Siddha Kalyan Sadhana

Recite this Sadhana with a Sankalp “My problems of restless legs syndrome are solved as early as possible and I should gain health”, which should be repeated in mind 3 – 3 times after each stanza. Any person irrespective of caste, creed, religion, faith, sex, and age can recite this Sadhana for free, which should be repeated at least twice daily. To know more, please click on this link.

4. CCPE products

These products work on the concepts of ‘Conceptual Creative Positive Energy’ (CCPE) within the provisions of the ‘CCPE Life System’ and the theory of Quantum Technology to a certain extent. However, please use these products for restless legs syndrome as mentioned below:

CCPE Extractor: The CCPE Extractor should be gently moved over the Agya Chakra in a circular motion at least for 30 to 60 seconds, thereafter, follow the same process on the brain, naval, and legs which finishes within almost 1-2 minutes.

CCPE Booster: Keep one Booster over the Agya Chakra and another over the brain, naval, and legs for 3 minutes. You may need to have 4 Boosters, which establishes positivity. 

CCPE Booster Powder: Mix a pinch of CCPE booster powder with a few drops of coconut oil and make a paste. Apply it around the forehead, naval, and legs, and leave it for about 30 minutes. Repeat the process every after 2 hours.

5. UAM or Touch Therapy

For quick and effective results, it is advisable to learn the unique methods of the Swami Hardas Life System. A trained person can only apply the UAM method or Touch therapy himself/herself and also become capable of healing others.

A daily routine

In general, a daily routine for restless legs syndrome may look like this:

• Follow the instructions of your Doctor
• Consume Sattvic diet
• Perform breathing exercises regularly
• Apply free touch therapy (UAM) a minimum 3 times a day, as explained above
• Perform Swayamsiddha Agnihotra daily, either self or the caretaker can perform
• In case, if someone wishes to learn advanced methods of Swami Hardas Life System, undergo unique training

Ensure to sprinkle in some fun during the day: Don’t forget to relax and laugh in between. Laughing is a great way to boost your immune system and help you.

Along with all the above activities, apply above explained free Siddha remedies minimum 3 times a day, the more is good. Just try the methods of Swami Hardas Life System. I am confident that you will surely find improvements within 7 days.

Training of Swami Hardas Life System

Any health, peace, and progress-related problem can be solved independently by undergoing Swami Hardas Life System training. It needs no money and medicines. Any person irrespective of religion, caste, creed, faith, sex, and age can undergo this unique training.

Conclusion

Because of the above, I am confident that you have learned about restless legs syndrome, symptoms, causes, diagnosis, treatment, Ayurveda, Home remedies, and Siddha remedies. Now, that you have become self-sufficient, hence it’s the right time to use your acquired knowledge for solving problems as per the provision available in Siddha Spirituality of Swami Hardas Life System.

However, keep learning and practicing the free Siddha remedies, which would help guide how to solve various problems regarding health, peace, and progress, without money and medicines.

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Frequently asked questions

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Which are the Siddha remedies for restless legs syndrome? In general, a daily routine for restless legs syndrome may look like this: Follow the instructions of your Doctor; Consume the Sattvic diet; Perform breathing exercises regularly; Apply free touch therapy (UAM) a minimum 3 times a day, as explained above; Perform Swayamsiddha Agnihotra daily, either self or the caretaker can perform; In case, if someone wishes to learn advanced methods of Swami Hardas Life System, undergo unique training, and ensure to sprinkle in some fun during the day: Don’t forget to relax and laugh in between. Laughing is a great way to boost your immune system and help you.