For many people living with Parkinson's, poor sleep is one of the most burdensome symptoms they experience. Parkinson's can negatively impact sleep quality in a number of ways, causing everything from insomnia to nighttime sweating to sleep fragmentation. One common sleep disturbance experienced by people with Parkinson's is REM Sleep Behavior Disorder (RBD), and the connections between RBD and Parkinson's continue to be widely studied. Though less common, another sleep disorder experienced by many people with Parkinson's is Restless Legs Syndrome (RLS). In this article, we'll explore the causes and symptoms of RLS and treatment options to help you manage the symptom if it's one you experience.
What is RLS?
As the name suggests, Restless Legs Syndrome (also called Restless Leg Syndrome and Willis-Ekbom Disease) is a condition that makes your legs feel restless. For example, you may feel an uncontrollable need to move your legs or a tingly, burning, twitching, creeping, or itching sensation up and down your legs. Most people report feeling these sensations inside their legs rather than on the skin. RLS can also affect the arms, trunk, or face muscles, though this is less common.
For most people with RLS, these symptoms only appear when they are at rest or lying down, and symptoms disappear when they begin moving. Symptoms typically emerge or worsen at night, so RLS is officially considered a sleep disorder. Many people with RLS have difficulty falling or staying asleep because of the sensations in their legs that make them feel like they have to stretch, massage, and move around all the time.
What causes RLS?
Although the root causes of RLS are not yet clear, researchers believe the neurological condition is associated with brain concentrations of dopamine and iron and specific genes. Some research suggests that it is caused by an imbalance of dopamine, the neurotransmitter that helps to facilitate movement, and is directly linked to Parkinson's. (Parkinson's impacts on the brain lead to lower dopamine levels, leading to motor impairment.) Because several Parkinson's medications mimic dopamine's effects and dopaminergic medications can help reduce the symptoms of RLS, many researchers believe that some aspect of dopamine function is altered in RLS.
Research also supports a connection between RLS and iron levels. According to Johns Hopkins Medicine, the single most significant environmental factor for RLS is low iron levels. Genetics have been found to play a significant role in RLS, with the RLS Foundation reporting that RLS is hereditary in 50% of affected individuals. Studies are ongoing that explore the connections between certain genes and the condition.
Some women develop RLS while pregnant, only to have it disappear after delivery. Other individuals experience RLS due to certain health factors, such as iron deficiency (which can worsen RLS), diabetes, kidney failure, and spinal cord damage. Research has also shown that certain lifestyle risk factors, including obesity, smoking, high alcohol intake, and a sedentary lifestyle, can increase the risk of or worsen RLS.
How is RLS connected to Parkinson's?
The relationship between RLS and Parkinson's is still under investigation. Although it is a common symptom of Parkinson's, RLS can be a stand-alone condition, and many people living with Parkinson's do not experience it.
While some studies about the links between RLS and Parkinson's have suggested that dopaminergic medications can cause RLS, others suggest that RLS may be an early manifestation of Parkinson's rather than a risk factor. Many studies have supported the hypothesis that Parkinson's and RLS share a common neuropathy, but several have suggested otherwise. And while some studies show that RLS is more common among people with Parkinson's than in the general population, other studies have found its prevalence among the Parkinson's community to be equal to that of the general population.
Despite these conflicting findings and the lack of a definitive link between RLS and Parkinson's, we know that RLS is experienced by many people in the Parkinson's community and can profoundly affect sleep and overall quality of life. The good news is that treatments are available to help you manage the symptom.
How is RLS treated?
If your RLS is caused by another health condition (such as those mentioned earlier), you may be able to mitigate it by treating the other condition. For example, if low iron levels cause your RLS, taking iron supplements may solve the problem. If a known condition does not cause your RLS, however, you can explore with your care team's guidance several lifestyle changes that may help. You can also work with your physician to see if medication adjustments may be an option.
As we stated above, many people with RLS have difficulty falling asleep due to their legs' tingling sensations and restlessness. In these cases, taking dopamine agonists before bed can be helpful. The US Food and Drug Administration (FDA) has approved rotigotine and pramipexole, two dopamine agonists, for treating moderate to severe RLS. Dopamine agonists are a group of drugs often prescribed for Parkinson's to help manage stiffness, slowness, and tremor. Because dopamine agonists can lead to severe side effects, be sure to discuss their use with your physicians.
Some people with RLS get relief from drugs that impact calcium channels, such as gabapentin, gabapentin enacarbil, and pregabalin. Under the careful guidance of their physicians, others may take opioids (such as codeine, hydrocodone, oxycodone, morphine, hydromorphone, methadone, buprenorphine, or pentazocine) or benzodiazepine receptor agonists for RLS management.
Although they have not been shown to cause RLS, certain medications can worsen it; these include certain antidepressants, antipsychotic medications, anti-nausea drugs, and cold and allergy medications. Talk to your providers if you take drugs in these categories and experience RLS to see if a medication change can help.
You can try several at-home therapies to help manage symptoms of RLS as well. Warm baths can help relax your muscles, as can alternating hot and cold compresses. Physical activity early in the day may also help and limiting or eliminating caffeine, alcohol, and smoking can ease symptoms.
You can also explore devices explicitly designed for RLS, such as vibrating foot and leg wraps or pads you can strap to your leg to put pressure on your muscles. Massage therapy can help your muscles and mind relax, and some people with RLS swear by "massage guns" with different settings for tailored pressure and relief. Finally, for some people, wearing compression stockings in bed helps minimize sensations.
Like other disorders associated with Parkinson's, RLS can significantly interfere with getting a restful night's sleep and may eventually lead to depression, excessive daytime sleepiness, chronic fatigue, and a lower quality of life. If you experience RLS, discuss your symptoms and available treatment options with your providers.