When an almost uncontrollable urge to move makes falling asleep an impossible task, the diagnosis is usually Restless Legs Syndrome (RLS). Those affected not only suffer from sleep and falling asleep disorders but often also develop depression or anxiety disorders. Scientific studies also highlight this connection between RLS and psychological conditions. For patients with depression and anxiety, this means that if the RLS symptoms disappear, it can also have a positive impact on their mental well-being. Conversely, RLS patients can significantly improve their quality of life through targeted depression and anxiety therapy. The connection between RLS, depression, and anxiety is now considered established. Therefore, there is hope for relief from Restless Legs Syndrome, which otherwise involves distressing sensations. This means that with the right psychotherapeutic measures, a significant reduction in Restless Legs Syndrome can also be achieved. This blog article will discuss which methods are particularly suitable for this and what else you can do against restless legs.
Overview of All Topics
What is Restless Legs Syndrome?
Thousands of ants crawling up and down the legs. An endless series of tiny electric shocks. Sparkling champagne flowing through the legs. The vivid descriptions from those affected can only hint at how much they are tormented by the so-called Restless Legs Syndrome night after night. The unpleasant sensations improve or disappear with activity. When the affected individuals stand up and walk around, they feel relief. Unfortunately, the symptoms return when they go back to sleep and their body comes to rest. The disease of “restless legs” was first described in the 17th century. The German doctor Theodor Wittmaack named it Anxietas tibiarum in 1861. The Latin word for anxiety, “Anxietas,” played a role in the description of the clinical picture from the beginning. The term Restless Legs Syndrome, as it is known today, was coined in 1945 by the Stockholm neurologist Karl-Axel Ekbom, who introduced the designation “Restless Legs.” Therefore, it is sometimes also referred to as Wittmaack-Ekbom Syndrome. Depending on the source, between 3 and 10 percent of the population struggles with “restless legs” at some point in their lives. Even during the day, affected individuals feel the typical tingling or pulling in their legs, especially during periods of rest. Other limbs, such as the arms, can also be affected. The distressing sensations severely limit everyday life. Visits to the cinema, air travel, or even dining in a restaurant become a torment for those affected. They feel a constant urge to move their legs to get rid of the unpleasant sensations. Friends and partners sometimes have little understanding for the constantly restless. And the symptoms often rob those affected of sleep. They suffer from persistent sleep disturbances and exhaustion.
But how is Restless Legs Syndrome diagnosed? Not everyone who feels a tingling in their limbs necessarily has a tendency towards RLS.
Restless Legs Syndrome: Examinations and Diagnosis
Grundsätzlich kann das Restless Legs Syndrom in jedem Lebensalter auftreten. Oft beginnen die Probleme aber in einem Alter zwischen 30 und 50 Jahren. Diagnostiziert wird RLS in erster Linie anhand der Symptomatik in einem Gespräch zwischen Arzt und Patient. Denn in vielen Fällen kann bei Untersuchungen keine genaue Ursache festgestellt werden. Es gibt dennoch Krankheiten und spezielle Umstände, die RLS auslösen können, auf die ich weiter unten eingehen werde. Um mögliche Ursachen und Krankheiten auszuschließen, können Blutuntersuchungen, Messungen der Nervenleitgeschwindigkeit oder eine Untersuchung im Schlaflabor durchgeführt werden. Im Gespräch mit dem Patienten aber kann RLS anhand dieser typischen Merkmale diagnostiziert werden:Restless Legs Syndrome (RLS) can occur at any age, but problems often begin between the ages of 30 and 50. RLS is primarily diagnosed based on symptoms during a conversation between doctor and patient. In many cases, no precise cause can be determined through examinations. However, there are diseases and specific circumstances that can trigger RLS, which I will discuss below. To rule out possible causes and diseases, blood tests, nerve conduction studies, or a sleep lab examination can be conducted. However, RLS can be diagnosed during the patient interview based on these typical features:
- Uncontrollable urge to move the legs, accompanied by an unpleasant feeling up to pain.
- Symptoms worsen during periods of rest, especially when sitting or lying down.
- Moving your legs (e.g., by walking or stretching) alleviates the symptoms.
- Symptoms peak in the evening and at night.
- Another disease as the cause of the symptoms can be excluded.
There are two main forms of RLS diagnosed: the primary (idiopathic) form, which affects more than half of all patients, and the secondary (symptomatic) form. These two forms differ in the cause of the disease.
RLS and Its Causes
The exact origin of Restless Legs Syndrome is not fully understood. The reasons for the uncontrollable urge to move are varied. While secondary RLS is caused by other diseases, no clear cause can often be identified for primary idiopathic RLS. There are various explanations for the disease’s development. One theory is that the transmission of signals in the nervous system is disrupted by a dopaminergic imbalance. The exact causes, however, are not clear. Genetic predisposition is also thought to play a role. It is believed that RLS can be hereditary since several family members sometimes suffer from the condition. Why RLS can be inherited is not fully understood. However, it is noticeable that psychological disorders, especially depression and anxiety disorders, frequently occur in conjunction with RLS.
If you suffer from tingling and unpleasant sensations in your limbs and dread the tormenting restlessness every time you go to sleep, you should first consult your primary care physician. Even though clear triggers for RLS are not always identifiable, sometimes a clear cause can be identified and thus eliminated. Thorough investigation into the causes is worthwhile. Common causes include:
- Iron deficiency
- Kidney function disorders
- Joint damage
- Neurological underlying diseases, such as Parkinson’s disease or polyneuropathy
- Hyperthyroidism or hypothyroidism
- Rheumatic diseases
- Medications
RLS symptoms also frequently occur during pregnancy, but typically disappear on their own after childbirth.
If you are diagnosed with RLS without a clear cause being found, it is good to know the connection between RLS and psychological disorders.
RLS, Depression, Anxiety, and Panic – Is There a Connection?
It has been known for decades that RLS is frequently observed in patients with depression, anxiety, and particularly panic disorders. However, the number of scientific studies examining this relationship in detail is surprisingly low. Is the supposed comorbidity between RLS and mental illnesses merely a coincidence? Does RLS lead to psychological complaints? Or do anxiety, depression, and panic actually promote the development of Restless Legs Syndrome?
RLS-Patienten haben ein höheres Risiko für psychiatrische Erkrankungen
A study presented in 2005 at the annual scientific assembly of the American College of Chest Physicians (ACCP) found that individuals with Restless Legs Syndrome (RLS) had a significantly higher prevalence of psychiatric disorders, particularly depression and anxiety. Approximately 40-50% of RLS patients reported having concurrent psychiatric conditions (ScienceDaily).
For the majority of those surveyed, psychiatric disorders occurred only after the first RLS symptoms.
Compared to the general population, RLS patients have a significantly higher likelihood of suffering from psychiatric disorders. The connection between RLS, depression, and anxiety is thus considered established. Therefore, it is all the more important for affected individuals to treat their psychological complaints as quickly and effectively as possible. I will explain what has proven particularly effective in this regard later. But first, let’s address the question:
What Therapy Helps with RLS?
If the cause of Restless Legs Syndrome is known, a specific therapy can lead to alleviation or cure of the disease. For iron deficiency, patients receive iron as a supplement or infusion. Underlying diseases from the rheumatic spectrum or kidney function disorders are specifically treated. If medications are suspected of triggering RLS, it may be helpful to change the medications in consultation with the doctor. If a polyneuropathy is detected through nerve conduction studies, a therapy tailored specifically to the patient follows.
If you also suffer from anxiety or even panic attacks in addition to RLS, you should definitely watch the video below.
If you do not have an anxiety disorder and no other cause for RLS has been found, medication is sometimes recommended for those who suffer severely. Most often, dopaminergic drugs, which are also used in higher doses against Parkinson’s disease, are prescribed. The additional administration of L-Dopa is intended to provide affected individuals with a few quiet hours. L-Dopa is a precursor of the neurotransmitter dopamine. Ropinirole, pramipexole, and rotigotine, which are dopamine agonists, are also prescribed and work similarly to L-Dopa. Even opiates, such as oxycodone and naloxone, are approved for treating severe symptoms. Antiepileptic drugs, like carbamazepine, can also provide relief, though they are not officially approved for this use.
Since the treatment options include medications with significant side effects and high addiction potential, they should only be taken if no other method provides relief. The risks otherwise outweigh the benefits.
RLS: Why Medication Should Be the Last Resort
Painkillers like oxycodone can be addictive. When discontinuing these medications, there is also the risk of withdrawal symptoms that are very similar to depression. This is a particularly severe consequence for RLS patients with depression. Dopaminergic drugs and dopamine agonists, which are supposed to restore the balance of the neurotransmitter dopamine, can cause serious side effects. With L-Dopa, the precursor to the neurotransmitter dopamine, the following side effects occur very frequently:
- Nausea
- Dizziness
- Cardiovascular disorders
An additional and significant risk is that L-Dopa therapy can lead to habituation. Increasing the dose can result in augmentation, where the medication treatment even worsens the symptoms of Restless Legs Syndrome! The National Association of Statutory Health Insurance Physicians even points out that medications like L-Dopa and dopamine agonists in higher doses can change behavior: one can become addicted to food or sex. Gambling, shopping addictions, and compulsive behaviors are also possible.
How to Often Alleviate RLS Symptoms Without Medication
Even a reduction in RLS symptoms can lead to a noticeable decrease in anxiety and depression. Here are some things you can do to alleviate your symptoms:
- Shower your legs with cold water when symptoms set in.
- Use cooling gels or ointments.
- Massage or stretch your legs.
- Avoid nicotine, alcohol, and caffeinated drinks before bedtime.
- Eat iron-rich foods to rule out iron deficiency as a cause of RLS.
- Use a weighted blanket*. Many people report that using these 15 to 25 lb blankets quickly leads to a significant reduction in unpleasant symptoms.
If you also suffer from anxiety or panic attacks in addition to RLS, the following video will be particularly interesting and will likely provide you with answers and explanations that no one has been able to give you satisfactorily until now.
How Self-Therapy Against Anxiety Disorders Can Become a Great Hope for RLS Patients
When I introduced a completely new self-therapy for anxiety in my book “How to calm Anxiety: Live a Life Free From Panic in Just a Few Weeks” in 2016, it garnered a lot of attention. And not just among therapists, but especially among those affected. It now allowed anxiety patients to significantly reduce or even completely overcome their anxieties within a few weeks without therapeutic support. Without medication, without exposure therapy, and without the painful digging into childhood. Many people with Restless Legs Syndrome also discovered that this method noticeably reduced the evening twitching and tingling in their legs, which is why our method quickly became a secret tip among people with RLS.
Improving Quality of Life Despite Restless Legs Syndrome: Here’s How
Even if a clear trigger for RLS cannot always be found, there are several things you can do for a peaceful night’s sleep, as listed above. If you also suffer from depression or anxiety, you should make every effort to quickly and permanently get rid of the psychological problems. This is because an RLS condition is a significant psychological burden that can exacerbate existing anxieties and depression, for example, due to the massive sleep deprivation that comes with it. Poor sleep often prevents proper physical and psychological regeneration, which can eventually lead to chronic depressive moods or occasional anxieties.
For anxiety, I recommend taking a closer look at our online online therapy “Finally Free from Anxiety!” For those who suffer more from depression or burnout, I advise reading the Spiegel bestseller “Overcoming Depression and Burnout.” Even if it may seem difficult to imagine in your current situation, there are numerous ways to actively reduce both Restless Legs Syndrome and many of the accompanying psychological issues. And whether you first address the restless legs or your psyche, both influence each other, giving you two starting points to actively improve your quality of life. In the spirit of the saying: It is better to light a candle than to complain about the darkness.
Troy A.
Tampa, Florida