Vascular
Restless Leg Syndrome
A condition that causes an uncontrollable urge to move your legs, usually because of an uncomfortable sensation.
Restless leg syndrome (RLS) is a neurological and vascular condition causing an uncomfortable, irresistible urge to move the legs — typically worse at night or at rest. In many patients, underlying venous insufficiency is a contributing or treatable cause.
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Restless leg syndrome (RLS) frequently disrupts sleep due to irresistible urges to move the legs, often linked to underlying venous issues.
Restless Legs: More Than a Nuisance
Restless leg syndrome (RLS) is an almost irresistible urge to move the legs, usually with an unpleasant crawling, tingling, aching or ‘fizzing’ sensation deep inside them. It comes on when you are still, is worst in the evening and at night, and eases the moment you get up and walk.
It is common, affecting perhaps one in twenty adults to a degree that troubles them, and its main toll is on sleep — and therefore on mood, concentration and daytime energy. At its core RLS is a problem with iron and dopamine signalling in the brain, but several contributors are treatable, and a subset of patients have leaking leg veins that, when fixed, make a real difference.
It is common, affecting perhaps one in twenty adults to a degree that troubles them, and its main toll is on sleep — and therefore on mood, concentration and daytime energy. At its core RLS is a problem with iron and dopamine signalling in the brain, but several contributors are treatable, and a subset of patients have leaking leg veins that, when fixed, make a real difference.
The Five Features That Define It
There is no scan or blood test that proves RLS. The diagnosis rests on five clinical features, all of which should be present.
- An urge to move the legs, usually with an uncomfortable sensation
- The urge begins or worsens at rest — sitting or lying down
- It is relieved by movement, at least while you keep moving
- It is worse in the evening and at night than during the day
- It is not better explained by another problem such as leg cramps, arthritis or positional discomfort
What Can Drive or Worsen It
RLS often has a trigger or an aggravating factor sitting behind it, and finding one changes the treatment.
- Low iron stores — a ferritin below about 75 can worsen RLS even when the blood count is normal
- Pregnancy, kidney disease, and diabetic nerve damage
- Medicines — sedating antihistamines, many antidepressants, anti-nausea drugs and some antipsychotics commonly aggravate it
- Venous insufficiency — in people with varicose veins, leg heaviness and ankle swelling, treating the refluxing veins improves restless legs in a meaningful proportion
Assessment in Singapore
The diagnosis is made from the history. Beyond that, we check ferritin and iron studies, kidney function and glucose, and review your medication list for aggravating drugs.
If there are signs of vein disease — visible varicose veins, an aching heaviness that builds through the day, ankle swelling — a venous duplex ultrasound is worthwhile, because reflux that can be treated may be part of the picture. Nerve conduction studies are added if a neuropathy is suspected. Where RLS is severe or not responding, a neurologist is involved alongside the vascular assessment we provide at Paragon Medical Centre on Orchard Road.
If there are signs of vein disease — visible varicose veins, an aching heaviness that builds through the day, ankle swelling — a venous duplex ultrasound is worthwhile, because reflux that can be treated may be part of the picture. Nerve conduction studies are added if a neuropathy is suspected. Where RLS is severe or not responding, a neurologist is involved alongside the vascular assessment we provide at Paragon Medical Centre on Orchard Road.
Treatment: Correct the Contributors First
The first steps are often the most rewarding: replace iron if ferritin is low (tablets, or an infusion if levels are very low or absorption is poor), cut back on caffeine, alcohol and nicotine, keep to regular moderate exercise and stretching, and swap out any aggravating medication where possible.
- Treat significant venous reflux — endovenous ablation or sclerotherapy — where a duplex scan shows it
- For moderate to severe RLS, an alpha-2-delta medication such as gabapentin or pregabalin is now preferred first-line
- Dopamine-based drugs are used more cautiously than before, because over time they can paradoxically worsen symptoms (augmentation)
- Warm baths, leg massage and a consistent sleep routine help alongside any medication
Restless Leg Syndrome: Common Questions
Concerned About Restless Leg Syndrome?
Dr. Peter Chang offers specialist assessment and personalised management at Paragon Medical Centre, Singapore.